ERRATUM: As pointed out by ZM A, I made an error at 12:10. While the most common cause of *painless* obstructive jaundice in western countries is malignancy, overall the most common cause of obstructive jaundice is probably common bile duct stones. www.ncbi.nlm.nih.gov/pubmed/23697262
Simply excellent. PLEASE PRODUCE MORE VIDEOS ON "APPROACH TO" !! Very grateful for clear, concise and well presented video. Thank you for the great channel. 😊😊 7/9/2019
The two classic ones: - Evidence Based Physical Diagnosis by Steve McGee - The Rational Clinical Examination: Evidence-Based Clinical Diagnosis - This is actually a bound version of on going series of review papers in JAMA. If you have free access to JAMA, you could access each paper individually, though having they all collected together in printed form is very convenient.
This is a great question! First, in G6PD deficiency, the oxidant damage to proteins within the RBCs lead to increased membrane rigidity, which makes them more susceptible to removal within the reticuloendothelial system (spleen, liver, bone marrow), though some references also state that intravascular hemolysis occurs to some extent as well. The anemia in malaria is more complicated. I know that many internet resources place malaria (and infections more generally) under the intravascular hemolysis category. I think this is usually done because people have the assumption that the hemolysis in malaria is largely due to the intraerythrocyte parasite maturing and bursting out of the cell and destroying it in the process like the xenomoprh in Alien. But that's not usually what happens, except in the relatively rare, unusually severe "Blackwater Fever" presentation. Other, usually more prominent contributors to the hemolytic anemia of malaria include lipid perioxidation damage to the RBC membrane, abnormal distribution of different types of phospholipids in the RBC membrane which makes them more susceptible to phagocytosis by macrophages, and opsonization of membrane antigens - marking them for immune system-mediated destruction. These 3 mechanisms lead to hemolysis within the spleen, which is considered extravascular. Interestingly, these processes also result in the increased removal of non-infected RBCs as well. Overall, these are both examples (particularly malaria) of how hemolysis isn't always purely intravascular or extravascular. Sorry the video totally glossed over these nuances, but I had been trying to keep these Approach to Symptom videos to under 15 minutes (a goal which I don't always meet).
@@StrongMed Thanks for the very detailed response, I understand it much better now. It's very reasonable to not be able to cover nuances such as these since the broader topic is jaundice and not hemolysis, I just had this misconception about those two conditions and I'm glad I've cleared it up now.
This was actually one of my first topics ever, but the quality was pretty poor (since I was just figuring out how to make videos), so I switched the availability of the video to "unlisted" (meaning it doesn't shop up on UA-cam searches; you need the direct URLs). I hope to make a much better version someday, but until then, you can watch the original here: Part 1: ua-cam.com/video/YS4dP01S2cQ/v-deo.html Part 2: ua-cam.com/video/IbipjCSN8jw/v-deo.html Part 3: ua-cam.com/video/plhtquhGoos/v-deo.html
First thank you so much for these fantastic videos! Second, hope someone can help: why does hepatocellular disease increase both conjugated and unconjugated bilirubin? Are more red blood cells broken down (unconjugated) and does the liver simply conjugate more or is conjugated in that case referring to albumin? Thank you!
Correct me if im wrong: Unconjugated bilirubin may be seen in hepatocellular disease probably due to decreased function of the liver to conjugate. Conjugated bilirubin is also evident perhaps secondary to its decreased secretion from the liver.
ERRATUM: As pointed out by ZM A, I made an error at 12:10. While the most common cause of *painless* obstructive jaundice in western countries is malignancy, overall the most common cause of obstructive jaundice is probably common bile duct stones. www.ncbi.nlm.nih.gov/pubmed/23697262
thanks sir do some sample short and long cases medicines for for post grad
Being a practitioner for the past 20 years ur videos inspire me
I love these “Approach to..” videos, thank you!
Me too. Its really good.
Big solute to u sir. Thanks a lot. I am sure u r helping indirectly many patients world wide☝🏼
Love u from Afghanistan 🇦🇫
Thank you . keep up the good work sir . Pls keep uploading such approaches 👍 . From a doctor who just started residency and find your stuff helpful .
Thank you so much, I wish something like this exist when I was a medical student 20yrs ago
Your videos motivate me to study medicine. Thanks for your video.
Amazing approach !
Thank you Sir. ❤
I would to say you are amazing. Appreciated
I wish I had someone who can summarize everything like this
Thank you very much, Dr. Eric for the practical lesson you always share us. Please develop a diagnostic workup for patients with Anemia.
It's hopefully coming next month.
@@StrongMed
Sir cover all approaches in Harrison
As it helpful for pgs,as well practioners
Simply excellent. PLEASE PRODUCE MORE VIDEOS ON "APPROACH TO" !! Very grateful for clear, concise and well presented video. Thank you for the great channel. 😊😊 7/9/2019
I have nothing to say but God bless you. Now bring on any Jaundice patient and test me. 😄
Thank you for this video!!😘
Thanku doctor for this vedio
......
