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.
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!
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.
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!
At 2:28, about iron: it is transported by transferrin after ceruloplasmin (ferroxidase) oxidizes the ferrous ion (Fe++) to its ferric form (Fe+++). This is because transferrin is able to transport up to two iron ions only when they are in a ferric state. Otherwise iron could be lost through urine, since it's able to pass glomerular basement membrane (which is, yes, charged negatively). If I made any mistake, please point it out. Have a nice day, guys!
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❤
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!!!!
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.
Dear Armando, thank you very much for elaborative lectures however, I would suggest that you kindly go through details without skipping important information. For example, when talking about hemoglobin breakdown to hem and Globin, it can’t be appreciated so much when you make a shift to unconjugated bilirubin immediately without mentioning viliburdin and reduction process to the bilirubin (unconjugated bilirubin) Thanks
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!
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!
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.
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
Great explanation of metabolism. Of course you missed some parts but that is understandable. I'm curious where did you find that information, that urobilinogen is absorbed by colon ? :O
he said 10 - 15% was reabsorbed into the blood and the rest excreted after being oxidized giving poo its color the large intestine does not absorb any.
how does this digestive process cause jaundice in the eyes and skin? and how is this process effected if the person has a hematologic disease...like sickle cell anemia?
Essentially, there are three types of jaundice, Pre-hepatic and Hepatic which causes a problem with the conjugation of bilirubin thus allowing un-conjugated bilirubin levels to rise (the build up of bilirubin is responsible for jaundice) or Post hepatic which causes a build up of conjugated bilirubin. To answer your second question, sickle cell anemia is an intravascular hemolytic disorder also known as a hemolytic anemia, which means when the cells sickle they get destroyed. When a cell gets destroyed, it releases heme which gets converted to bilirubin. Large amounts of sickled and hemolyzed cells account for the large build up of bilirubin. Hope this helps!
@@medlabplus6849 Ok Medlab, maybe U can give me a hint, or any kind of advice about unconjugated bilirubinemia sindrom or known as Gilbert sindrome, i have this condition for over 10 years now and most of the time its really frustrating to walk around with yelowish skin and eyes and have a poor lifestyle and yea tiredness plays a huge role in it, Everything else is ok, all my life doing sports, no tobaco no alkohol,trying to get most that i can, so if there is any help on this topic I would be so grateful., God bless and thanks in advance
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
🧠 TEST YOUR KNOWLEDGE FROM THIS LECTURE! ✅
youmakr.ai/test-playground/questionnaire/673d496a859b9c170836f09a
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.
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.
You do an amazing job sir! The graphics and explanations are terrific! Perfect marriage between science and art :)
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!
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!
Stunning how all of this is continually happening and each part of the body is doing its part. Amazing mechanism.
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
I was just spending hours to understand bilirubin metabolism, until I saw this video. You do great job.
This was incredibly helpful, and presented in a much easier way to follow than in class. Thank you very much!
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 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❤
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
Amazing explanations you are one of my best you tube tutors
Thank you Armando! After years of reading text books I finally understand jaundice with your animation.
you are such a good teacher.well presented.greetings from Zimbabwe
6:00 you mentioned that urobilinogen is lipid soluble, it is indeed a water soluble molecule.
At 2:28, about iron: it is transported by transferrin after ceruloplasmin (ferroxidase) oxidizes the ferrous ion (Fe++) to its ferric form (Fe+++). This is because transferrin is able to transport up to two iron ions only when they are in a ferric state. Otherwise iron could be lost through urine, since it's able to pass glomerular basement membrane (which is, yes, charged negatively).
If I made any mistake, please point it out. Have a nice day, guys!
I have come back to this video quite often so far in my medical career. Thank you for this concise explanation!
So artistic, very well explained and enjoyable to hear too. Thank you so much it was very helpful
Agreed.
superb explanation....Fantastic teacher.....awesomely explained...So very very well simplified.....keep up the good work. God bless....cheers....
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❤
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 video deserves (❤️) button. Well done. 🙌🙌🙌
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.
This one video just cleared all my doubts , thank you very much!!
Excellent tutorial! Simple language makes it easy to understand the process.
Thank you.
- Nitin
thank you for this uncomplicated explanation
It's the 1st video i am watching on this site.. it's really helpful.thanks sir and keep it up.
He his the best teacher i have seen
YOUR THE CHIEF ARTIST!!. YOU'RE AMAZING💖. THANKS
Best explanation I’ve seen on this. Thanks.
Dear Armando, thank you very much for elaborative lectures however, I would suggest that you kindly go through details without skipping important information. For example, when talking about hemoglobin breakdown to hem and Globin, it can’t be appreciated so much when you make a shift to unconjugated bilirubin immediately without mentioning viliburdin and reduction process to the bilirubin (unconjugated bilirubin)
Thanks
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
thanks a lot Armando Hasudungan for your help
you are one of the best lecturer ever ...well done
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
Excellent. Very useful video.
