Podcasts about Bilirubin

"The Ballad of Bilirubin" an autobiographical poem shared in honor of Caleb Smith's twenty fifth birthday.

Hepatitis means inflammation of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights infections. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis. However, hepatitis is often caused by a virus. In the United States, the most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C. ​Hepatitis D, also known as “delta hepatitis,” is a liver infection caused by the hepatitis D virus (HDV). Hepatitis D only occurs in people who are also infected with the hepatitis B virus. Hepatitis D is spread when blood or other body fluids from a person infected with the virus enters the body of someone who is not infected. Hepatitis D can be an acute, short-term infection or become a long-term, chronic infection. Hepatitis D can cause severe symptoms and serious illness that can lead to life-long liver damage and even death. People can become infected with both hepatitis B and hepatitis D viruses at the same time (known as “coinfection”) or get hepatitis D after first being infected with the hepatitis B virus (known as “superinfection”). There is no vaccine to prevent hepatitis D. However, prevention of hepatitis B with hepatitis B vaccine also protects against future hepatitis D infection. ​Hepatitis E is a liver infection caused by the hepatitis E virus (HEV). HEV is found in the stool of an infected person. It is spread when someone unknowingly ingests the virus – even in microscopic amounts. In developing countries, people most often get hepatitis E from drinking water contaminated by feces from people who are infected with the virus. In the United States and other developed countries where hepatitis E is not common, people have gotten sick with hepatitis E after eating raw or undercooked pork, venison, wild boar meat, or shellfish. In the past, most cases in developed countries involved people who have recently traveled to countries where hepatitis E is common. Symptoms of hepatitis E can include fatigue, poor appetite, stomach pain, nausea, and jaundice. However, many people with hepatitis E, especially young children, have no symptoms. Except for the rare occurrence of chronic hepatitis E in people with compromised immune systems, most people recover fully from the disease without any complications. No vaccine for hepatitis E is currently available in the United States. (credits CDC)

In this podcast, expert faculty, Dr Stuart Gordon and Dr Nancy Reau, use an illustrative patient case to explore the roles of ALP and other biochemical markers in PBC management, and explain what to expect from treatment. Topics covered include: How baseline ALP can affect ALP normalization after second-line treatment with elafibranor and seladelparPotential outcomes if ALP normalization cannot be achievedThe importance of managing fatigue, pruritus, and sleep disturbances independently of the biochemical responsePresenters:Stuart C. Gordon, MDProfessor of MedicineWayne State University School of MedicineDirector, Division of HepatologyHenry Ford HealthDetroit, MichiganNancy Reau, MDProfessor of MedicineRichard B. Capps Chair of HepatologyChief, Section of HepatologyAssociate Director, Solid Organ TransplantationRush University Medical CenterChicago, IllinoisTo learn more about PBC management, check out our program, Curbside Consults: Expert Insights on Challenges in PBC Management.  

Dr. Bikman's lecture this week explores the metabolic roles of bilirubin, a molecule typically associated with liver disease and jaundice but now emerging as a key player in metabolism, oxidative stress, and fat regulation.Bilirubin is produced from the breakdown of red blood cells and is transported to the liver, where it undergoes conjugation to become water-soluble and is then excreted into bile.While historically viewed as a waste product, recent research suggests that bilirubin plays a significant role in protecting against oxidative stress and inflammation, and may even contribute to metabolic flexibility and fat metabolism.One of bilirubin's most fascinating properties is its potent antioxidant effect. It neutralizes reactive oxygen species (ROS), helping to reduce oxidative stress—a key driver of chronic diseases, including insulin resistance, cardiovascular disease, and neurodegeneration. Bilirubin also acts as an anti-inflammatory agent, inhibiting key inflammatory pathways such as NF-kappa B, which is involved in obesity-related inflammation. Interestingly, individuals with Gilbert Syndrome, a genetic condition that causes mildly elevated bilirubin levels, have been shown to have a significantly lower risk of cardiovascular disease.Beyond its antioxidant and anti-inflammatory roles, bilirubin also influences fat metabolism. Studies suggest that bilirubin enhances mitochondrial function and thermogenesis, particularly in brown and beige fat, by increasing UCP-1 (uncoupling protein 1) expression, which helps the body burn fat more efficiently.Ben concludes by discussing ways to naturally increase bilirubin levels. Since bilirubin is excreted in bile, diets higher in fat may enhance enterohepatic recycling, allowing more bilirubin to re-enter circulation and exert its beneficial effects. While excessive bilirubin can be toxic, modestly elevated levels, as seen in Gilbert Syndrome, appear to provide metabolic advantages.This growing body of research challenges the outdated view of bilirubin as a mere waste product and suggests that it may be a crucial player in metabolic health.Show Notes/References:For complete show notes and references referred to in this episode, we invite you to become a Ben Bikman Insider subscriber. As a subscriber, you'll enjoy real-time, livestream Metabolic Classroom access which includes live Q&A with Ben, ad-free Metabolic Classroom Podcast episodes, show notes and references, Ben's Research Reviews Podcast, and a searchable archive that includes all Metabolic Classroom episodes and Research Reviews. Learn more about becoming an Insider on our website: https://www.benbikman.com Hosted on Acast. See acast.com/privacy for more information.

Send us a textUnbound bilirubin and risk of severe neurodevelopmental impairment in extremely low birthweight newborns. Arnold CC, Maric I, Wong RJ, Tyson JE, Stevenson DK.Pediatr Res. 2025 Jan 23. doi: 10.1038/s41390-025-03872-x. Online ahead of print.PMID: 39849115As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

In this episode, Sonal Kumar, MD, MPH, discusses key findings from primary biliary cholangitis (PBC) studies presented at AASLD 2024, including:ELATIVE, a phase III trial of elafibranor for PBCRESPONSE, a phase III trial of seladelpar for PBCASSURE, another phase III trial of seladelpar for PBCPresenter:Sonal Kumar, MD, MPHDirector, Clinical Gastroenterology and HepatologyAssistant Professor of MedicineWeill Cornell Medical CollegeNew York, New YorkLink to full program:https://bit.ly/41tvSDuGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

In this episode, Sonal Kumar, MD, MPH, discusses key findings from primary biliary cholangitis (PBC) studies presented at AASLD 2024, including:ELATIVE, a phase III trial of elafibranor for PBCRESPONSE, a phase III trial of seladelpar for PBCASSURE, another phase III trial of seladelpar for PBCPresenter:Sonal Kumar, MD, MPHDirector, Clinical Gastroenterology and HepatologyAssistant Professor of MedicineWeill Cornell Medical CollegeNew York, New YorkLink to full program:https://bit.ly/41tvSDuGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

Christian startet heute mit einer kniffeligen Quiz-Frage. Wissen Peter, Daniel und/oder Marius, was Bilirubin ist? Anschließend geht es um moderne Möglichkeiten der Wissensvermittlung. Was ist digital heute möglich? Was ist zum Beispiel Picture in Picture? Und wie kann man das umsetzen? Neugierig geworden? Dann hört rein in #ersthosedannsocken Wenn du diesen Podcast unterstützen möchtest, dann erzähle deinen Freunden, Kolleginnen und Kollegen von ihm und bewerte ihn beim Podcastdienstleister deiner Wahl! Ihr findet unsere Sponsoren unter: BOK Dental Die Praxisentwickler Ihr findet uns online unter: Doc.Blattner: Instagram Threads Doc.Tandon: Instagram Threads Youtube Website Christian Both: Instagram Threads Marius: Instagram Fundamental: Instagram Threads YouTube Website

An ultrasound revealed a large mass in Melinda Bachini's liver, and that led to a diagnosis of cholangiocarcinoma, a form of bile duct cancer.  Doctors removed two thirds of her liver.  Unfortunately, her cancer returned three months.  Melinda was hoping to take part in a clinical trial, but when insurance wouldn't cover a clinical trial, settled for a chemotherapy regimen.  When the chemo didn't help but left her with a bunch of awful side effects, she decided to end the chemotherapy treatment and live as long as she could.  Then she and her husband found out about another opportunity for a clinical trial, pursued it, qualified for it.  The trial led to her achieving survivorship.

