Management of the Adult in Primary Care

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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.

Raynaud's Phenomenon

Raynaud's phenomenon refers to an abnormally marked and sudden vasoconstrictive response to cold temperature or emotional stress. The condition was first described by a medical student, Maurice Raynaud, in 1862. These "vasospastic attacks" are usually but not always limited to the fingers or toes and are associated with sharply demarcated triphasic color changes at the distal portions of the digits. There is initial blanching with numbness, followed by cyanosis, both of which correspond to the phase of constricted blood flow; subsequently, there is a red blush of reperfusion after rewarming or resolution of the provocative stressful event. Raynaud's phenomenon may be primary (idiopathic) or secondary. Patienten*innen stellen sich häufig im zweiten und dritten Lebensjahrzehnt mit einer rezidivierenden, intermittierenden Makrohämaturie vor. Viele Patienten*innen haben asymptomatische Verläufe und fallen in Routineuntersuchungen durch eine Mikrohämaturie und/oder Proteinurie auf. Häufig hatten die Betroffenen einen vorausgegangenen Infekt der oberen Atemwege oder des Magen-Darm-Trakts. Die Diagnose wird anhand von Anamnese, klinischem Erscheinungsbild und Labordiagnostik gestellt. Die sichere Diagnosestellung erfolgt durch eine Nierenbiopsie mit Immunfluoreszenzfärbung. Da die Erkrankung meist einen guten Verlauf hat, wird die Nierenbiospie nur bei schweren oder chronischen Verläufen durchgeführt. Die Behandlung ist abhängig vom Schweregrad der Proteinurie, der Nierenfunktion und den pathologischen Veränderungen. Zu den Behandlungsmöglichkeiten zählen ACE-Hemmer oder Angiotensin-Rezeptor-Blocker (ARBs), um das Fortschreiten der Krankheit zu verlangsamen. Eine persistierende Proteinurie und ein Anstieg des Kreatinins sind Indikationen für eine immunsuppressive Therapie mit Glukokortikoiden und ggf. Zytostatika.

Your Educators of course Management of the Adult in Primary Care (APRN)

Joseph Alpert, MD

Dr. Joseph Alpert is the Professor of Medicine in the Department of Medicine, Director of Coronary Care and Medical Director of Cardiac Rehabilitation at the University of Arizona (UA) College of Medicine, USA.
He obtained his Medical Degree cum laude from Harvard Medical School in 1969. Currently, he is a member of the Board of Trustees of the Association of Professors of Medicine, and Editor-in-Chief of The American Journal of Medicine.
Due to his achievements, he earned the Gifted Teacher Award from the American College of Cardiology in 2004.
Within Lecturio, Dr. Alpert teaches courses on Cardiology and the Cardiac System.

Paul Moss, PhD, OBE, FMed, FRCPath

Dr. Paul Moss is Professor of Hematology within the Institute of Immunology and Immunotherapy at the University of Birmingham, UK, and Deputy Head of the College of Medical and Dental Sciences.
He studied Medical Sciences at the University of Cambridge and was a fellow of the Royal College of Pathologists. During the coronavirus pandemic, he has been leading the UK Coronavirus Immunology Consortium (UK-CIC).
Dr. Moss makes substantial contributions to teaching both within the University of Birmingham and beyond.
Within Lecturio, he teaches courses on Hematology.

Jeremy Brown, PhD, MRCP(UK), MBBS

Professor Jeremy Brown is a Professor of Respiratory Infection at the University College of London (UCL) in England, UK.
He obtained his PhD in molecular microbiology from the University of London in 1999. Currently, he is a Senior Lecturer and Honorary Consultant at UCL, and Lead Teacher for respiratory medicine undergraduate teaching at the University College London Hospitals (UCLH).
Due to his achievements, he obtained a Welcome Advanced Research Fellowship for further scientific training at the University of Adelaide. He has also led internationally respected research programs in pneumonia prevention and antibiotic resistance.
Within Lecturio, Dr. Brown teaches courses on Respiratory Medicine and Pulmonology.

