(On Thursday of March 23, 2023). Equinox Verani. On the Matter of Medical Disorders of The Liver by MD Paul W. Bolin (From Proprietary CRASH! Medical Review Series) Otherwise Gastroenterology and Pathology Therein: 1) Liver is a Right Upper Quadrant (RUQ Organ) with Multiple Functions within the Body (Exocrine Organ [Bile Acid], Endocrine Organ [TPO]) as well as these Herein Functions of 1) Albumin (65-70 kDa Protein; 250 pm Length) Biosynthesis of a Globular Structure with Various Receptor-Ligand Capacity, 2) Coagulation Factor Biosynthesis Locus (Factors II, V, VII, X), Digestion/Lower Extremity Portal Venous Circulation, and Detoxification Organ Par Excellence (Ammonia, Nitrogen, Urea Cycle Metabolism) of Nitrogen, Estrogen Metabolism, and Enzyme Cytochrome P-450 Prodrug/Inactive Drug Metabolism. Pathology within the Liver: 1) Cirrhosis is Fibrosis Or Scarring within the Parenchyma Thereof due to Chronic Infection and/or Inflammation. The Aetiology of Cirrhosis in US Epidemiology is Alcoholism. End-Stage Liver Disease is Irreversible and, other than Liver Transplantation, uncurable otherwise; 2) Hepatocellular Carcinoma is Malignancy of Proliferation Disease (Neoplasia) of the Primary Functional Cell of the Liver. Signs And Symptoms Therein are Related to the Aforementioned Functions of the Liver. Ascites is the most blatant expression of Portal Hypertension and Hypoalbuminemia which is Generally Correlated to Cirrhosis and End-Stage Liver Disease (At the Time when only Liver Transplantation is the Last Remaining Option). Serum Albumin-Ascites Gradient (SAAG) is attainable via a Periocentesis (Sample Ascitic Fluid for SAAG Laboratory Measurement) where Serum Albumin Level is Subtracted by the Albumin Present within the Ascitic Fluid (SAAG=Serum Albumin - Albumin Within Ascitic Fluid). The Transudate (Low SAAG < 1.1) is Different than Portal Hypertension Ascites (High SAAG of > 1.1), for the latter Results via (Cirrhosis or Congestive Heart Failure Aetiology [Cardiac Output Hemodynamic Parameters]) while the Former is a Process from Infection (TB, Cancer, and Other Infiltrative/Proliferative Diseases) Hemodynamics (Edema and Vasodilation). 3) Spontaneous Bacterial Peritonitis (SBP; Fever and/or Abdominal Pain) is a Life-threatening Complication of Ascites (Portal Hypertension and/or Infection). Dx: Via Periocentesis for Culture and Sensitivities. Tx is Via Third Generation Cephalosporin Beta-lactam Antibiotics (Cell Wall Synthesis Inhibitors of Synthetic origin) such as Ceftriaxone or Cefotaxime. 2) Albumin Transfusion (Severe Hypoalbuminemia); 3) ICU Admissions; 4) Repeat Periocentesis; 4) Cirrhosis Aetiology: 1) Alcoholic Cirrhosis (Chronic Abuse of Alcohol and/or Alcoholism); 2) Chronic Hepatitis (HBV, HCV, HDV) is Inflammation and Fibrosis within the Liver of Long Duration due to Viral Infection(s). The Hepatitides are Well-known Heptocyte Targeting Virions with Associated Risk Factors (RFx) such as Intravenous Drug Use (IVDU), Multiple Sexual Partners, Men-Sex-Wtih-Men (MSM), Tattoos, Healthcare Profession with Needle sticks with Infected Blood Products. The Pathogenesis of all Hepatitis Infections are Insidious resulting in Symptoms when the Disease has Matured and Complete metamorphosed the Liver Parenchyma; Dx is Via Serology for Hepatitis Titers: 1) HBV has Presence of HBsAg (Antigens of the Virus); and 2) HCV has Anti-HCV Antibodies and a Positive Viral Load (Viral Replication, Humoral Immune Response [Poor Response]); Tx for both with Interferon-Alpha (Pegylated) with HBV with Anti-Hepatitis Antivirals of Lamivudine and Adefovir; while HCV gets Ribavirin Combination Therapy; 3) Primary Sclerosing Cholangitis (PSC) is an Idiopathic Inflammatory Process of the Biliary