Dear Armando, I am a chief physician and manager of an emergency clinic in Norway. In 2 weeks I am spending a whole day teaching our staff in causes of abdominal pain and symptoms from diseases causing abdominal pain. I needed a quick memory refreshener on the complete bilirubin metabolism to explain the aspects of jaundice and saw this.. This video is just simply brilliant! Thank you so much.
as a MS1 I truly appreciate learning this stuff and then coming and watching your videos which allows me finally see how it all comes together and keeps the bigger picture in mind.
Very nice video. Just for the sake of some more details, please allow me to further specialise and sum up: RBC when denaturing are taken up by Macrophages located predominantly in the Cords of Billroth in spleen, bone marrow and liver. It is an important point to understand that RBC normally do not undergo intravascular lysis. Billirubin is a breakdown product from Hb. Heme Oxygenase cleaves Heme (the Porphyrin part) into Verdoglobin (if Heme is still attached) or Billiverdin which will finally be reduced by Billiverdin-Reductase into Billirubin. Oppositely, Fe is recycled by Apoferritin in Ferritin and complexes to Hemosiderin. Note: This function of Hb breakdown by HO can occur in virtually every cell and is NOT liver-specific. In liver, hepatocytes release Billirubin-binding-proteins in the circularly system. Those newly formed complexes of Plasma-Protein-Bound-Billirubin are too large large and cannot diffuse back to microcirculatory system. Note: Up to now, we are still talking about unconjungated (indirect) Billirubin which is not water soluble due to intra molecular hydrogen bonds and thus cannot be filtered into urine. This form, still in the circulatory system, is highly toxic, but now trapped. Trough the hepatic artery and the portal system it goes to liver which will take it up. Within hepatic sinusoids, it enters the endoplasmic reticulum and will be conjugated with Glucuronic Acid by GT (Glucuronyltransferase). It became now highly polar and trapped within the hepatocytes. On the canalicular side of the hepatocytes are active transporters that will drain it into biliary ducts. Next it will be concentrated in bile and finally released into GIT. Microbes and enzymes will convert it now into Urobilinogen. Some is reabsorbed and goes back into enterohepatic cycle and since it is highly polar and unbound, it will be renally filtered and passed out by the urinary tract. However, the largest part will remain in the bowl and be converted by bacteria into Stercobilinogen which will be oxidized into Stercobilin that makes the dark color of feces.
MarC NIcolA Fraessdorf thanks a lot for your explanation. But it's said that urobillirubin is bound to albumin after absorption (6:56) and you say that urobillinogen is highly polar and unbound. So what's the truth?
Sir you got amazing skills , mind and a great method of teaching ! I am a Med student I found your tutorials very useful specially when Im studying guyton for physio...
I always watch your videos to review material before tests or quizzes, when I'm too tired to read or just don't feel like reading, or just want another take on material that's already familiar to me. You sometimes put things just a bit differently than my teachers do and that can make the material stick to my head much more easily. Your channel is an incredibly valuable complement to my teachers and their class notes.
You. Are. Awesome. I used to mug this up every year, all theough four years of medschool. Finally UNDERSTANDING it in my final year. Thank you so much. You have a gift!
What an explanation. Even a illiterate can understand easily. The uses of different colour and explanations of everything made it so easy to understand. I really appreciate your work from heart and mind. Thank you for sharing such an awesome video.
As someone who has been diagnosed with Gilbert Syndrome (elevated blood concentrations of unconjugated bilirubin), this is a great video to see. I love what you're doing!
I love your videos, the drawings look amazing, and you can really see the effort in them. The explanations are amazing. Super grateful for all your work.
Thank you very very much. Although I am a non- medical trained person but this has helped me to understand why a young member of family’s bilirubin has doubled since entered university. He does has constipation prob. & likes eating ready made meal. I think for his case the fix is stop junk foods, drink plenty, more fibre & Magnesium citrate to discharge stool and possibly taking ox bile or similar. Thanks again❤
great video man I like all the videos you do. Just to add an extra step when the haeme is converted to bilirubin there is an intermediate step whereby the haeme is cleaved by haeme oxygenase a cytochrome P450 enzyme to biliverdin. This biliverdin is water soluble unlike bilirubin and it is the enzyme reduction of the biliverdin via biliverdin reductase that creates the lipid soluble bilirubin.
