Hepatorenal Syndrome mechanism

Рет қаралды 199,698

7 жыл бұрын

😍🖼Animated Mnemonics (Picmonic): www.picmonic.com/viphookup/me...
- With Picmonic, get your life back by studying less and remembering more. Medical and Nursing students say that Picmonic is the most comprehensive and effective way to bridge learning and test prep...
Disclaimer: I use affiliate links....
►👨‍🏫💊Antibiotics Lectures: www.medicosisperfectionalis.c... ... Check out my brand new "Electrolytes" course at www.medicosisperfectionalis.c... and use the PROMO code: ELECTROLYTES50 to get a 50% discount. Reference: Goldman-Cecil Medicine 25th edition, Chapter 153, page 1024,
► Right Now! You can get access to all my hand-written hematology video notes (the notes that I use on my videos) on Patreon...There is a direct link through which you can view, download, print and enjoy! Go to / medicosis Reference:- Goldman-Cecil Medicine 25th edition, Chapter 153, page 1024
Hepatorenal syndrome is a difficult disease to understand and the pathophysiology is still controversial.
The liver secretes Nitric oxide (NO) into the circulation, which will lead to vasodilatation of blood vessels and hypotension.
Without sufficient pressure, the kidney is severely affected.
So, a problem in the liver (hepato) leads to a problem in the kidney (renal), therefore; hepatorenal syndrome.
The main issues are; vasoconstriction (of the efferent arteriole) and vasodilation (all over the body due to the nitric oxide).
Hope it helps!
And as I said, it is not fully understood yet.
Please click on the "red SUBSCRIBE button" to get new medical videos every week, and click on “the bell” next to it, so you never miss a new video.
In my opinion, the fastest way to raise your score on USMLE is flashcards.
There is a program called firecracker, it’s really fun, they made flashcards for you and they repeat questions based on YOUR OWN specific knowledge of each one, they may be offering DISCOUNTS now mbsy.co/gcHHP
Don’t forget to check my recommended collection of the best medical books out there www.amazon.com/shop/medicosis...
This set of flashcards covers “the most likely diagnosis”… a must have for any exam, I have gone over them more than 3 times to review and refresh, that’s how good they are. goo.gl/FZqTsn
If you want flashcards for pharmacology, these cards rock, trust me, I have tried them myself, goo.gl/Hxdr9y
As of flashcards for Diagnostic tests, these are especially helpful for USMLE step 2 and COMLEX step 2, goo.gl/awWm7B
Last, here is a set of flashcards about "physical findings” which is great for USMLE step 1, step 2CS, CK or step 3 goo.gl/pJqw5Z
(Disclaimer: The medical information contained herein is intended for educational purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)
Disclaimer: these links are affiliate links so that I get paid a percentage of the sale, to support the channel, however, the customer is not affected as they pay the same price.
To watch all my Hematology videos, my best playlist ever, click here: • Hematology/ Oncology
Like my page on Facebook where I post many questions and answers regularly. Also you can leave me a message.
/ medicosis
Follow Medicosis on Twitter: / medicosis
Listen to soundtracks on Sound Cloud: / medicosis
Follow us on Instagram here: / medicosisperfectionalis
----My website will launch soon, so stay tuned…
My dream is to do whiteboard classroom teaching, audio podcast and live online webinars. But, I need your support to do this.
To help support me and keep my videos available on youtube, visit me on Patreon, / medicosis
The funniest thing is that I have a playlist containing only “mnemonics", yes, MEDICAL MNEMONICS, here: • Medical Mnemonics
Whether you’re studying for the USMLE, shelf exam, NCLEX, COMLEX, PLEB, MCCEE, AMC_CAT, PANCE,…etc., these videos will help! Take it to the bank :) If you like my videos, please consider leaving a tip at www.paypal.me/perfectionalis/
► Visit my website: www.medicosisperfectionalis.com/ My Favorite Productivity App: airtable.com/invite/r/2zH40fus/ 📱Save on your mobile phone bill: fbuy.me/q6bMj 🏦 Qbank (TrueLearn): truelearn.referralrock.com/l/...