Ducts without Hepatic Involvement (IBD Association and Male Predominance). SSx are Non-Specific, Fatigue to Pruritus and Jaundice (Hepatic Signs). Malabsorption (Steatorrhea) and Cirrhosis Maybe Present However. Dx is via LFTs with Normal ALT, AST but Abnormal ALP and GGTP (Both will be Elevated). AMA Titers (Negative) will Differentiate this PSC from PBC. ASMA and p-ANCA are Positive However. Endoscopic Retrograde Cholepancreatography (ERCP) or Transhepatic Cholangiogram will be Definitive of the Pathology Therein; Tx via Bile Acid Binding Resins (Cholestyramine); 2) Liver Transplantation; 4) Primary Biliary Cirrhosis (PBC) or Primary Biliary Cholangitis (PBC) is an autoimmunity Infiltrative Disease Process with well-known Environmental Risk Factors (Middle Aged Female) causing Cholestasis and Some Hepatic Cytological Features (Features of Infiltration Mostly but Pruritus, Jaundice and Fatigue), and Speculated Gene(s) making this an Autoimmunity Diathesis (Polyfactorial) if a Specific Gene had been Agreed on (My reckoning HLA-DR, TYK2). Female Incidence Predominance with Other Autoimmunity Diseases (Sjoegren's Syndrome, SLE, Rheumatoid Arthritis Etcetera). Dx is via Laboratories of LFTs: 1) AST; ALT are Normal while 2) Alkaline Phosphatase and GGTP are Elevated (Pointing to Ductal System Inflammation). Thereafter, 3) AMA Titers via Serology (Positive) and Herein Excluding PSC; 4) Biopsy of the Liver will be Definitive of This Pathology. Tx is Via Bile Acid Binding Resins and thereafter Liver Transplantation; 5) Hemochromatosis (HC) is Generally a Metabolic Disease With Multiple Possible Aetiologies Therein. HFE Gene Variation (Three So Far Identified) is One Genetic Diathesis of Metabolic Disease where Iron Toxicity ensues due to the Inability to Regulate Uptake within the Small Intestines. Hepcidin Hormone from the Liver Itself can become disrupted leading to Iron Overload. Neonate Autoimmunity and Multiple Blood Transfusions in a Chronic Anemia Patient. Dx is via Regular Iron Studies of Anemia (Serum Iron [High]; Ferritin [High] and TIBC [Low]); Tx is also the Opposite of Iron Deficiency Anemia or rather Phlebotomy (Withdrawing Iron-Infused Blood seems most Reasonable); 2) Iron Chelation Therapy (Deferoxamine and Others); 6) Alpha-1Anti-trypsin Deficiency (AATD) is a Metabolic Disease of Genetic Aetiology and Mechanism where a Serine-Proteinase Inhibitor which Protects the Lungs is Unavailable (SSx of Dyspnea, Wheezing, Exercise Intolerance within a Male Aged 25-50 [COPD/Emphysema And Not Smoking]). AAT is a Protein Biosynthesized within the Liver by SERPINA1 Gene Expression Localized to Chromosome 14q32 (Wtih Over 75 Known Variation/Mutations); 7) Wilson's Disease (Copper Metabolism Inability) has Characteristically the Kayser-Fleischer Ring (Aniridia) due to Copper Deposition Therein (Brain, Liver are Detrimental Sites). In WD there is a Genetic Aetiology of Gene (ATP7B) on Chromosome 13 (13q14.3) Expressed primarily in the Liver, Kidney, and Placenta; 8) Autoimmune Hepatitis (AH) is A Rare Genetic Predisposition where Plasmacytic Cells Infiltrate the Liver and Chronically Damage Parenchyma to the Point Liver Transplantation is the Only Remedy; Dx: Biopsy of Liver; Tx is Corticosteroids, Immunosuppressants (Azathioprine) and Ultimately if Irreversible/Refractory to the Aforementioned Treatment, Liver Transplantation. Goodness, my Grandest of Assets, the Hepato-King in check by petty and Menial assaults (Quotidian and Prevailing Events). The Liver Reigns where the Brain ails!-Maxim of SAGES. MD Paul W. Bolin, es geht sehr gut zu vernichten die Krankenheit aber wir auch muessen Leben--Wie Lebensraum Mensch haette Gesagt. Heil!
Back to the lovely medical tutorials !!!!!