WATCHING FOR THE 'NTH TIME!!!! YOU'RE AWESOME ARMANDO!!!!! THANK YOU VERY MUCH!! YEARS OF SITTING IN MY CLASS WAS NOTHING FOR EVERY FEW MINUTES SPENT WATCHING YOUR WORK!!!! GREAT JOB!!!!
You are AMAZING! I'm a visual learner and always follow up my reads by listening to your videos; which immensely aid in the retention of this knowledge. I have vowed to donate in the future! Thank you for all that you do!
hi, nice video and explanation! however in urobilinogen part you mentioned that it was lipid soluble, but in some literature that i read, they said that urobilinogen is a highly water soluble substance so it can later excreted into the kidney, hmmm did i mistaken? hope you can check it later, thanks for the video! :D Greetings from Indonesia
At this age of 64 years I had USG, CT & MRI four years back on the complain of obstructive jaundice. To know about bilirubin , the root of all evil then in details is really amezing for a common man like me. Thanks
A little detail... When heme is broken down, is produced biliverdin, this is then reduced to bilirubin... Sorry for terrible english, I'm italian :) your videos are awesome!
thank you so much, great video, i always have slight increase of total bilirubin and collesterol (not too high but upper to the normal), with a normal liver function, all hepatic enzymes have normal values, no galblather stones or ducts obstrution, good pancreatic function, don’t understand my blood work results ... any idea ? also always small amount of ferritin
thank you very much.this is very helpful for me ,and easy to understand ,and can I ask something ,can you tell me about your reference about bilirubin that you've tell in this video ?
Dear Armando, I am a chief physician and manager of an emergency clinic in Norway. In 2 weeks I am spending a whole day teaching our staff in causes of abdominal pain and symptoms from diseases causing abdominal pain. I needed a quick memory refreshener on the complete bilirubin metabolism to explain the aspects of jaundice and saw this.. This video is just simply brilliant! Thank you so much.
I am doctor passed out 15yr back.loved ur drawing.needed clarity and revision.so grateful for this.love from India.
You do an amazing job sir! The graphics and explanations are terrific! Perfect marriage between science and art :)
as a MS1 I truly appreciate learning this stuff and then coming and watching your videos which allows me finally see how it all comes together and keeps the bigger picture in mind.
Very nice video. Just for the sake of some more details, please allow me to further specialise and sum up:
RBC when denaturing are taken up by Macrophages located predominantly in the Cords of Billroth in spleen, bone marrow and liver. It is an important point to understand that RBC normally do not undergo intravascular lysis.
Billirubin is a breakdown product from Hb. Heme Oxygenase cleaves Heme (the Porphyrin part) into Verdoglobin (if Heme is still attached) or Billiverdin which will finally be reduced by Billiverdin-Reductase into Billirubin. Oppositely, Fe is recycled by Apoferritin in Ferritin and complexes to Hemosiderin.
Note: This function of Hb breakdown by HO can occur in virtually every cell and is NOT liver-specific.
In liver, hepatocytes release Billirubin-binding-proteins in the circularly system. Those newly formed complexes of Plasma-Protein-Bound-Billirubin are too large large and cannot diffuse back to microcirculatory system.
Note: Up to now, we are still talking about unconjungated (indirect) Billirubin which is not water soluble due to intra molecular hydrogen bonds and thus cannot be filtered into urine.
This form, still in the circulatory system, is highly toxic, but now trapped. Trough the hepatic artery and the portal system it goes to liver which will take it up. Within hepatic sinusoids, it enters the endoplasmic reticulum and will be conjugated with Glucuronic Acid by GT (Glucuronyltransferase). It became now highly polar and trapped within the hepatocytes. On the canalicular side of the hepatocytes are active transporters that will drain it into biliary ducts. Next it will be concentrated in bile and finally released into GIT. Microbes and enzymes will convert it now into Urobilinogen. Some is reabsorbed and goes back into enterohepatic cycle and since it is highly polar and unbound, it will be renally filtered and passed out by the urinary tract.
However, the largest part will remain in the bowl and be converted by bacteria into Stercobilinogen which will be oxidized into Stercobilin that makes the dark color of feces.
