Internal Medicine

Internal Medicine

Internal Medicine

by Joseph Alpert, MD, Paul Moss, PhD, Jeremy Brown, PhD u.a.

Internal medicine, one of the most intellectually demanding medical specialties, focuses on the diagnosis and management of diverse diseases using a combination of pharmacological and non-pharmacological approaches, often involving small procedures. In this course, we invite medical students to embark on a comprehensive exploration of the main subspecialties within internal medicine, including cardiology, nephrology, and gastroenterology, among others.

A competent physician in internal medicine must possess a range of skills and knowledge acquired during clerkships. This includes developing a clinician's mindset, the ability to quickly and effectively understand complex patients, and strategic use of interventions, whether pharmacological or otherwise. Additionally, a comprehensive understanding of the gold standard management for common conditions informs the processes of screening and referral, leading to improved outcomes and enhanced quality of life for patients.

In this course, students will delve into the intricacies of each subspecialty, building upon a solid foundation of preclinical sciences such as anatomy, physiology, histology, pathophysiology, and pharmacology. Through engaging lectures, interactive discussions, and case-based learning, students will gain a comprehensive understanding of the principles, diagnostic approaches, and management strategies within each subspecialty.

By the end of this course, students will have a deep appreciation for the unique challenges and nuances of each subspecialty. They will develop the ability to think critically and apply their knowledge to complex clinical scenarios. Furthermore, students will acquire the skills necessary to provide optimal patient care, improving health outcomes and overall quality of life.

Course Details

Videos 1333
Duration 109:04 h
Quiz questions 3810
Concept Pages 687

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Content

Hepatorenal Syndrome (Clinical)

Hepatorenal syndrome (HRS) is a “functional” type of acute kidney injury (AKI) in patients who have portal hypertension, usually due to cirrhosis. HRS may also be caused by other liver diseases which are associated with portal hypertension, which causes decreased systemic arterial blood volume and activation of neurohormonal mechanisms, including the renin-angiotensin-aldosterone system. The resulting vasoconstriction and reduced renal perfusion trigger the release of vasodilatory substances like nitric oxide, which induces splanchnic arterial vasodilatation, leading to a decrease in systemic vascular resistance and effective circulating volume, thereby exacerbating renal hypoperfusion. HRS is a diagnosis of exclusion, and is associated with a poor prognosis. Without treatment, most patients die within weeks of the onset of AKI. Patients typically present with a progressive rise in serum creatinine, a benign urine sediment, no (or minimal) proteinuria, and a low urine sodium concentration. Ascites is often present, and severe cases are associated with oliguria. Treatment is aimed at improving liver function, if possible. Medical therapy includes increasing the systemic blood pressure with norepinephrine and albumin infusions, and administering agents that cause splanchnic vasoconstriction (e.g., terlipressin). Transjugular intrahepatic portosystemic shunt (TIPS) may be successful, and dialysis is a temporizing solution while waiting for liver transplant. The prognosis of patients with HRS is highly dependent upon reversal of the hepatic failure, whether spontaneous, following medical therapy, or following transplantation.