Пікірлер: 135

@MedicosisPerfectionalis 5 жыл бұрын

🔬📄 Reference to this video: Goldman-Cecil Medicine 25th edition, Chapter 153, page 1024 💊 👨‍🏫 Antibiotics Lectures: www.medicosisperfectionalis.com/products/courses/antibiotics/ 💉 📜 My Notes, cases and courses www.medicosisperfectionalis.com/ 😅 If you like mnemonics, try Picmonic: www.picmonic.com/referrals/JK55NQXQQB9JLC119 📕📗 Books that I recommend, www.amazon.com/shop/medicosisperfectionalis

@koenraijer7596 4 жыл бұрын

The main components causing systemic underfilling is actually splanchnic vasodilation due to portal hypertension and the leakage of vasodilators into the systemic circulation through portosystemic shunts. Then when the heart can no longer compensate for this by increasing cardiac output, you get a lower mean arterial pressure, to which the body responds by secreting renin in the kidneys and activating the sympathetic nervous system. This causes Type 2 HRS, the slower variant, in most cases. This can then progress into Type 1 HRS, the faster variant, by a precipitating event that causes a sudden drop in blood pressure. These events can be infections, paracentesis without plasma expansion or gastro-intestinal hemorrhage (i.e. esophageal varices). The systemic vasoconstrictor response causes a sudden vasoconstriction in the renal arteries which can only be averted by liver transplantation, taking away the causes (portal hypertension and ascites).

@deepwithin6517 Жыл бұрын

Thank you ❤️

@another7430 10 ай бұрын

Amazing explanation

@royer_redos 10 ай бұрын

Thank you for an actual good explanation.

@uruzmag 9 ай бұрын

Excellent

@MedicosisPerfectionalis 6 жыл бұрын

My FAVORITE BOOK to study Pathology and Pathophysiology for step 1 USMLE or COMLEX is “Goljan", you can check it out here: goo.gl/9ojg6M

@hanch96 Жыл бұрын

i'm always so relieved when i search something and your channel pops up

@KetofolKing 8 ай бұрын

Watching a 2017 medicosis video makes me appreciate 2023 medicosis.

@MedicosisPerfectionalis 8 ай бұрын

Thank you!

@zhilahaghbin4766 2 жыл бұрын

Thanks so much for such precious educational tips. Makes me want to be a medical student all over again. I envy the students these days with such easy access to understanding difficult concepts. It is not too late I am learning and reviewing it now and even the comments so educational

@MedicosisPerfectionalis 2 жыл бұрын

Thank you 🙏

@adityatangirala3609 5 жыл бұрын

Excellent video! On point ! So hepatic renal syndrome is hepatic failure, leading to arteriolar hypoperfusion, thereby triggering pre renal AKI auto regulatory mrchanisms Suggestions : You may consider jumping into details and variours mechanisms that are linked to heaptic failure and the activation of pre renal AKI.

@swedishdoctor 6 жыл бұрын

I think you are wrong, more logical mechanism would be: hepatic failure/cirrhosis -> portal hypertension -> splanchnic vasodilation (due to pooling of blood) and systemic vasoconstriction (due to low blood volumes and reflex responses) -> decreased renal blood flow -> decrease in urine output and increase in serum urea and serum creatinine and secondary hyperaldosteronism.

@MedicosisPerfectionalis 6 жыл бұрын

Carlos Alexanderson Thanks for your feedback, but you can check Goldman-Cecil Medicine 25th edition, Chapter 153, page 1024, it says the same explanation that I've said. Thanks again!

@user-bk5be9tx6n 6 жыл бұрын

Carlos Alexanderson Davidson internal medicine say renal vasoconstriction due to underfilling of arterial circulation

@pato20995 6 жыл бұрын

arabic name Brussels says the same

@jamiexxo 5 жыл бұрын

"In cirrhosis, the primary cause of the increase in portal pressure is the enhanced resistance to portal outflow. However, also an increase in splanchnic blood flow worsens and maintains portal hypertension. The vasodilatation of arterial splanchnic vessels and the opening of collateral circulation are the determinants of the increased splanchnic blood flow. Several vasoactive systems/substances, such as nitric oxide, cyclooxygenase-derivatives, carbon monoxide and endogenous cannabinoids are activated in portal hypertension and are responsible for the marked splanchnic vasodilatation." ..Arterial resistance has been shown to decrease due to hypoxia alone, rather than the increase in portal resistance

@takysin 5 жыл бұрын

@@jamiexxo Best answer here Thanks

@KarimYeb 6 жыл бұрын

I really liked this one!

@MedicosisPerfectionalis 6 жыл бұрын

Great...Appreciate your comment...Good luck!

@reeva89 4 жыл бұрын

You are a hub of knowledge.. Great job 👍

@MedicosisPerfectionalis 4 жыл бұрын

Thanks 🙏

@ruqayasuadad3105 7 жыл бұрын

best explanation god bless U

@MedicosisPerfectionalis 7 жыл бұрын

+ruqaya suadad God bless you too, Thanks for your kind words, Please share with your colleagues!