Very well explained! The enzymes are crucial to know for exams
nice addition to the video, I was looking for these enzymes.thanx a lot
Thanks man
MarC NIcolA Fraessdorf thanks a lot for your explanation. But it's said that urobillirubin is bound to albumin after absorption (6:56) and you say that urobillinogen is highly polar and unbound. So what's the truth?
Much obliged buddy!
Sir you got amazing skills , mind and a great method of teaching ! I am a Med student I found your tutorials very useful specially when Im studying guyton for physio...
Have u finished mbbs as yr comment was posted 5 yrs ago???
And now I'm here..i'm 1st yr mbbs student
So artistic, very well explained and enjoyable to hear too. Thank you so much it was very helpful
Agreed.
I always watch your videos to review material before tests or quizzes, when I'm too tired to read or just don't feel like reading, or just want another take on material that's already familiar to me. You sometimes put things just a bit differently than my teachers do and that can make the material stick to my head much more easily. Your channel is an incredibly valuable complement to my teachers and their class notes.
You. Are. Awesome.
I used to mug this up every year, all theough four years of medschool. Finally UNDERSTANDING it in my final year. Thank you so much. You have a gift!
Thank you Armando! After years of reading text books I finally understand jaundice with your animation.
What an explanation. Even a illiterate can understand easily. The uses of different colour and explanations of everything made it so easy to understand. I really appreciate your work from heart and mind. Thank you for sharing such an awesome video.
As someone who has been diagnosed with Gilbert Syndrome (elevated blood concentrations of unconjugated bilirubin), this is a great video to see. I love what you're doing!
Hello
How high was your unconjugated levels ? And what you do now to treat the gilbert syndrome ?
Thanks
I was just spending hours to understand bilirubin metabolism, until I saw this video. You do great job.
You make things so simple. It took me 3 hrs to understand things by myself. What a life saver
I am veterinary Student and it is very helpful , clear doubts and gives the image in mind which is remembering in lifetime❤
I love your videos, the drawings look amazing, and you can really see the effort in them. The explanations are amazing. Super grateful for all your work.
Excellent tutorial! Simple language makes it easy to understand the process.
Thank you.
- Nitin
You should release the final thing as a poster. I'd even pay a little bit for it!
David Grainger I second that. pls do sir.
+Wan Nurin Yes please! I try to recreate them but I'm so bad at drawing. My liver is an inverted triangle..
you can become a patron on patreon to get HD pdfs of the whole thing
yes I would like a copy of the posters
Thank you very very much. Although I am a non- medical trained person but this has helped me to understand why a young member of family’s bilirubin has doubled since entered university. He does has constipation prob. & likes eating ready made meal. I think for his case the fix is stop junk foods, drink plenty, more fibre & Magnesium citrate to discharge stool and possibly taking ox bile or similar. Thanks again❤
superb explanation....Fantastic teacher.....awesomely explained...So very very well simplified.....keep up the good work. God bless....cheers....
great video man I like all the videos you do. Just to add an extra step when the haeme is converted to bilirubin there is an intermediate step whereby the haeme is cleaved by haeme oxygenase a cytochrome P450 enzyme to biliverdin.
This biliverdin is water soluble unlike bilirubin and it is the enzyme reduction of the biliverdin via biliverdin reductase that creates the lipid soluble bilirubin.
Best explanation I’ve seen on this. Thanks.
WATCHING FOR THE 'NTH TIME!!!! YOU'RE AWESOME ARMANDO!!!!! THANK YOU VERY MUCH!! YEARS OF SITTING IN MY CLASS WAS NOTHING FOR EVERY FEW MINUTES SPENT WATCHING YOUR WORK!!!! GREAT JOB!!!!
This was an excellent and succinct explanation, really helpful!
Thanks for posting a great video on bilirubin metabolism
You are AMAZING! I'm a visual learner and always follow up my reads by listening to your videos; which immensely aid in the retention of this knowledge. I have vowed to donate in the future! Thank you for all that you do!
Wished someone would make a video on the causes of chronic elevated bilirubin
This video deserves (❤️) button. Well done. 🙌🙌🙌
Thank you Sir. Amazing
YOUR THE CHIEF ARTIST!!. YOU'RE AMAZING💖. THANKS
Excellent. Very useful video.