Holmberg's Morning Sickness - Brady Report - Friday January 5, 2024 Learn more about your ad choices. Visit megaphone.fm/adchoices

Holmberg's Morning Sickness - Brady Report - Friday January 5, 2024 Learn more about your ad choices. Visit megaphone.fm/adchoices

A Christmas Day Miracle, by Dean and Talya Rotbart, is adapted from their 2020 biography of Margaret and Riyaz Adat, titled Improbable Lives: A Scot, A Tanzanian, and Their Canadian Love Story.  A true-life, inspirational adult yuletide tale, A Christmas Day Miracle offers a universal message — regardless of readers' religious beliefs — about the wonder and power of life's unexpected blessings. Since the book was first published two years ago, it has become a perennial holiday favorite. We hope you enjoy it.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.07.26.550752v1?rss=1 Authors: Guzelkaya, M., Onal, E., Gelinci, E., Kumral, A., Cakan-Akdogan, G. Abstract: Unresolved neonatal hyperbilirubinemia may lead to accumulation of excess bilirubin in the body, and bilirubin in the neural tissues may induce toxicity. Bilirubin induced neurological damage (BIND) can result in acute or chronic bilirubin encephalopathy, causing temporary or lasting neurological dysfunction or severe damage resulting in infant death. Although serum bilirubin levels are used as an indication of severety, known and unknown individual differences affect the severity of the symptoms. The mechanisms of BIND have not been fully understood yet. Here, a zebrafish newborn hyperbilirubinemia model is developed and characterized. Direct exposure to excess bilirubin induced dose and time dependent toxicity linked to the accumulation of bilirubin in the body and brain. Introduced bilirubin was processed by liver which increased the tolerance of larvae. BIND in larvae was demonstrated by morphometric measurements, histopathological analyses and functional tests. The larvae that survived hyperbilirubinemia displayed mild or severe morphologies associated with defects in eye movements, body posture and swimming problems. Interestingly, the plethora of mild to severe clinical symptoms were reproduced in the zebrafish model. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

This week, join Kate, Henry, Gary and Mark as they discuss point of care bilirubin tests for neonatal jaundice, guideline for evaluating children in close contact with abused children, early return to activity after concussion, and terminology preferences by patients being treated for substance use disorder.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.07.12.548684v1?rss=1 Authors: Pranty, A. I., Wruck, W., Adjaye, J. Abstract: Bilirubin induced neurological damage (BIND), which is also known as Kernicterus, occurs as a consequence of defects in the bilirubin conjugation machinery, thus resulting in unconjugated bilirubin (UCB) to cross the blood brain barrier (BBB) and accumulation. Severe hyperbilirubinemia can be caused by a mutation within the UGT1A1 encoding gene. This mutation has a direct contribution towards bilirubin conjugation leading to Kernicterus as a symptom of Crigler Najjar Syndromes (CNS1, CNS2) and Gilbert syndrome, which results in permanent neurological sequelae. In this comparative study, we used human induced pluripotent stem cells (hiPSCs) derived 3D-brain organoids to model BIND in vitro and unveil the molecular basis of the detrimental effects of UCB in the developing human brain. hiPSC derived from healthy and CNS patients were differentiated into day 20 brain organoids, these were then stimulated with 200nM UCB. Analyses at 24 and 72 hrs post-treatment point at UCB induced neuro-inflammation in both cell lines. Transcriptome and associated KEGG and Gene Ontology analyses unveiled activation of distinct inflammatory pathways such as cytokine cytokine receptor interaction, MAPK signaling, calcium signaling, NFkB activation. Furthermore, both mRNA expression and secretome analysis confirmed an upregulation of proinflammatory cytokines such as IL6 and IL8 upon UCB stimulation. In summary, this novel study has provided insights into how a human iPSC derived 3D-brain organoid model can serve as a prospective platform for studying the etiology of BIND Kernicterus. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

In hour one, a Juan Luis Guerra jam gets us into breaking down Bilirubin and liver function. Solana has a dry glizzy at the Marlins game last night and reveals his trepidation with public condiment stations. Then, Dolphins reporter David Furones joins the show with the latest on Dalvin Cook and reveals he is a strong pineapple on pizza fan. 

Find out more about Thorsten at: www.the-incubator.org/132/____________________________________________________________________As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. enjoy!This podcast is proudly sponsored by Chiesi.

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!_____________________________________________________________________________________Show notes, articles, and CME form can be found on our website: http://www.the-incubator.org/130/

Overview Total bilirubin Normal Value Range Pathophysiology Special considerations Elevations in Total bilirubin Nursing Points General Normal values 0.1-1.2 mg/dL Patho Breakdown product of RBCs Specifically heme (iron portion of hemoglobin) Transported to liver Bound with bile Excreted via GI tract and kidneys Conjugated Water soluble Unconjugated Not able to excrete it Carried to liver via albumin Conjugated in liver Special Considerations Submit in green top tube Usually submitted with liver function tests Elevated Total Bilirubin Newborn jaundice Treated with phototherapy Liver tumors Liver disease Cirrhosis Hepatitis Alcoholism Cholecystitis Biliary obstruction Assessment Assess patients for jaundice or icterus, or changes in color of stool (clay colored) Therapeutic Management Phototherapy for newborns, as they are unable to properly breakdown bilirubin Treat primary cause of liver/gallbladder disease Nursing Concepts Lab Values Gastrointestinal/Liver Metabolism

Unexplained sharp pains, pale, floating stool or diarrhea? You could have a gallbladder/bile issue. Learn about the role of bile in digesting fats, digestive support after gallbladder removal, the possible benefits of TUDCA, supplements that can help with bile issues and how the interaction between the microbiome and bile contributes to inflammation in IBD with Dr. Laura Brown. Lindsey Parsons, your host, helps clients solve gut issues and reverse autoimmune disease naturally. Take her quiz to see which stool or functional medicine test will help you find out what's wrong. She's a Certified Health Coach at High Desert Health in Tucson, Arizona. She coaches clients locally and nationwide. You can also follow Lindsey on Facebook, Tiktok, Twitter, Instagram or Pinterest or reach her via email at lindsey@highdeserthealthcoaching.com to set up a free 30-minute Gut Healing Breakthrough Session. Show Notes