(On Thursday of March 23, 2023). Equinox Verani. On the Matter of Medical Disorders of The Liver by MD Paul W. Bolin (From Proprietary CRASH! Medical Review Series) Otherwise Gastroenterology and Pathology Therein: 1) Liver is a Right Upper Quadrant (RUQ Organ) with Multiple Functions within the Body (Exocrine Organ [Bile Acid], Endocrine Organ [TPO]) as well as these Herein Functions of 1) Albumin (65-70 kDa Protein; 250 pm Length) Biosynthesis of a Globular Structure with Various Receptor-Ligand Capacity, 2) Coagulation Factor Biosynthesis Locus (Factors II, V, VII, X), Digestion/Lower Extremity Portal Venous Circulation, and Detoxification Organ Par Excellence (Ammonia, Nitrogen, Urea Cycle Metabolism) of Nitrogen, Estrogen Metabolism, and Enzyme Cytochrome P-450 Prodrug/Inactive Drug Metabolism. Pathology within the Liver: 1) Cirrhosis is Fibrosis Or Scarring within the Parenchyma Thereof due to Chronic Infection and/or Inflammation. The Aetiology of Cirrhosis in US Epidemiology is Alcoholism. End-Stage Liver Disease is Irreversible and, other than Liver Transplantation, uncurable otherwise; 2) Hepatocellular Carcinoma is Malignancy of Proliferation Disease (Neoplasia) of the Primary Functional Cell of the Liver. Signs And Symptoms Therein are Related to the Aforementioned Functions of the Liver. Ascites is the most blatant expression of Portal Hypertension and Hypoalbuminemia which is Generally Correlated to Cirrhosis and End-Stage Liver Disease (At the Time when only Liver Transplantation is the Last Remaining Option). Serum Albumin-Ascites Gradient (SAAG) is attainable via a Periocentesis (Sample Ascitic Fluid for SAAG Laboratory Measurement) where Serum Albumin Level is Subtracted by the Albumin Present within the Ascitic Fluid (SAAG=Serum Albumin - Albumin Within Ascitic Fluid). The Transudate (Low SAAG < 1.1) is Different than Portal Hypertension Ascites (High SAAG of > 1.1), for the latter Results via (Cirrhosis or Congestive Heart Failure Aetiology [Cardiac Output Hemodynamic Parameters]) while the Former is a Process from Infection (TB, Cancer, and Other Infiltrative/Proliferative Diseases) Hemodynamics (Edema and Vasodilation). 3) Spontaneous Bacterial Peritonitis (SBP; Fever and/or Abdominal Pain) is a Life-threatening Complication of Ascites (Portal Hypertension and/or Infection). Dx: Via Periocentesis for Culture and Sensitivities. Tx is Via Third Generation Cephalosporin Beta-lactam Antibiotics (Cell Wall Synthesis Inhibitors of Synthetic origin) such as Ceftriaxone or Cefotaxime. 2) Albumin Transfusion (Severe Hypoalbuminemia); 3) ICU Admissions; 4) Repeat Periocentesis; 4) Cirrhosis Aetiology: 1) Alcoholic Cirrhosis (Chronic Abuse of Alcohol and/or Alcoholism); 2) Chronic Hepatitis (HBV, HCV, HDV) is Inflammation and Fibrosis within the Liver of Long Duration due to Viral Infection(s). The Hepatitides are Well-known Heptocyte Targeting Virions with Associated Risk Factors (RFx) such as Intravenous Drug Use (IVDU), Multiple Sexual Partners, Men-Sex-Wtih-Men (MSM), Tattoos, Healthcare Profession with Needle sticks with Infected Blood Products. The Pathogenesis of all Hepatitis Infections are Insidious resulting in Symptoms when the Disease has Matured and Complete metamorphosed the Liver Parenchyma; Dx is Via Serology for Hepatitis Titers: 1) HBV has Presence of HBsAg (Antigens of the Virus); and 2) HCV has Anti-HCV Antibodies and a Positive Viral Load (Viral Replication, Humoral Immune Response [Poor Response]); Tx for both with Interferon-Alpha (Pegylated) with HBV with Anti-Hepatitis Antivirals of Lamivudine and Adefovir; while HCV gets Ribavirin Combination Therapy; 3) Primary Sclerosing Cholangitis (PSC) is an Idiopathic Inflammatory Process of the Biliary Ducts without Hepatic Involvement (IBD Association and Male Predominance). SSx are