@user-hg2gf1jh9i 6 жыл бұрын

Thank you very much

@ebr3ys 6 жыл бұрын

So helpful, thanks

@MedicosisPerfectionalis 6 жыл бұрын

My pleasure! Thanks for your comment! You made my day :)

@daniaali1374 4 жыл бұрын

Thanks alot for this amazing vedio

@khaledelmagraby9090 3 жыл бұрын

Thanks alot, great explanation

@MedicosisPerfectionalis 3 жыл бұрын

Thanks 🙏

@AP_Pratheepan 2 жыл бұрын

What a voice, rhytm, tone and accent. 😃 1st i hate then soon after that it was so pleasant to hear 😍

@MedicosisPerfectionalis 2 жыл бұрын

Haha 😂 Thank you ☺️

@saadshaker6283 3 жыл бұрын

Very nice explanation thanxxxx

@hdh2179 Жыл бұрын

amazing job as usual thanks

@MedicosisPerfectionalis Жыл бұрын

Thank you 😊

@muayadbayat6242 2 жыл бұрын

What software do you use to produce this content? Thanks!

@mansdoctooor 6 жыл бұрын

Thanks

@MedicosisPerfectionalis 6 жыл бұрын

You’re very welcome!

@pingupingu9839 3 жыл бұрын

Very nicely explained sir

@MedicosisPerfectionalis 3 жыл бұрын

Thank you so much 😊

@lidystefanyvargasrenza6080 3 жыл бұрын

Thank you!! :D

@MedicosisPerfectionalis 3 жыл бұрын

My pleasure 😇

@Aya-fk5tz 4 жыл бұрын

why do we give albumin as a treatment? how does it work? also if the kidney is already producing adh.. why do we give adh analogue as a treatment too?

@sitinursharida8728 2 жыл бұрын

Anyone can answer?

@abdullahmustafa9396 2 жыл бұрын

Bc liver failure patients have decreased albumin production, thus albumin concentration is low in blood. This causes fluids to to leave the vessels and increase ascites and thus reducing volume and more hypotension. By giving albumin we increase pulling force or oncotic pressure of the blood for fluids and prevent fluids from leaving the vessels of splanchnic circulation

@rashmikaviraj9079 Жыл бұрын

We dont use albumin who said that. What we do is we just cut off the dietary na intake. Albumin usage has nothing to do with this

@tefahunter1880 Жыл бұрын

@@rashmikaviraj9079 IV Albumin can be used in cases of paracentesis of more than 5L/day of ascitic fluid.

@drabdirahmansaladibrahim4602 8 ай бұрын

Watched u while in Turkish In Mogadishu and now I’m in Cairo and the story goes on

@fafaaa5688 6 жыл бұрын

L love your vedios thanxs alot

@MedicosisPerfectionalis 6 жыл бұрын

You’re very welcome!

@ahmadmusawer9392 4 жыл бұрын

Dude, Pts é Hepatorenal Syndrome dosen't respond to volume expansion. How would they have EA VC and still oliguric?!

@VisualKeiArtist 5 ай бұрын

Should I treat with vasopressin or another med that increases renal perfusion (afferent arteriole dilation)?

@mish3l456 7 ай бұрын

Medicosis lore is awesome

@brandonw77 Жыл бұрын

I love this stuff, mostly because he is the most sarcastic person I’ve ever listened to. But second, bc he gets straight to the point, no BS and the content is extremely relevant to me.

@MedicosisPerfectionalis Жыл бұрын

Thank you 🙏

@deepwithin6517 Жыл бұрын

Thank you💙💜

@MedicosisPerfectionalis Жыл бұрын

My pleasure 😇

@Zain_altouka Жыл бұрын

Thank you soooo mush 🤍🤍

@MedicosisPerfectionalis Жыл бұрын

@JoaoPedro-kx5lt 5 жыл бұрын

HUGE!!

@khalel010. Жыл бұрын

Old but still diamond ❤❤❤

@MedicosisPerfectionalis Жыл бұрын

Thank you 🙏

@kumarraman6050 5 жыл бұрын

Superb

@MedicosisPerfectionalis 5 жыл бұрын

Thanks 🙏

@tasneemahmed5797 3 жыл бұрын

Thanks :))

@edbn24 6 жыл бұрын

nice video

@MedicosisPerfectionalis 6 жыл бұрын

+edbn24 Thanks a million for your kind words! This means Everything to me. Please share with your friends! Thanks!

@ganeshb-1364 3 жыл бұрын

You did the video well but please do say a little energitic way

@MedicosisPerfectionalis 3 жыл бұрын

@madeline8968 Жыл бұрын

the best. just.. the best.

@afraiddoctor2277 4 жыл бұрын

U said in previous video that due to hypoxia there is systemic vasodilation except lungs to increase blood supply Now in this u r saying that kidney doesn't receive enough blood supply in afferent arteriole and decreased gfr due to which kidney activates Ras mechanism? How plz explain

@MedicosisPerfectionalis 4 жыл бұрын

What causes vasodilation here is the nitric oxide (NO).