Commentary by Dr Dennis W.T. Nilsen

Please join Drs. Graham Skelhorne-Gross, Jordan Nantais and Ashlie Nadler from our Emergency General Surgery Team for a discussion on cirrhotic patients.   Child-Pugh Score (https://www.mdcalc.com/calc/340/child-pugh-score-cirrhosis-mortality) ·      Bilirubin, albumin, INR, ascites, encephalopathy ·      Used to predict operative mortality based on cirrhosis severity ·      Mortality in EGS: - Child-Pugh A: 10% electively and 22% emergently - Child-Pugh B: 30% electively and 38% emergently - Child-Pugh C: 80% electively and up to 100% emergently Model for End Stage Liver Disease (MELD) (https://www.mdcalc.com/calc/10437/model-end-stage-liver-disease-meld?utm_source=site&utm_medium=link&utm_campaign=meld_12_and_older) ·      creatinine, bilirubin, INR, and sodium ·      MELD < 20 – 1% increase in mortality with each point increase ·      MELD > 20 – 2% increase in mortality with each point increase Pre-operative Planning ·      Identification of cirrhosis with physical examination, bloodwork and imaging ·      Involvement of other medical services (internal medicine, hepatology, ICU) as needed ·      Cirrhosis optimization, if possible ·      Abdominal wall mapping Unexpected Intraoperative Finding Communicate unexpected findings to the operative team and think of additional adjuncts you may need such as additional ports, topical hemostatic agents or energy devices. Think about why you are in the OR. If its an elective situation and can wait, consider bailing. If its emergent, you may have to do something more definitive. Exposure may be a challenge, you may have to alter your typical approach including where the assistant grabs and retracts. Extra hands are helpful. Bleeding can be a big deal. If possible, map out the abdominal wall ahead of time with cross-sectional imaging. Stay away from varices around the umbilicus or porta Ventral Hernia + Cirrhosis ·      Ideally, control ascites pre-operatively, if you can't consider leaving drains ·      Small (< 2cm) hernias close primarily ·      Larger (>2cm) hernias repair with mesh unless infected filed (controversial) ·      Minimally invasive repairs can be performed Benign Biliary Disease + Cirrhosis ·      Incidence of gallstones is 4-5 times higher in cirrhotic patients ·      Prophylactic laparoscopic cholecystectomy (LC) generally not done ·      LC generally considered acceptable in CP A or B but not C (exceptions: HD instability, gangrenous cholecystitis, hemorrhagic cholecystitis) ·      Cholecystostomy and ERCP are safe References:  Bleszynski, M. et. Al. Acute care and emergency general surgery in patients with chronic liver disease: how can be optimize perioperative care? A review of the literature. 2018. World Journal of Emergency Surgery; 13:32 Mansour A, Watson W, Shayani V, et al. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997;122:730–5. Yeom SK, Lee CH, Cha SH, Park CM. Prediction of liver cirrhosis, using diagnostic imaging tools. World J Hepatol. 2015 Aug 18;7(17):2069-79. doi: 10.4254/wjh.v7.i17.2069. PMID: 26301049; PMCID: PMC4539400. Jain D, Mahmood E, V-Bandres M, Feyssa E. Preoperative elective transjugular intrahepatic portosystemic shunt for cirrhotic patients undergoing abdominal surgery. Ann Gastroenterol. 2018 May-Jun;31(3):330-337. doi: 10.20524/aog.2018.0249. Epub 2018 Mar 15. PMID: 29720858; PMCID: PMC5924855. **Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Emergency General Surgery episode here: https://behindtheknife.org/podcast-category/emergency-general-surgery/

This episode from our clinical series is brought to you by Elanco, makers of the broadest range of parasiticides including Advocate, Milbemax, Seresto and Credelio Plus. "The question about the biochemistry is really interesting, because what your question now is, is 'what is it, and where is it?' And the problem that we have is that the liver enzymes aren't gonna tell us, because it's really hard to separate hepatic from post-hepatic on bloods. ALP is very insensitive in the cat and will go up with both hepatic and post-hepatic. ALT will go up with hepatic and post-hepatic. Bilirubin will be up. So what?!" We recorded this case-based interactive session about how to work up the jaundiced cat with one of the world's leading Small Animal Medicine specialists and teachers, ⁠Prof Jill Maddison⁠ at session our live event in 2022. Prof Jill Jill Maddison, BVSc, DipVetClinStud, PhD, SFHEA, MRCVS, is a professor of general practice, the director of professional development, and the BVetMed and CertAVP course director at Royal Veterinary College. She is also a coordinator for London Vet Show and is a consultant at a local veterinary practice and at Beaumont Sainsbury Animal Hospital in London. Dr Maddison is the senior editor of the second edition of Small Animal Clinical Pharmacology and the senior editor of Clinical Reasoning in Small Animal Practice. She has lectured worldwide on clinical problem-solving, small animal internal medicine, and clinical pharmacology.  In this session she helps us reason through a case of jaundice in a cat to create a deeper understanding, rather than a simple list of facts. She also shifts some long-standing beliefs around diagnostic testing in liver disease in both dogs and cats. Topic list: 5:07 Where to begin your workup. 6:05 Defining the problem and localising the problem: Pre-hepatic, hepatic or post-hepatic? 9:17 How much does dehydration actually affect PCV? 10:43 Bilirubin - how useful is it? "It's the most over-interpreted test I reckon. I have so many vets tell me, “Oh, the bilirubin is 16, it has to have a problem with its liver…” No, it probably just has inflammatory disease." 13:14 Dd's for hepatic disease in cats. 14:20 Dd's for post-hepatic causes of jaundice. 16:04 Biochem in jaundice: ALP, ALT, GGT. "The problem that we have is that the liver enzymes aren't going to tell us." 19:51 Why bile acids are useless in the diagnosis of liver disease. "The bile acids don't tell you anything more than you already know. There is no relationship between the level of bile acids and the prognosis or reversibility of the lesion." 24:25 Can't I just trial-treat? 26:16 Ultrasound. 28:27 Signalment: how useful is it? 29:36 Cholesterol and liver disease. 30:52 Pancreatic lipase and pancreatitis in cats. "What we found was that we had 24% false negatives. So we had a quarter of our cats who had what seemed to be pancreatitis that did not have an increased Pli." 36:54 Hepatic lipidosis. For more world-class specialists in an easy-to-consume format join our community of Vet Vault Nerds at vvn.supercast.com. Visit thevetvault.com for the show notes for this episode. Join us in at Vets on Tour in Wanaka, New Zealand on 13 - 18 August 2023 for great CE, more live podcasting and snow... lots of snow! --- Send in a voice message: https://podcasters.spotify.com/pod/show/vet-vault/message