Non-Specific, Fatigue to Pruritus and Jaundice (Hepatic Signs). Malabsorption (Steatorrhea) and Cirrhosis Maybe Present However. Dx is via LFTs with Normal ALT, AST but Abnormal ALP and GGTP (Both will be Elevated). AMA Titers (Negative) will Differentiate this PSC from PBC. ASMA and p-ANCA are Positive However. Endoscopic Retrograde Cholepancreatography (ERCP) or Transhepatic Cholangiogram will be Definitive of the Pathology Therein; Tx via Bile Acid Binding Resins (Cholestyramine); 2) Liver Transplantation; 4) Primary Biliary Cirrhosis (PBC) or Primary Biliary Cholangitis (PBC) is an autoimmunity Infiltrative Disease Process with well-known Environmental Risk Factors (Middle Aged Female) causing Cholestasis and Some Hepatic Cytological Features (Features of Infiltration Mostly but Pruritus, Jaundice and Fatigue), and Speculated Gene(s) making this an Autoimmunity Diathesis (Polyfactorial) if a Specific Gene had been Agreed on (My reckoning HLA-DR, TYK2). Female Incidence Predominance with Other Autoimmunity Diseases (Sjoegren's Syndrome, SLE, Rheumatoid Arthritis Etcetera). Dx is via Laboratories of LFTs: 1) AST; ALT are Normal while 2) Alkaline Phosphatase and GGTP are Elevated (Pointing to Ductal System Inflammation). Thereafter, 3) AMA Titers via Serology (Positive) and Herein Excluding PSC; 4) Biopsy of the Liver will be Definitive of This Pathology. Tx is Via Bile Acid Binding Resins and thereafter Liver Transplantation; 5) Hemochromatosis (HC) is Generally a Metabolic Disease With Multiple Possible Aetiologies Therein. HFE Gene Variation (Three So Far Identified) is One Genetic Diathesis of Metabolic Disease where Iron Toxicity ensues due to the Inability to Regulate Uptake within the Small Intestines. Hepcidin Hormone from the Liver Itself can become disrupted leading to Iron Overload. Neonate Autoimmunity and Multiple Blood Transfusions in a Chronic Anemia Patient. Dx is via Regular Iron Studies of Anemia (Serum Iron [High]; Ferritin [High] and TIBC [Low]); Tx is also the Opposite of Iron Deficiency Anemia or rather Phlebotomy (Withdrawing Iron-Infused Blood seems most Reasonable); 2) Iron Chelation Therapy (Deferoxamine and Others); 6) Alpha-1Anti-trypsin Deficiency (AATD) is a Metabolic Disease of Genetic Aetiology and Mechanism where a Serine-Proteinase Inhibitor which Protects the Lungs is Unavailable (SSx of Dyspnea, Wheezing, Exercise Intolerance within a Male Aged 25-50 [COPD/Emphysema And Not Smoking]). AAT is a Protein Biosynthesized within the Liver by SERPINA1 Gene Expression Localized to Chromosome 14q32 (Wtih Over 75 Known Variation/Mutations); 7) Wilson's Disease (Copper Metabolism Inability) has Characteristically the Kayser-Fleischer Ring (Aniridia) due to Copper Deposition Therein (Brain, Liver are Detrimental Sites). In WD there is a Genetic Aetiology of Gene (ATP7B) on Chromosome 13 (13q14.3) Expressed primarily in the Liver, Kidney, and Placenta; 8) Autoimmune Hepatitis (AH) is A Rare Genetic Predisposition where Plasmacytic Cells Infiltrate the Liver and Chronically Damage Parenchyma to the Point Liver Transplantation is the Only Remedy; Dx: Biopsy of Liver; Tx is Corticosteroids, Immunosuppressants (Azathioprine) and Ultimately if Irreversible/Refractory to the Aforementioned Treatment, Liver Transplantation. Goodness, my Grandest of Assets, the Hepato-King in check by petty and Menial assaults (Quotidian and Prevailing Events). The Liver Reigns where the Brain ails!-Maxim of SAGES. MD Paul W. Bolin, es geht sehr gut zu vernichten die Krankenheit aber wir auch muessen Leben--Wie Lebensraum Mensch haette Gesagt. Heil!
Paracentesis not periocentesis. Amazing video!
you must either be a doc or a medical transcriptionist like me!!
Will also cover what required for Step 3, yes I have donated
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