@afraiddoctor2277 4 жыл бұрын

@@MedicosisPerfectionalis plz tell me the effect of vasodilation and vasoconstriction on BLOOD PRESSURE, BLOOD SUPPLY and heart rate??

@zzAGONYxx 4 жыл бұрын

@@afraiddoctor2277 vasodilation --> reduced preload --> reduced stroke volume --> reduced BP --> sensed at baroreceptors at carotid bodies --> increased HR to compensate for the reduced stroke volume --> low SV + high HR = normal cardiac output and therefore BP

@afraiddoctor2277 4 жыл бұрын

@@zzAGONYxx tysm🙂🙏but plz also tell ki when did BLOOD SUPPLY to any organ INCREASES, on vasodilation or vasoconstriction?? If on vasodilation then why in hypoxia, in lungs happens vasoconstriction as said in video?? And kidney activates Ras mechanism (vasoconstriction) to increase GFR, how it is possible to increase blood supply and hence gfr by vasoconstriction??since vasoconstriction causes decreased blood supply 😨

@afraiddoctor2277 4 жыл бұрын

@@zzAGONYxx plz tell me if u know it🙌

@j-bo8568 3 жыл бұрын

you are best slow awesome person ❤️

@MedicosisPerfectionalis 3 жыл бұрын

Thank you!

@temporaryrelief2981 2 ай бұрын

Amazing explanation thank you!

@MrJIJO7 7 жыл бұрын

How does efferent arteriolar vasodilation damage the kidney?... It's kind of a protective mechanism to increase blood pressure right??!

@MedicosisPerfectionalis 7 жыл бұрын

+JSM Thanks for asking. The efferent arteriole doesn't dilates, it constricts. and yes, this vasoconstriction of efferent arteriole will improve the perfusion of the kidney, but the blood going from the efferent arteriole to the medulla will be decreased dramatically, which will affect the rest of the tubules. Hope it helps!

@mahmodglilat8112 5 жыл бұрын

what is your reference please ?

@MedicosisPerfectionalis 5 жыл бұрын

For the video or for the previous comment?

@ThatsWhy- 3 жыл бұрын

@@MedicosisPerfectionalis how affect on the rest of the tubule? Is it bad mechanism if it is on the long run?

@ThatsWhy- 3 жыл бұрын

@@MedicosisPerfectionalis RAAS , IS IT a bad mechanism ? I mean does it cause kidney ischemia after long time?!

@dr-hayaal-yasjin6185 5 жыл бұрын

With all due respect, this wrong: RAS activation leads to renal artery vasoconstriction.

@MedicosisPerfectionalis 5 жыл бұрын

I said that RAS activation will cause vasoconstriction of efferent arteriole...Regarding the renal artery, RAS only constricts arterioles, not arteries...Remember your physiology; “arterioles are the resistance vessels”...But, if you mean the afferent arteriole, RAS constricts both the afferent arteriole and the efferent arteriole, having a greater effect on efferent arterioles than afferent. And don’t forget that the afferent arteriole was already dilated because of “NO” from the liver...and in pathology, your body doesn’t fully compensate, if it did, there is no pathology to talk about...Hope it helps!

@olivermarchand1852 5 жыл бұрын

I think he is probably right, just simplified it and did not show a inbetween reaction. I also studied that after portosystemic shunt occurs, will lead to vasoconstriction

@MedicosisPerfectionalis 5 жыл бұрын

Thanks

@user-lb1uw3hw5z 3 жыл бұрын

Agree!! This really makes me confused

@ThatsWhy- 3 жыл бұрын

@@olivermarchand1852 do the veins constrict or dilates? Who is responsible for this mechanism? I wish the Dr reply

@drlukechirayil7551 5 жыл бұрын

How can vasodilation cause decreased blood flow....be logical Refer poisseules law-when radius increases flow increases 16 folds

@MedicosisPerfectionalis 5 жыл бұрын

Hey! Great question...but you missed an important clue...The vasodilation isn’t local and isn’t exclusive for the kidneys! If it were, you would be correct...However, the fact of the matter is that the vasodilation is general, all over the body, which will lead to hypotension due to pooling of blood. Also you can check Goldman-Cecil Medicine 25th edition, Chapter 153, page 1024, it says the same explanation that I've said. Thanks!

@ramossiahaan5203 4 жыл бұрын

Maybe im too late, but its called underfilling theory, that when the vasodilation occur, blood pressure will drop, then the body signals to safe vital organs such as heart, brain, lungs, so they shut down renal, but the renal respond by RAAS, increase sodium and water reabsorbtion, trying to get blood pressure up, but it wont work forever, the resut is ascites and renal failure

@drlukechirayil7551 4 жыл бұрын

@@ramossiahaan5203 Atlast.....after my exams...thank you man