Episode 133: Neonatal JaundiceJennifer explained the pathophysiology of neonatal jaundice and how to treat it and described why screening for hyperbilirubinemia is important.    Written by Jennifer Lai, MS3, College of Osteopathic Medicine of the Pacific Western University of Health Sciences. Comments by Hector Arreaza, MD.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is neonatal jaundice? Jenni: Infant jaundice, also known as hyperbilirubinemia, is when there is a high level of serum bilirubin causing yellow discoloration of the newborn's skin and eyes. Bilirubin is a red-orange byproduct of hemoglobin catabolism that gives yellow pigment to skin and mucosa membranes. Arreaza: When we see jaundice on the eyes, it is actually the conjunctiva color we are seeing. So, the term “scleral icterus” should be changed to “conjunctival icterus,” but you may get corrected by unaware clinicians. Bilirubin actually binds elastin.What's the pathophysiology/ big picture?Jenni: The key problem is the accumulation of high levels of bilirubin in serum and if left untreated, it can bind to tissues and cause toxicity. There are multiple reasons why there might be too much bilirubin in the serum. Excess bilirubin can be due to a benign normal condition, but it can also be due to a pathologic reason. It is important to differentiate between these two because the management and treatment can differ significantly. Arreaza: Highly bilirubin means that it is being either overproduced or under-eliminated. Physiologic jaundice Most of the time, hyperbilirubinemia is benign and physiologic, with yellowing typically occurring between 2-4 days. Normally, there is a period of transition caused by the turnover of the fetal red blood cells and the immaturity of the newborn's liver to efficiently metabolize bilirubin and increased enterohepatic circulation. The most common reason is that the liver isn't mature enough to get rid of the bilirubin in the bloodstream or because the baby's gut is sterile, so it does not have the bacteria to convert the bilirubin to get it out of the body. In general, newborns have a higher level of total serum or plasma bilirubin levels compared to adults for the following reasons: Newborns have more red blood cells (hematocrit between 50-60), and fetal red blood cells have a shorter life span (85 days vs. 120 days) than those of adults. After birth, there is an increased turnover of fetal red blood cells, so there is more bilirubin.Bilirubin clearance (conjugation and excretion) is decreased in newborns, mainly because of a deficiency of the hepatic enzyme UGT.Increase in the enterohepatic circulation of bilirubin as the amount of unconjugated bilirubin increases due to the limited bacterial conversion of conjugated bilirubin to urobilin.Pathologic JaundicePathologic jaundice includes severe neonatal hyperbilirubinemia, extreme neonatal hyperbilirubinemia, and bilirubin-induced neurologic disorders. We determine the severity of the jaundice using the total serum bilirubin (TSB). It is defined as a TSB >25 (severe) and TSB >30 (extreme). Other concerning signs include a TSB over the 95% percentile, a greater than 5mg/dL/day or 0.2mg/dL/hour, or jaundice that lasts for more than 2-3 weeks. Potential pathologic causes include but are not limited to: Increased bilirubin production from increased hemolysis which is when the red blood cells in the baby are being destroyed faster than normal, this can be due to blood group incompatibilities where the mom's immune system starts to attack the baby's red blood cells (such as Rh incompatibility) or from RBC membrane defects (spherocytosis).Birth Trauma when the head gets bruised after a vacuum or forceps is used to remove the baby from the vaginal canalInfection which prevents the bilirubin from being metabolized and excretedProblems with bilirubin clearance either from enzyme deficiencies such as Crigler-Najjar or Gilbert syndromeObstructed biliary systems causing bile to get stuck in the liverArreaza: Indirect bilirubin is the one elevated in newborns, but if you see direct hyperbilirubinemia, then you have to think of an obstruction.Jenni: Severe hyperbilirubinemia can cause brain damage. The amount of bilirubin and the duration of bilirubin ultimately determine the severity of the brain damage. This is because the bilirubin blocks some mitochondrial enzymes from being able to function properly, also it inhibits DNA synthesis/protein synthesis, and can cause DNA damage. This can ultimately lead to acute bilirubin encephalopathy which is described as 3 different phases: Phase 1 with poor feeding, lethargy, hypotonia, and seizures, Phase 2 with increased tone in extensor muscles causing neck contractions (retrocollis and opisthotonos), and Phase 3 with generalized increased tone. If the bilirubin encephalopathy persists it can also ultimately cause cerebral palsy, sensorineural hearing loss, and gaze abnormalities.  How and when do we treat? No phototherapy:The goal of treating jaundice is to safely decrease the amount of bilirubin in the body. Oftentimes babies with mild hyperbilirubinemia don't get any treatment and we just watch and wait. In premature babies, there is an increased risk for brain toxicity because a lower amount of bilirubin can result in brain toxicity. For these babies, it is important to ensure there is adequate breast milk to both prevent and treat jaundice because it helps the baby get rid of bilirubin through the stool and urine. Arreaza: Indirect sunlight exposure of the baby.Phototherapy:Other babies get phototherapy or more commonly known as light therapy. Phototherapy light treatment is when the baby's skin is exposed to a special blue light which will help break down bilirubin and help with the excretion in stool and urine. The phototherapy should be continuous and placed on as much skin as possible and the treatment should be administered until bilirubin levels drop to a safe level based on the baby's hour-specific thresholds. Arreaza: Home phototherapy is an option (UV blanket) available for rent or purchase.Phototherapy is very safe, however, with any treatment, there are risks and potential side effects. Some of these include skin rashes, loose stools, overheating, and dehydration. Occasionally, babies turn a dark gray-brown color in their skin and urine, but this is temporary and usually resolves on its own. While the baby is receiving phototherapy, it is important to continue breastfeeding to ensure appropriate fluid hydration, but in babies that cannot get enough breast milk, they may need to supplement with formula or even potentially start IV fluids. Benefits of screeningIt is therefore essential for universal bilirubin screening for all newborns prior to discharge to identify newborns who are at risk for developing severe hyperbilirubinemia. Hyperbilirubinemia is extremely common in newborns, with nearly all neonates having a higher total serum bilirubin than adults. The reason we screen is that this reduces the risk of developing severe hyperbilirubinemia and ultimately brain damage. This universal screening also then decreases hospital readmissions for neonatal hyperbilirubinemia. Arreaza: So, we check at 12-24 hours in a typical pediatric unit. We use a bilimeter (transcutaneous) and if we suspect it is not accurate, we do a serum bili. Be aware of the accuracy of bilimeters.How do we screen? We do this prior to newborn discharge through a transcutaneous bilirubin device (TcB) or lab total serum bilirubin (TSB). The bilirubin level is used with the assessment of risk for the development of severe hyperbilirubinemia. Newborn bilirubin screening guidelines include TSB or TcB within 24-48 hours after birth or before discharge. TcB is the noninvasive test, but TSB is the gold standard for assessing neonatal bilirubin. Newborns with visible jaundice in the first 24 hours should be concerned for severe hyperbilirubinemia. These babies should be screened earlier because of the risk of pathologic causes of jaundice. In addition to the bilirubin test, physicians will clinically assess by examining the skin under ambient or daylight to assess whether there is a yellow discoloration of the buccal, gingival, or conjunctival mucosa. Additionally, if a baby presents with scleral icterus, pallor, bruising, hepatosplenomegaly, or cephalohematoma (enclosed hemorrhage), these can be clinical presentations of neonatal jaundice. Follow up:After screening, we recommend that babies be closely monitored if jaundice does occur as it can be well managed with early treatment. A quick way to assess this at home is to press gently on the baby's forehead and if the skin looks yellow where you press, it's probably jaundice. If your baby doesn't have jaundice, then the place where you pressed it should look lighter than normal. _____________________Conclusion: Now we conclude episode number 133, “Neonatal Jaundice.” Jennifer explained the pathophysiology behind the increased levels of bilirubin in babies. She reminded us that it is a physiologic process, but when the level of bilirubin is too high, then we need to start treatment. Treatments include indirect sunlight exposure of the baby, breastfeeding, and in some cases phototherapy, IV fluids, and even antibiotics and exchange transfusion in some cases. Dr. Arreaza reminded us of the importance of screening and monitoring “bili babies” in the clinic. This week we thank Hector Arreaza and Jennifer Lai. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! ___________________Links:Episode 17: Why does bilirubin deposit in the eyes? – The Curious Clinicians, https://curiousclinicians.com/2021/01/20/episode-17-why-does-bilirubin-deposit-in-the-eyes/.Ansong-Assoku B, Shah SD, Adnan M, et al. Neonatal Jaundice. [Updated 2022 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532930/.Mayo Clinic. “Infant Jaundice – Symptoms and Causes.” Mayo Clinic, 2018, www.mayoclinic.org/disease-conditions/infant-jaundice/symptoms-causes/syc-20373865.“Newborn Jaundice.” Nhs.uk, 19 Oct. 2017, www.nhs.uk/conditions/jaundice-newborn/#:~:text=Jaundcie%20in%20newborn%20babies%20is.Preud'Homme D., “Neonatal Jaundice.” American College of Gastroenterology, Dec 2012, https://gi.org/topics/neonatal-jaundice/.Wong R., et al. “Risk factors, Clinical Manifestations, and Neurologic Complications of Neonatal Uncomplicated Hyperbilirubinemia.” Up to Date, Last Updated: Jan 5, 2023, https://www.uptodate.com/contents/risk-factors-clinical-manifestations-and-neurologic-complications-of-neonatal-unconjugated-hyperbilirubinemiaRoyalty-free music used for this episode: “Gushito - Burn Flow." Downloaded on October 13, 2022, from https://www.videvo.net/

Jon talks about being on steroids (2:30), checking your bilirubin(8:45), Tom Brady doing stand-up(14:38), 2yrs no booze(16:35), the BlendJet fiasco(20:00), MTG(29:35) & inner city lunches(32:38), VA legalization screwups(38:30), an email from Vincent(45:47), investing in those around you(55:20), and more on the rebrand(58:10). Email the show: jondpodcom@gmail.com Sponsors are: Newsly.me "Stop Scrolling News, Start Listening" THEEJOND for 1-month FREE Premium subscription MondoMonsterWear.com "Shirts That Feed The Geeky Mind" PODCAST for exclusive discount Support the show thru Venmo @jondpodcom

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!_____________________________________________________________________________________Show notes, articles, and CME form can be found on our website: http://www.the-incubator.org/113/

In this episode, The Curious Clinicians examine why patients with liver injury or dysfunction have conjugated hyperbilirubinemia. Why is this particular function (conjugation) seemingly spared in liver disease? "Hop" in for the ride! Read the show notes here. Click here to obtain AMA PRA Category 1 Credits™ (0.5 hours), Non-Physician Attendance (0.5 hours), or ABIM MOC Part 2 (0.5 hours). Audio edited by Clair Morgan of Nodderly.com.