John Fisher, MD

Dr. John F. Fisher is a Professor of Medicine and Infectious Diseases at the Medical College of Georgia, Augusta University in the USA.
He obtained his medical degree from Virginia Commonwealth University School of Medicine in 1969. He is a Master of the American College of Physicians (MACP) and is certified by the American Board of Internal Medicine in Medicine and Infectious Diseases.
Due to his achievements, he has earned the Annual J. Willis Hurst Teaching Award, the Jane F. Deforges Excellence in Medical Education Award, and the Infectious Diseases Society of America's Clinical Teacher Award.
Within Lecturio, Dr. Fisher teaches courses on Infectious Diseases.

Hetal Verma, MD

Dr. Hetal Verma is a Clinical Instructor of Radiology and the Co-Director of the Radiology Cambridge Integrated Clerkship at Harvard Medical School, MA, USA.
She is a graduate of the University of Massachusetts Medical School and completed her Breast Imaging fellowship at the Massachusetts General Hospital. Since 2012, she is the Director of Breast Imaging at Cambridge Health Alliance Radiology, a teaching affiliate of Harvard Medical School.
She is passionate about women's health and has vast experience in teaching medical students and residents at Harvard Medical School.
Within Lecturio, Dr. Verma teaches courses on Radiology.

Charles Vega, MD

Dr. Charles Vega is the Health Sciences Clinical Professor of Family Medicine at the University of California, Irvine in California, USA.
He obtained his Medical Degree from the University of Wisconsin, and completed residency training in Family Medicine at UC Irvine. Currently, he is the Executive Director of UCI’s Program in Medical Education for the Latino Community.
Due to his achievements, he earned a Macy Faculty Scholarship to improve patient-centered health education at UCI.
Within Lecturio, Dr. Vega teaches courses on Family Medicine.

Sharon Bord, MD

Dr. Sharon Bord is an Assistant Professor in the Department of Emergency Medicine at the Johns Hopkins University School of Medicine, Maryland, USA.
She obtained her MD at the George Washington University School of Medicine and Health Sciences in 2004 and then completed residency training at Boston Medical Center.
She has a focus on both undergraduate and graduate medical education, and is a member of the Teaching College, a group of faculty members in the Department of Emergency Medicine dedicated to educational endeavors for residents and medical students.
Within Lecturio, Dr. Bord teaches courses on Emergency Medicine.

Helen Farrell, MD

Dr. Helen M. Farrell is a board-certified psychiatrist and works in private practice in Boston MA. She obtained her MD from Trinity College Dublin, Ireland in 2006. Dr. Farrell served on the Harvard Medical School faculty for over a decade, during which time she was an award-winning lecturer.

Due to her achievements, she is well-published in the field of psychiatry and forensic psychiatry and has appeared as an expert witness in court. She also delivered the TEDx Talk, “Creating Hope for Mental Health” in 2015 and has since contributed to multiple TED-Ed videos on mental health, which have over 30 million collective views.

Within Lecturio, Dr. Farrell teaches courses on Psychiatry.

Michael Lazarus, MD

Dr. Michael Lazarus is a Professor of Clinical Medicine at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).
He obtained his MD from the University of the Witwatersrand School of Health Sciences, South Africa, and trained at the Washington University School of Medicine. In 2003, he joined the faculty at UCLA and currently serves as the Medical Director of the UCLA Hospitalist Section.
He has won various teaching awards, such as the Serge & Yvette Dadone Clinical Teaching Award, and was featured in the Los Angeles Magazine's Top Doctors Guide in 2021.
Within Lecturio, Dr. Lazarus teaches courses on Endocrinology.

Rhonda Lawes, PhD, RN

Dr. Rhonda Lawes is a Certified Nurse Educator (CNE), and an Assistant Professor at the University of Oklahoma College of Nursing in Oklahoma, USA.
She obtained her PhD in Educational Psychology from Oklahoma State University in 2016.
Due to her achievements, she has earned numerous teaching awards. She teaches nursing students how to use the science of cognitive learning to maximize their study effectiveness.
Within Lecturio, Dr. Lawes is the Director of Nursing Education Programs, and teaches courses on Pharmacology (Nursing), Medical Surgical Nursing and Pathophysiology.