I also wanna become doctor❤❤
Sure
Really well layed out and well informed video sir
Thank you for this valuable presentation
Thank you sir.. Pls keep make videos on approach to symptoms of respiratory system , CNS, CVS and abdomen
Approach to Diarrhea coming tomorrow (I hope)
Solid! Nice approach for clinical practice : )
I used to eat more than a kilo of carrots a day but didn’t get carotenemia I don’t think. How much does one need to eat to get orange?
I"m sorry, I don't know, but I would assume quite a lot!
I have no idea, but I would assume a lot. I’ve eaten up to 5 carrots a day and never got anything beyond softer orange bowel movements.
Wow...thanks for the video
Brilliant algorithm
Thank you for this and your other videos.. They've really helped me
You are amazing thankd ❤️ proteinuria where ?
Sir, can you recommend any book or website about evidance based clinical examination?
The two classic ones:
- Evidence Based Physical Diagnosis by Steve McGee
- The Rational Clinical Examination: Evidence-Based Clinical Diagnosis - This is actually a bound version of on going series of review papers in JAMA. If you have free access to JAMA, you could access each paper individually, though having they all collected together in printed form is very convenient.
@@StrongMed Thank You.
Sir please make a vedio on approach to yellow fever also👍🌟
Thank you Doctor Strong
Excellent sir
Jaundice due to leptospirosis- in which catagory it will be fit in?
Wouldn't G6PD deficiency and malaria result in intravascular rather than extravascular hemolysis?
This is a great question! First, in G6PD deficiency, the oxidant damage to proteins within the RBCs lead to increased membrane rigidity, which makes them more susceptible to removal within the reticuloendothelial system (spleen, liver, bone marrow), though some references also state that intravascular hemolysis occurs to some extent as well.
The anemia in malaria is more complicated. I know that many internet resources place malaria (and infections more generally) under the intravascular hemolysis category. I think this is usually done because people have the assumption that the hemolysis in malaria is largely due to the intraerythrocyte parasite maturing and bursting out of the cell and destroying it in the process like the xenomoprh in Alien. But that's not usually what happens, except in the relatively rare, unusually severe "Blackwater Fever" presentation. Other, usually more prominent contributors to the hemolytic anemia of malaria include lipid perioxidation damage to the RBC membrane, abnormal distribution of different types of phospholipids in the RBC membrane which makes them more susceptible to phagocytosis by macrophages, and opsonization of membrane antigens - marking them for immune system-mediated destruction. These 3 mechanisms lead to hemolysis within the spleen, which is considered extravascular. Interestingly, these processes also result in the increased removal of non-infected RBCs as well.
Overall, these are both examples (particularly malaria) of how hemolysis isn't always purely intravascular or extravascular. Sorry the video totally glossed over these nuances, but I had been trying to keep these Approach to Symptom videos to under 15 minutes (a goal which I don't always meet).
@@StrongMed Thanks for the very detailed response, I understand it much better now. It's very reasonable to not be able to cover nuances such as these since the broader topic is jaundice and not hemolysis, I just had this misconception about those two conditions and I'm glad I've cleared it up now.
Sir aid video on approach to spleenomegaly
Thank you sir for approach to jaundice
Sir we want presentation on approach / examination to unconscious patient ....
This was actually one of my first topics ever, but the quality was pretty poor (since I was just figuring out how to make videos), so I switched the availability of the video to "unlisted" (meaning it doesn't shop up on UA-cam searches; you need the direct URLs). I hope to make a much better version someday, but until then, you can watch the original here:
Part 1: ua-cam.com/video/YS4dP01S2cQ/v-deo.html
Part 2: ua-cam.com/video/IbipjCSN8jw/v-deo.html
Part 3: ua-cam.com/video/plhtquhGoos/v-deo.html
Thanks for information
That was excellent
First thank you so much for these fantastic videos!
Second, hope someone can help: why does hepatocellular disease increase both conjugated and unconjugated bilirubin? Are more red blood cells broken down (unconjugated) and does the liver simply conjugate more or is conjugated in that case referring to albumin? Thank you!
Correct me if im wrong:
Unconjugated bilirubin may be seen in hepatocellular disease probably due to decreased function of the liver to conjugate. Conjugated bilirubin is also evident perhaps secondary to its decreased secretion from the liver.
Thank you 🙏🏼
Thank you sir ❤️❤️
Thankyou Dr...
Very helpful
Sir how to get your slides
I'm sorry, but I do not provide slides because I have discovered far too many people plagiarizing them over the years.
Amazing!
Brilliant
Great, thank you:)
men this is strong!
Thanx man
Thank u
god bless you doc , vertigo doc!!!
It's on the list. Just can't predict when I'll get to it with so many other great suggestions!
nice
Tq
❤️❤️❤️🇧🇩🇧🇩🇧🇩❤️❤️❤️
💜💜
LFTs
usefull but you talk too fast. unsubscribed!
That's fine, but you can also change the playback speed by selecting the gear icon.