Merhaba  Bu yazımızda kalabalık acillerde hemen her gün karşımıza çıkan patolojiler olan safra taşlarına, akut kolesistit ve kolanjite değineceğiz. Bu tablolarla ilgili gastroenteroloji, dahiliye ve genel cerrahi kliniklerinin farklı yaklaşımları olabileceğini biliyoruz. Fakat başlıktan da anlaşılacağı üzere temel hedefimiz, acil servislerde çalışan pratisyen hekimlerin veya asistanlığın ilk yıllarındaki hekimlerin ilk yaklaşımını gözden geçirmek olacak. Başlamadan, karın ağrısı ile ilgili bu yazımızı ve ilişkili diğer konular olan hepatit ve pankreatit yazılarını da okuyabilirsiniz. Nedir? Öncelikle aslında bildiğimiz tanımlarla başlayalım.  Safra taşlarının safra kesesi içinde bulunup, herhangi bir tıkanıklığa ve semptoma sebep olmadığı duruma kolesistolithiazis denir. Bu taşların safra kanallarına doğru hareket etmeleri, geçici tıkanıklıklara sebep olmaları ve safra kesesindeki basıncın artmasıyla ağrının ortaya çıkması ise biliyer kolik olarak adlandırılır. Taşlar zaman zaman safra kesesi içine veya duodenuma düşerler ve tıkanıklık açılır, semptomlar geriler. Biliyer kolikte hastanın ağrısının yaklaşık 6 saat içinde sonlanması beklenir. Bu durumda tıkanıklık, uzun süreli total bir obstrüksiyon olmadığından, hastanın staz parametreleri (ALP, GGT, Bilirubin) ve enfektif bir süreç olmadığından WBC, CRP normal olarak tespit edilir. Şikayetleri de gerileyeceğinden hastanın semptomatik tedavi sonrası elektif poliklinik kontrolü önerilerek acil servisten taburcu edilmesi uygun olur. Yani her safra taşı olan hastanın acil yatışı gerekmeyebilir. Fakat tıkanıklık devam ederse safra kesesindeki distansiyon devam eder, inflamasyon başlar ve bazı durumlarda enfeksiyon da tabloya eklenir. Safra kesesinin bu inflamatuar sürecine akut kolesistit denir.​1​ Hastalar sağ üst kadran ağrısı, bulantı kusma, ateş yüksekliği şikayetleri ile başvurabilir. Tanımından da anlaşılacağı üzere bir enfeksiyondan bahsettiğimizden lökositoz tespit edilir. Bu intraabdominal enfeksiyon, istisnalar haricinde, hastane yatışı ve iv antibiyotik tedavisi gerektirir. Akut kolesistitin komplikasyonları, perforasyon, gangrenöz kolesistit, amfizematöz kolesistit, kolesistoenterik fistül ve safra taşı ileusu olarak sayılabilir ve bu komplikasyonların varlığında acil cerrahi müdahale gerekecektir. Çok daha nadir olarak akut kolesistit safra taşı olmaksızın da ortaya çıkabilir. Genellikle immunsupresif, geçirilmiş cerrahi öyküsü olan, başka bir sebeple hastanede yatmakta olan kritik hastalarda görülen akalküloz kolesistit​2​, temel olarak safra kesesinin dolaşımının bozulması ile ilişkili olarak değerlendirilmiştir. Kliniği, tetkikleri ve tedavi yaklaşımı taşlı kolesistit ile aynıdır. Altta yatan patolojilere göre prognozu, taşlı kolesistitten daha kötü seyredebilir. Safra Yolları Koledokolithiazis ise safra taşlarının koledokta olmasıdır. Primer olarak orda oluşmuş olabilirler ya da safra kesesinde oluşan taşların yer değiştirmesiyle orda bulunabilirler. Koledokolithiazis ya da striktür, tümor gibi dışardan basılarla koledok kanalının obstrüksiyonu safra yollarının enfeksiyonuna yol açar ve bu duruma da akut kolanjit denir​3​. Laboratuvar tetkiklerinde belirgin obstrüksiyon sebebiyle staz parametrelerinde yükselme ve lökositoz tespit edilir. Yine bir intraabdominal enfeksiyondan bahsettiğimiz için, tıpkı kolesistit gibi, iv antibiyotik tedavisi ve cerrahi müdahale gerekecektir. Bu enfeksiyonların doğru tedavi edilmediğinde sepsise kadar ilerleyebileceği unutulmamalıdır. Buraya kadarını hepimiz teoride biliyoruz. Peki biz acilciler için yaklaşımda neler önemli? Ne Yapmalı? Öncelikle hastaların kliniğini hatırlayalım. Sağ üst kadranda belirgin karın ağrısı tipik semptomumuz. Ağrıya, bulantı kusma da sıklıkla eşlik eder. Kolesistit ve kolanjitte tıkanıklığın uzun sürmesi sarılığa sebep olabilir ve inflamatuar süreçlerle ateş görülebilir. Hastanın muayenesinde sağ üst kadranda defans, rebound ve Murphy bulgusu (sağ üst kadranın kot al...

Join the conversation about the 2022 AAP Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation with Tim Bahr, MD, FAAP and Host Paul Wirkus, MD, FAAP. In week one the differences between the old and new guidelines will be discussed. Submit your questions for Dr. Bahr to questions@vcurb.com. They will be answered in week four. For more information about available credit visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

KSQD 10-26-2022: Gene of the week: FOXO3 is important for longevity; States with conservatives policies have higher mortality statistics; Genes selected for survival during bubonic plague (the Black Death during Middle Ages) has increased risks for other diseases; Suppressing tumors before they are detectable by inhibiting blood vessel growth; Why are my eosinophils and bilirubin levels high? Patient diagnosed with intractable cervical radiculopathy may also have a cerebrospinal fluid leak

Find out more about Ross and First Day Healthcare at: www.the-incubator.org______________________________________________________________________________________As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. enjoy!This podcast is proudly sponsored by Chiesi.

Get a free nursing lab values cheat sheet at NURSING.com/63labs   Objective: Determine the significance and clinical use of measuring Direct or Conjugated Bilirubin in clinical practice   Lab Test Name: Direct or Conjugated Bilirubin   Description: Bilirubin is a substance made when your body breaks down old red blood cells. This is a normal process. Bilirubin is also part of bile, which your liver makes to help digest the food you eat. A small amount of bilirubin in your blood is normal. Some bilirubin is bound to albumin in the blood. This type of bilirubin is called unconjugated, or indirect, bilirubin. In the liver, bilirubin is changed into a form that your body can get rid of. This is called conjugated bilirubin or direct bilirubin.  This bilirubin travels from the liver into the small intestine. A very small amount passes into your kidneys and is excreted in your urine. This bilirubin also gives urine its distinctive yellow color and contributes to the brown color of stool.   Indications: Newborns – immature liver has trouble clearing bilirubin and manifests as jaundice Investigate jaundice in adults Blockage of bile ducts- (liver or gallbladder) Detection of liver disease- particularly hepatitis Monitor progression of hepatitis Detect issues with RBC breakdown→hemolytic anemia Suspected drug toxicity- many medications are metabolized and cleared in the liver   Normal Therapeutic Values: Normal – 0.0-0.2 mg/dL Collection: Plasma separator tube   What would cause increased levels? Increased levels linked to: Poor liver function or hepatitis Certain medications Hemolytic anemia Pregnancy Sepsis- poor perfusion Exercise TPN ETOH   What would cause decreased levels? Studies are inconclusive regarding risk or association with disease process in the presence of a decreased bilirubin level.