Sean Elliott, MD

Dr. Sean Elliott is the Professor of Clinical Pediatrics and the Associate Chair for the Department of Pediatrics at The University of Arizona, USA.
He obtained his MD from Columbia University College of Physicians and Surgeons in 1993. Currently, he is Pediatric Infectious Disease Specialist at the University of Arizona Medical Center.
He devotes time to Quality Improvement, graduate medical education efficacy and his scholarship with the Tucson Hospitals Medical Education Program (THMEP).
Within Lecturio, Dr. Elliott teaches courses on Microbiology.

Stephen Holt, MD, MS

Dr. Stephen Holt is the Associate Program Director for Ambulatory Education in the Primary Care Program at the Yale School of Medicine in Connecticut, USA.
He obtained his MD from Columbia College of Physicians and Surgeons in 2004. Currently, he is Director of the Addiction Recovery Clinic and Codirector of Clinician Educator Distinctions Pathway at Yale School of Medicine.
Because of his achievements, he earned the Faculty Teacher of the Year award from the Yale Primary Care Residency Program in 2009 and 2017.
Within Lecturio, Dr. Holt teaches courses on Physical Examination, Dermatology, and Rheumatology.

Kelley Chuang, MD

Dr. Kelley Chuang is an Assistant Clinical Professor at the David Geffen School of Medicine at the University of California in Los Angeles (UCLA), USA, and works as a hospitalist at the VA Greater Los Angeles Healthcare System.
She obtained her medical degree from the Icahn School of Medicine at Mount Sinai and completed a chief residency in Internal Medicine at UCLA.
Dr. Chuang also holds a Master's Degree in Teaching and combines her interests in medicine and teaching as a medical educator.
Within Lecturio, she teaches courses on Gastroenterology.

Amy Sussman, MD

Dr. Amy Sussman is an Associate Professor of Medicine and the Vice Chair of Education in the Department of Medicine of the University of Arizona (UA), USA.
She obtained her MD from the University of Arizona in 2001 and completed residency and a Nephrology Fellowship at the University of Washington. Dr. Sussman was recruited back to the UA in 2009 and also serves as her department's clerkship director, and as the program director of the UA Nephrology Fellowship.
Because of her strong emphasis on medical student teaching, she has been distinguished with multiple teaching awards in the UA College of Medicine.
Within Lecturio, Dr. Sussman teaches courses on Nephrology.

Roy Strowd, MD

Dr. Roy Strowd is the Assistant Dean of Undergraduate Medical Education at the Wake Forest Baptist Medical Center, in North Carolina, USA.
He obtained his MD from Wake Forest School of Medicine in 2009, and his MEd from Johns Hopkins University in 2021. Currently, he co-directs the Neurofibromatosis and Tuberous Sclerosis Clinics at Wake Forest Baptist Medical Center, and is a researcher for the Adult Brain Tumor Consortium (ABTC) and Alliance for Clinical Trials in Neuro-Oncology.
Due to his achievements, he earned the M. Brownell Anderson Award from the Association of American Medical Colleges.
Within Lecturio, Dr. Strowd teaches courses on Clinical Neurology.

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Amazing lecture

By Nariel G. on 10. July 2024 for Anticoagulant Drugs – Thrombosis and Anti-Thrombotic Therapy

Thank you for this succinct lecture. Key highlighted areas are great, particularly coverage on novel anticoagulants and DOACs

Thanks

By Nafessa M. on 06. July 2024 for Hepatitis B Infection with Case

That was fasinating lecture It gave me deep insight into HBV thank you doctor

Excellent

By Alexandra K. on 30. June 2024 for Other Forms of Therapy – Hypertension

Excellent review! These are series reallly completes and easy to understand

"Cruel, i know"

By Alejandro M. on 19. June 2024 for Adhesive Capsulitis (Frozen Shoulder)

Usar casos clínicos complejos hace que el aprendizaje se refuerce.

Management of the Adult in Primary Care (APRN)

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