Explained in simple words , in a clear voice.
thank you for this uncomplicated explanation
hi, nice video and explanation! however in urobilinogen part you mentioned that it was lipid soluble, but in some literature that i read, they said that urobilinogen is a highly water soluble substance so it can later excreted into the kidney, hmmm did i mistaken? hope you can check it later, thanks for the video! :D Greetings from Indonesia
you are correct
If it was Highly water soluble, why is it taken By Albumin for its conjugation (to get it soluble)?
thanks a lot Armando Hasudungan for your help
This made me want to study medicine again! Great explanation!
you are one of the best lecturer ever ...well done
Dude! Thaaaank u sooooo much for the clarifying vid !!!!!💗💗💗
zo'r rahmat. i'm uzbek. thank you very much
Thankyou for explaining beautifully
Fantastic piece of work....... Nice explanation in this short time ....
At this age of 64 years I had USG, CT & MRI four years back on the complain of obstructive jaundice. To know about bilirubin , the root of all evil then in details is really amezing for a common man like me. Thanks
I'm going to write this metabolism ( as u told ) in my xm which I never understand in any buks ... Great help in my practice of medicine xm 😁😁😁
Understood much better than a whole year of med school!
Brilliant work sir
This presentation is amazing. Thank you!
It's the 1st video i am watching on this site.. it's really helpful.thanks sir and keep it up.
6:00 you mentioned that urobilinogen is lipid soluble, it is indeed a water soluble molecule.
Thanks Dr. Armando for your efforts ,you have such a great passion in teaching medicine as if you are playing piano.
A little detail... When heme is broken down, is produced biliverdin, this is then reduced to bilirubin... Sorry for terrible english, I'm italian :) your videos are awesome!
Thank you so much
Thank you 🥰
Maravillosa la explicación! Sin palabras . Muchas gracias. Dios te bendiga 🙌🏾🙏🏾🇨🇺🇨🇺
So easy to understand thanks
The digestive juice that also contains waste products (like bilirubin) is:
1. pancreas juice
2. saliva
3. gastric juice
4. juice bile
Is it 4 ?
thank you so much, great video, i always have slight increase of total bilirubin and collesterol (not too high but upper to the normal), with a normal liver function, all hepatic enzymes have normal values, no galblather stones or ducts obstrution, good pancreatic function, don’t understand my blood work results ... any idea ? also always small amount of ferritin
Really very helpful for students like us,gr8 job sir
thanks Mr.Armando may God bless u for making peoples' lives easier
excellent explanation, you made it nice and easy ! thank you.
Muchas gracias!
Great Teacher
thanks a lot! really helped a lot in reviewing for my pathophysiology test. keep up the great work!
I CAN'T THANK YOU ENOUGH
May God bless and guide you thanks a lot !!
terima kasih
May Allah bless u sir
Sharmin Akter amen
Fuck Allah, there is NO god, get over it
thank u so much sir ,very nicely explained with good draw,ur great
Thank you very much sir
Thank You..
Thank you
Thank u so much..
ما شاء الله .. شرح اكثر من رائعععع
Super helpful!! Thank you so much for clearing this up with your amazing illustrations!
your videos are so sharp and understandable. you are a very enthusiast tutor. keep on the good work.
Dear Armando, thank you for a great animation. I was wondering if I could use your video to teach some nurses about bilirubin
Good for making up the foundation and concept...
thank you sooooo much
thank you so much
I'm vet student. It's really helpful with your amazing drawing.
This is really helpful video sir... informative and easily understandable
Perfect video!!! Thank you so much!!!
such lovely diagrams and wonderful way of teaching ❤️
Thank you sir
Very well explained thanku sir ♥️🥰🤗
thank you armando, you're amazing!
Thank you sir!!! 🙌🙌🙌
thank you, armando!! i will owe you this degree 💃🕺
thank you very much !
Thank you!
It helped me a lot dude, greetings from Mexico.
Thank you a lot..
thank you very very much
thank you very much.this is very helpful for me ,and easy to understand ,and can I ask something ,can you tell me about your reference about bilirubin that you've tell in this video ?
U R A FREAKING LEGEND
Absolutely fantastic video
thankyou 🤗
Thank you sir ❤️❤️ from nepal
You are a life saver ! I would not have never understood this without your video. Thank you.
thank you
Amazing explanation and drawing
really easy to understand and your detailed explanation. What a great video!!!!!
Awesome sir, great job
You r truly gem sir🙏❤️