As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. Papers discussed in today's episode are listed and timestamped below.enjoy!_____________________________________________________________________________________Show notes and articles can be found on our website: www.the-incubator.org/082/This episode is sponsored by Chieisi

For our 33rd podcast episode, I review the recommendations for screening and managing hyperbilirubinemia. The American Academy of Pediatrics recommends universal screening of bilirubin levels in newborns, so I review how that can be done, when it should occur, and when it should be repeated. We discuss which infants are more at risk for elevated bilirubin levels and how those risk factors contribute to guidelines for the treatment plan. I discuss the nomograms commonly used and recommended by the American Academy of Pediatrics that guide the care of identifying infants at risk as well as when they should be treated. I review phototherapy, the primary treatment plan for hyperbilirubinemia, including how it effectively lowers bilirubin levels as well as the clinical considerations that should be applied during treatment. Whether you are a neonatal clinician or a parent, this review on how to effectively screen for and manage hyperbilirubinemia will be beneficial. Hyperbilirubinemia is incredibly common in neonates. Clinicians who care for infants whether they are a term newborn in the nursery or an infant in the NICU, will manage infants with elevated bilirubin levels. And parents of either term, healthy infants, or those critically ill in the NICU, it is essential that you understand the risks of hyperbilirubinemia and the screening and management process for it. Tune in now to learn more!Our NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/NeoTech NeoShades Free Sample: neotechneoshades.comNICU Mama Hats: https://empoweringnicuparents.com/hats/NICU Milestone Cards: https://empoweringnicuparents.com/nicuproducts/Bilirubin Document: https://empoweringnicuparents.com/bili/Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/episode33Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparentsPinterest Page: https://pin.it/36MJjmH

It is likely that you have heard the terms jaundiced and/or bilirubin. And although it is very common for infants to develop elevated bilirubin levels otherwise known as hyperbilirubinemia, do you actually know or understand why? As a NICU provider, I think it is essential that parents know the condition their infant is facing, but it is also important to understand the why behind its occurrence. If you do not understand the why, the treatment plan will also not make very much sense to you. I believe parents should be actively involved and partners in their baby's care. But, it is nearly impossible to be actively engaged in the decision-making process if you do not understand the why behind the condition.  For our 32nd podcast episode, I break down how our bodies process bilirubin, how we eliminate it, what causes the skin color to become jaundiced, why we as neonatal clinicians monitor bilirubin levels so closely, and I also review some of the common conditions that increase your infant's risk of developing hyperbilirubinemia. Some of the pathophysiology of hyperbilirubinemia can be confusing, but I review it in a way that will make sense to you so you can learn why elevated bilirubin levels occur, and even more importantly, understand your baby's treatment plan. The review will also be very beneficial for novice NICU clinicians or those that need a refresher on the pathophysiology of hyperbilirubinemia in term and preterm infants. So let's get to it!Our NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/NeoTech NeoShades Free Sample: neotechneoshades.comNICU Mama Hats: https://empoweringnicuparents.com/hats/Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/episode31Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparentsPinterest Page: https://pin.it/36MJjmH

Today, I am blessed to have here with me the President and CEO of AJ Consulting Company, Dr. Anthony Jay. Dr. Jay earned a B.A. with a double major in Biology and Theology from Ave Maria University in Naples, Florida, where he researched HIV (human immunodeficiency virus) inhibitors. This is a repeat episode which originally aired on April 19th 2021. After college, he continued to work with virus (lentivirus) in the context of Alzheimer's disease for the U.S. Department of Veteran's Affairs. Next, Dr. Jay earned his Ph.D. in Biochemistry from Boston University School of Medicine, researching fats, hormones, and cholesterol. Dr. Jay has also worked for 3 years as a scientific researcher at Mayo Clinic in Rochester, Minnesota, researching stem cells, epigenetics, and infrared light. Currently, in addition to leading AJCCo, Dr. Jay is a bestselling author of Estrogeneration. Did you know that the water from our faucet is full of birth control? In this episode, Dr. Jay reveals how he found his passion for artificial estrogens. Then, we jump into the importance of getting sunshine every single day. Not only are there loads of mental health benefits, but the UV will help break up toxins under your skin. Then, Dr. Jay talks about cholesterol and all-cause mortality, optimal vitamin D levels, and sunscreen problems. We end the conversation jumping into all things Covid, including face masks and vaccines. Order Keto Flex: http://www.ketoflexbook.com -------------------------------------------------------- / / E P I S O D E   S P ON S O R S  The Beauty & The Broth - High Quality Bone Broth, Concentrated Packets. Visit http://www.thebeautyandthebroth.com  PureForm Omega Plant Based Oils (Best Alternative to Fish Oil): http://www.purelifescience.com Use ben4 for $4.00 off. Text me +1 (786) 364-5002 [00:20] About Dr. Jay + His Interest In Artificial Estrogens Jay got interested in artificial estrogens way back in college. In college, they told him the water from the faucet was full of birth control. It opened up an entire can of worms. Jay started to recognize fake estrogen chemicals all over the place. So, he compiled a top ten list of these daily exposures and wrote the book You can get the book here: https://www.amazon.com/dp/B01MRAFYZL/benazadi-20  [03:10] The Benefits of Getting Sunshine Every Single Day There are a lot of interesting genetic risks that are dependent on sunshine and basically fixed by getting out in the sun. Sunshine will help increase your body's metabolism. The sun will also help break down toxin removal. Laser removal of tattoos is literally zapping heavy metals. Those heavy metals are in big enough chunks that your immune system cannot clear them. Sunshine will zap the large chunks of heavy metals. Even if you don't have tattoos, the UV will help you break up toxins from under your skin. Jay's favorite benefit is that it increases your body's natural production of melanotan. Plus, sunshine will help combat seasonal affective disorder (SAD). Watch the video on YouTube: https://www.youtube.com/watch?v=9Y-1fsJbd0A [12:25] An Intriguing Study! Total Cholesterol And All-Cause Mortality There's a study called: Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults. You can check it out here: https://www.nature.com/articles/s41598-018-38461-y The research is very clear about optimal levels for total cholesterol. When you get above 200 on your cholesterol, doctors will tell you that you need statins as soon as possible. Jay takes the prescriptions and then throws them out. However, if your blood sugar's above 85, fasted, that's a threefold higher risk of heart disease. Anything above 85 is not considered optimal. Americans will come in at 95, and a cardiologist will ignore that. [16:30] The Optimal Ranges For Your Vitamin D Levels 30 – 70 or 30 – 100 are optimal ranges. The average American is at 30. As soon as you get below 50, you see associations with health issues. For instance, people will suffer from gut issues, chronic fatigue, and depression with those levels. If you are at 200, there is some risk of calcifying your arteries. Keep it between 50 and 100 for optimization. Getting in the sun will bump your levels up to 70 or 80. [19:50] The Issues With Sunscreen - How Safe Is Sunscreen? The main ingredient is oxybenzone. It's a manmade chemical, and it acts like estrogen in your body. You do not want to rub it on your skin. After one application of sunscreen, oxybenzone levels were above the government's safety levels even one week later. The government limits are absurd, anyway! Estrogen chemicals don't kill the cells because they act like estrogen. It will do a lot of weird things to the cell instead. Zinc is an excellent alternative for sunscreen. Check out the products that Dr. Jay uses: https://www.ajconsultingcompany.com/whatiuse.html [24:25] Dr. Jay's Favorite Ways To Optimize Your Immune System   The best way to optimize your immune system is to sleep. Most people are sleep-deprived. Jay will get an hour and a half of deep sleep and an hour and a half of REM sleep. In college, Dr. Jay would sleep three hours a night. He would brag about it! Infrared lights will help you sleep way better. Also, the colder the bedroom, the deeper sleep you will get. Intermittent fasting will also help with your immune system. That way, your cells can take out the trash. Sunshine is another way to improve your immune system. Don't forget to get your skin in the sun – take those shirts off! [36:45] Why You Might Want To Think Twice About The Covid Vaccines When researchers do all these studies for pharmaceutical companies and come out with a drug, they don't actually have to release that study. When someone has an adverse reaction to a drug, the company has to release the study. With vaccines, the companies do not have to release the studies. So, the general public has not been able to see the vaccine study. We cannot see the study on the vaccine; that's a red flag. Also, this vaccine is very experimental. If the chemicals in these vaccines were in cleaning products, we wouldn't use them. [42:20] Unfortunately, The Vaccines Could Be Manipulating Your Epigenetics These vaccines could be messing with our epigenetics. There's a cool epigenetic study where they actually use electricity and zap rats every time they smell cherry blossoms. Cherry blossoms smell good, but the zap gave them an aversion to the blossoms. The offspring of the rats would have a fear response to cherry blossoms. Epigenetics is super powerful.   [45:30] Covid-19 In America: It's Time To Wake The [BLEEP] Up! The only positive lining in this whole Covid thing is it's woken a lot of people up to how much shenanigans goes on behind the scenes. Sadly, scientists are manipulating data. You pick your own peer reviewers – it is easily manipulated. You saw the same thing with the manipulation of Covid numbers. People should have the freedom to get the vaccines, and they should have the freedom not to get the vaccine. We should never blindly accept anything that comes out of pharmaceutical companies. [51:50] How Well Do Face Masks Even Work? Herd Immunity For The Win! If you wear the wrong type of face masks, it can disperse the droplets even more. N95 mask will help people with autoimmune conditions. In fact, they should give them away to those people. Everyone else should not wear masks. We want herd immunity! Herd immunity works, and it's successful. AND MUCH MORE! Resources from this episode: Check out AJ Consulting: https://www.ajconsultingcompany.com Follow Dr. Jay Instagram: https://www.instagram.com/anthonygjay/ Facebook: https://www.facebook.com/ajconsultingcompany/ YouTube: https://www.youtube.com/channel/UCkiTp9kSAJ70a5cD-BbNNog Get Estrogeneration: How Estrogenics Are Making You Fat, Sick, and Infertile: https://www.amazon.com/dp/B01MRAFYZL/benazadi-20 Listen to DNA with DRJ: https://www.ajconsultingcompany.com/dnadrj.html Join theKeto Kamp Academy: https://ketokampacademy.com/7-day-trial-a WatchKeto Kamp on YouTube: https://www.youtube.com/channel/UCUh_MOM621MvpW_HLtfkLyQ Order Keto Flex: http://www.ketoflexbook.com / / E P I S O D E   S P ON S O R S  The Beauty & The Broth - High Quality Bone Broth, Concentrated Packets. Visit http://www.thebeautyandthebroth.com  PureForm Omega Plant Based Oils (Best Alternative to Fish Oil): http://www.purelifescience.com Use ben4 for $4.00 off.