Explained in simple words , in a clear voice.
im so enjoyed with your amazing explanation
now I have the final exams and I cannot leave your videos . big thanks for you
one of the best on RUclips to explain this cycle! good job!
This made me want to study medicine again! Great explanation!
That good feeling when you get great video of something you want to learn in first attempt . Thankyou for this amazing video and explanation
Tomorrow I have internal med exam and this helped me thanx a lot
Understood much better than a whole year of med school!
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 for this amazing explanation
Thanks for posting a great video on bilirubin metabolism
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
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.
Sir, Thank you so so much.
I am very thankful to you
This was an excellent and succinct explanation, really helpful!
Really very helpful for students like us,gr8 job sir
your best teacher in the world....thanks
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)?
This is really helpful video sir... informative and easily understandable
You, Sir are a GOD to all med students.
Fantastic piece of work....... Nice explanation in this short time ....
your videos are so sharp and understandable. you are a very enthusiast tutor. keep on the good work.
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 😁😁😁
It helped me a lot dude, greetings from Mexico.
Maravillosa la explicación! Sin palabras . Muchas gracias. Dios te bendiga 🙌🏾🙏🏾🇨🇺🇨🇺
Thank you so much ❤
Dude! Thaaaank u sooooo much for the clarifying vid !!!!!💗💗💗
You are fabulous !!! Just WOW !!!
Keep it up cuz You're the BEST 💪🏻
Great Explanation of the process of Bilrubin, examples are excellent and well explained
such lovely diagrams and wonderful way of teaching ❤️
Thanks Dr. Armando for your efforts ,you have such a great passion in teaching medicine as if you are playing piano.
i agree with christopher! i too would buy those diagrams if they were available. really helpful, so clear, fantastic!!
thanks Mr.Armando may God bless u for making peoples' lives easier
This presentation is amazing. Thank you!
Dear Armando, thank you for a great animation. I was wondering if I could use your video to teach some nurses about bilirubin
Great explanation of metabolism. Of course you missed some parts but that is understandable. I'm curious where did you find that information, that urobilinogen is absorbed by colon ? :O
he said 10 - 15% was reabsorbed into the blood and the rest excreted after being oxidized giving poo its color the large intestine does not absorb any.
really easy to understand and your detailed explanation. What a great video!!!!!
Thank you sir!!! 🙌🙌🙌
Nicely done . I enjoyed it . Superb drawings 😁👍
Thanku so much sir its very clear and easy to understand 🙏
You r truly gem sir🙏❤️
Your videos are the greatest! Nice work.
That was awesome 🤗
Keep going ; God bless U 🌻
It was so helpful to me:D thank you so much!!
THIS PERSON NEEDS WRITE A BOOK ; BIOLOGY FOR DUMMYS.
Thank you very much! All of your videos are brilliant
YOURE AWESOME ARMANDO!!
ITS SUCH ENLIGHTMENT!
THANKS SO MUCH FOR MAKING THESE!
KEEP UP UR AWESOME WORKS!
WE DOCTORS TOBE OWE YOU MUCH!!!
thank you armando, you're amazing!
thanks a lot! really helped a lot in reviewing for my pathophysiology test. keep up the great work!
how does this digestive process cause jaundice in the eyes and skin? and how is this process effected if the person has a hematologic disease...like sickle cell anemia?
Essentially, there are three types of jaundice, Pre-hepatic and Hepatic which causes a problem with the conjugation of bilirubin thus allowing un-conjugated bilirubin levels to rise (the build up of bilirubin is responsible for jaundice) or Post hepatic which causes a build up of conjugated bilirubin. To answer your second question, sickle cell anemia is an intravascular hemolytic disorder also known as a hemolytic anemia, which means when the cells sickle they get destroyed. When a cell gets destroyed, it releases heme which gets converted to bilirubin. Large amounts of sickled and hemolyzed cells account for the large build up of bilirubin. Hope this helps!
+MedLab Plus thanks
No Prob :)
@@medlabplus6849 Ok Medlab, maybe U can give me a hint, or any kind of advice about unconjugated bilirubinemia sindrom or known as Gilbert sindrome, i have this condition for over 10 years now and most of the time its really frustrating to walk around with yelowish skin and eyes and have a poor lifestyle and yea tiredness plays a huge role in it,
Everything else is ok, all my life doing sports, no tobaco no alkohol,trying to get most that i can, so if there is any help on this topic I would be so grateful., God bless and thanks in advance
Nice video! Thanks for share! Greetings from Tabasco, Mexico
thank you so much
I'm vet student. It's really helpful with your amazing drawing.
Thank you 🥰
zo'r rahmat. i'm uzbek. thank you very much
thank you, armando!! i will owe you this degree 💃🕺
Super helpful!! Thank you so much for clearing this up with your amazing illustrations!
You are a life saver ! I would not have never understood this without your video. Thank you.
Brilliant work sir
Good video! Really helped my understanding of bilirubin metabolism!
Hey nice video well explained but enterohepatic circulation 95 percentage is reabsorbed and only 2-4g is excreted ...
Kindly look into it
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
I CAN'T THANK YOU ENOUGH