Akut hepatit, hepatik parankimde inflamasyonu ve hepatosit hasarının sebep olduğu karaciğer enzim yüksekliğini tanımlayan, 6 aydan kısa süren geniş bir spektrumu tanımlar. Sebepleri enfeksiyöz ve non-enfeksiyöz olarak ikiye ayrılır; enfektif olmayan sebepler otoimmün, toksik ve biliyer hastalıklara sekonder gelişebilir. Acil servis yaklaşımı; semptomları ve nedenleri tanımak, fulminan hepatik yetmezliğe gidişi tanımak, özellikle ilaç ilişkili durumlarda geri döndürülebilir durumları tanımak ve tedaviyi başlatmaktan oluşur. Sırasıyla bunları ele alalım. ​1–4​ Etiyoloji Kaynak: ichastaliklaridergisi.org Öykü ve Fizik Muayene Hasta spektrumu, asemptomatik karaciğer enzim yüksekliğinden fulminan karaciğer yetmezliğine kadar değişir. Başvuru şikayetleri arasında yorgunluk/halsizlik, ateş, mide bulantısı, kusma, baş ağrısı, iştahsızlık, karın ağrısı bulunur. Akut hepatitin sonraki aşamalarında sarılık, akolik dışkı ve koyu renkli idrar meydana gelebilir. Öyküde enfeksiyöz etkenlere olası maruziyet durumunu, günde 4 gr üzerinde kronik ya da 10 gr üzerinde akut asetaminofen kullanımını, antibiyotik kullanımını, takviye ürün kullanımını, madde kullanımını ya da mantar/bitki yeme öyküsünü sorgulamak gerekir. Muayenede palpasyonda hepatomegali ve sağ üst kadran hassasiyeti bulunur. Kolestatik hepatitte skleralar ikteriktir. Karaciğer yetmezliğine ve pıhtılaşma faktörlerinin sentezinde azalmaya ikincil olarak hastalarda ekimoz, kanama görülebilir. İlerleyen evrelerde hepatik ensefalopati söz konusudur. Bu konuda ileri okuma için Dr. Altuğ Kanbakan tarafından kaleme alınan ‘Acilci Gözüyle Hepatik Ensefalopati' yazısına göz atabilirsiniz. Tanı Acil serviste kullandığımız karaciğer fonksiyon testleri aspartat aminotransferaz (AST), alanin aminotransferaz (ALT), alkalen fosfataz (ALP) ve bilirubin ve pıhtılaşma faktörleridir. Hepatoselüler hepatitte AST ve ALT, ALP ve bilirubine göre daha yüksektir. Kolestatik paternde ise tam tersi görülür.  Karaciğer hasarı için ALT, iskelet ve kalp kasında da bulunan AST'ye göre daha spesifiktir. AST>ALT ise alkolik hepatit akla gelir, bazen tiroid ve kas hastalıklarında da bu durum görülebilir. Hepatosellüler katabolik/metabolik aktivitenin göstergeleri de yükselen amonyak ve bilirubindir. Bilirubin yüksekliği açısından intrahepatik/ekstrahepatik obstrüksiyon ve safra atılımında bozulmadan şüpheleniliyorsa hepatobiliyer USG, abdominal BT veya MRCP ile ileri görüntüleme gerekir. K vitaminine bağlı pıhtılaşma faktörleri (II, VII, IX, X) karaciğerin sentez fonksiyonunun azalmasına bağlı olarak düşer. Bu hasta grubunda INR >1,5 iken akut karaciğer yetmezliği düşünülür ve kötü prognostik gösterge olarak kabul edilir. Albüminde düşme karaciğer hasarına özgü olmadığı için akut hepatit tanısında yeri sınırlıdır. Amerikan Gastroenteroloji Derneği (ACG) tarafından anormal karaciğer fonksiyon testleri olan hastaların değerlendirilmesi için yayınlanan kılavuzda ALT ve AST'nin yükselme derecesine bağlı olarak başlangıç testleri ve yaklaşım değişir:​5​ Serum transaminazlarında hafif yükselme (normalin üst sınırının 5 katının altında): tam kan sayımı, AST, ALT, ALP, bilirubin, albümin, PT/INR, HAV IgG, HAV IgM, HBsAg, HBcAg, Anti HBs, Anti HCV ve demir paneli (serum demiri, total demir bağlama kapasitesi, serum transferrin saturasyonu ve serum ferritin) ve batın ultrasonu ile görüntüleme. Serum transaminazlarında şiddetli yükselme (normalin üst sınırının 15 katının üstünde): EBV ve CMV araştırılması, seruloplazmin, otoimmün belirteçler, asetaminofen içeren ilaç paneli testi ve idrar toksikolojisi. Kılavuz ayrıca vasküler tıkanıklığı ekarte etmek için hepatik ven, portal ven ve hepatik arterin Doppler USG görüntülemesinin yapılmasını önerir. Acil servis laboratuvar değerlendirmesi akut veya kronik alımı ya da alım şüphesi olan hastalarda asetaminofen, salisilat ve antiepileptik ilaç düzeyleri ile sepsisten şüpheleniliyorsa laktatı da içermelidir.

A list of amazing women that invented something medicalish related.  We have quite the list of women!  Hope you enjoy!It is rated e because I through in a couple of bad words. Support the show (https://www.patreon.com/Dissecting)

In this episode, Dr. Carole Keim MD explains what you should expect when going into labor. Why she, as a pediatrician, recommends having your baby at the hospital vs a home birth. She also goes into great detail on what to expect from a c-section or vaginal birth. It's all here in this episode to make your life easier pre and post-delivery in an unfamiliar environment where you may feel overwhelmed by your new responsibilities.Knowing the right questions to ask and having the right answers before your baby arrives will decrease your stress during your labor and delivery. Why is a vitamin K injection important and how erythromycin ointment protects your newborn from pink eye. She even gives you advice and tips for breastfeeding success.  Good luck with your new baby. You are going to do awesome!How to tell you're in labor: (00:42)Water breaksContractionsWhen to go to the hospitalHow long you're going to be in laborWhat happens at the hospital: (01:59)Delivery options (vaginal, c-section)Delivery staffWhat the pediatrician does, APGAR scoreNewborn screenWhat I recommend while still in the hospital: (08:41)Feeding: only breastfeed, push through the pain because it gets better.  Start pumping while in hospital.  Work with the nurses to check baby's latch, learn how to listen for milk movement/swallowingWrite down every time your baby starts and stops eating, and every time they pee and poop.  You're going to be asked this by everyone who walks in the room so one less thing to have to remember.Vitamin K shotErythromycin ointmentHep B vaccine: get it in the hospital if you want your baby to have it.  (explain why it's safe for newborns)Bilirubin/jaundice checks: all babies get screened before discharge (either visually or with TCB or blood test)Blood sugar testing - for babies who are LGS or SGA; pros/consCatch up on your sleep because this might be your only chanceBuy a copy of The Baby Manual on Amazon so it's waiting at home for youDischarge instructions: (17:49)Jaundice precautionsFeverCar seat safetyFollowup appointmentBaby development / what to expect before the next appt (weight loss and weight gain, length changes, sleep deprivation)Who to call if you need helpResources discussed in this episode:The Baby Manual - Available on AmazonDr. Carole Keim MD: linktree | tiktok | instagram

in this episode, Dr Mike and Dr Matt explore how our body deals with old or damaged red blood cells. They walk through the metabolism of bilirubin (a toxic breakdown product of red blood cells) and discuss what happens if this bilirubin isn't removed from the body or accumulates - resulting in a yellow discolouration of the skin, called Jaundice.

Is jaundice always bad? What causes jaundice? How does bilirubin work in the body? In today's episode, Sarah & Charli talk all about this common situation for newborns and how the midwifery model treats jaundice differently than the standard medical model. --- https://hearthandhomemidwifery.com  

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDocs cast with Brit Long, MD (@long_brit), we cover jaundice in adults. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

In dieser kurzen Podcastfolge, besprechen wir den Bilirubinkreislauf und werfen einen Blick auf die Zirkulation des Enterohepatischen Kreislaufs. Was ist der Unterschied zwischen indirektem und direktem Bilirubin und was ist überhaupt Urobilinogen? Höre in die große Leber folge rein: https://www.natuerlich-elli.de/2021/01/24/big-points-der-leber-warum-dich-dieses-organ-faszinieren-sollte/ Schreibe dich für DEINE Prüfungsvorbereitung auf die Warteliste: https://www.natuerlich-elli.de/heilpraktikerprüfung-meistern-onlinekurs/ Folge mir für mehr Tipps & Tricks auf Instagram: https://www.instagram.com/natuerlich_elli/ Komm in meine kostenlose FB Lerngruppe: https://www.facebook.com/groups/natuerlichelli

If you are a NICU parent and feel completely overwhelmed and scared by all of the wires, tubes, and equipment around them, this episode is for you! There really is no preparation for parents - especially when it comes to YOUR child - But after this episode, you will have a better understanding of all of the many different wires and tubes that are on your baby, what their purpose is, what pieces of equipment they are hooked up to, and how it relates to your baby's plan of care. After listening, you will have a much better grasp of common NICU equipment, so you can confidently ask your baby's NICU care team questions and understand what they are referring to!

There are so many questions and concerns that come up for NICU parents, but in my experience, once your infant is stabilized, THE most common question on a parent's mind is, when will my baby be able to come home?In this episode, we break it down and answer that question with some common diagnoses of infants in the NICU including extremely preterm infants, very preterm infants, moderately preterm infants, late preterm infants, as well as common conditions for term infants admitted to the NICU including hypoglycemia, respiratory distress, hypoxic ischemic encephalopathy (HIE), and post-surgical cases. We are here to help you during your baby's NICU journey, but each baby and their circumstances are unique, so always stay involved with your baby's care team and continue to ask questions about their plan of care.

This episode covers bilirubin!

This episode covers neonatal jaundice.Written notes can be found at https://zerotofinals.com/paediatrics/neonatology/jaundice/ or in the neonatology section in the Zero to Finals paediatrics book.The audio in the episode was expertly edited by Harry Watchman.

Ask Dr. Neal your question about health, nutrition, diet, fitness, and more here: http://OLDPodcast.com/ask or call: 614-568-3643 Episode 700: Q&A - How Can I Lower My Triglycerides Quickly? Elevated Triglyceride & Bilirubin Levels in the Blood The original post is located here: https://oldpodcast.com/lower-blood-pressure-quickly/ Please Rate & Review the Show! Visit Me Online at OLDPodcast.com and in The O.L.D. Facebook Group Learn more about your ad choices. Visit megaphone.fm/adchoices

Today on the podcast, Dave Scudamore, MD, joins us to talk about neonatal jaundice. Dr. Scudamore is the Director of Inpatient Medicine for the Network of Care at Children's Colorado, and he is also an assistant professor of pediatrics in hospital medicine at the University of Colorado School of Medicine. In this episode: The major risk factors for severe jaundice that can cause complications with neonates How to assess mom and baby for the risk factors of neonatal jaundice by reviewing patient history and birth data Difference between the risk factors for elevated bilirubin and the risk factors for neurotoxicity The significance of the ratio between albumin and bilirubin Standard protocols for bilirubin workups and monitoring for risk factors How you can provide elevated patient care by using a patient-centered care approach and considering the context of the case The way to utilize the Bhutani curve to assess risk and the AAP guidelines to initiate phototherapy Understanding the importance of follow ups and their role in intervention

Today on the podcast, Dave Scudamore, MD, joins us to talk about neonatal jaundice. Dr. Scudamore is the Director of Inpatient Medicine for the Network of Care at Children's Colorado, and he is also an assistant professor of pediatrics in hospital medicine at the University of Colorado School of Medicine. In this episode: The major risk factors for severe jaundice that can cause complications with neonates How to assess mom and baby for the risk factors of neonatal jaundice by reviewing patient history and birth data Difference between the risk factors for elevated bilirubin and the risk factors for neurotoxicity The significance of the ratio between albumin and bilirubin Standard protocols for bilirubin workups and monitoring for risk factors How you can provide elevated patient care by using a patient-centered care approach and considering the context of the case The way to utilize the Bhutani curve to assess risk and the AAP guidelines to initiate phototherapy Understanding the importance of follow ups and their role in intervention