Discover and read the best of Twitter Threads about #cirrhosis
Most recents (5)
What is hepatorenal syndrome?
A #Livertwitter #tweetorial
Hepatology is awesome, exciting, but also humbling.
Nowhere is that clearer than HRS, a true unmet need for patients with ascites
Aims
1. What
2. Why
3. How to prevent/treat
4. ❤️ #cirrhosis physiology
A #Livertwitter #tweetorial
Hepatology is awesome, exciting, but also humbling.
Nowhere is that clearer than HRS, a true unmet need for patients with ascites
Aims
1. What
2. Why
3. How to prevent/treat
4. ❤️ #cirrhosis physiology
What:
1. Ascites trashes QOL & is deadly enough to merit mention in the bible(Fig1)
2. Ascites physiology damages other organs; Austin Flint said it 1st (Fig2)
3. HRS is the knockout punch of portal hypertension. What begins as elevated portal mmHg and ascites ends as HRS(Fig3)
1. Ascites trashes QOL & is deadly enough to merit mention in the bible(Fig1)
2. Ascites physiology damages other organs; Austin Flint said it 1st (Fig2)
3. HRS is the knockout punch of portal hypertension. What begins as elevated portal mmHg and ascites ends as HRS(Fig3)
What:
1. HRS is not rare in pts w/ascites (Fig1)
2. HRS is deadly (Fig2)
3. For a definition of terms, check out the Ascites Club (that's a thing!)
ref: gut.bmj.com/content/gutjnl…
or see my review: amjmed.com/article/S0002-… (Fig3)
1. HRS is not rare in pts w/ascites (Fig1)
2. HRS is deadly (Fig2)
3. For a definition of terms, check out the Ascites Club (that's a thing!)
ref: gut.bmj.com/content/gutjnl…
or see my review: amjmed.com/article/S0002-… (Fig3)
Hepatic encephalopathy in the hospital (An ode to #lactulose):
A brief #livertwitter #tweetorial
Aims:
1. Share the greatest t-shirt ever made
2. Rule out infection!
3. Laxation now! But how?
keywords: #cirrhosis, paracentesis, stool pH
A brief #livertwitter #tweetorial
Aims:
1. Share the greatest t-shirt ever made
2. Rule out infection!
3. Laxation now! But how?
keywords: #cirrhosis, paracentesis, stool pH
1. This shirt, made by a patient, reminds us:
▶️HE is horrible, unpredictable
▶️Preventing HE is hard
▶️Dont be quick 2 label pts as 'noncompliant' - there's more to the story
▶️Our patients are awesome. Hepatology is the best
#lactuloseorcomatose
▶️HE is horrible, unpredictable
▶️Preventing HE is hard
▶️Dont be quick 2 label pts as 'noncompliant' - there's more to the story
▶️Our patients are awesome. Hepatology is the best
#lactuloseorcomatose
2. Think of hepatic encephalopathy as a biomarker.
For what? The answers form a mandatory checklist of sorts
1. Para to r/o SBP. Delay @ your patient's peril. (Fig1)
2. GI Bleeding?
3. UA/Blood Cultures/CXR
3. What's the Cr? Na? K?
review: nature.com/articles/s4139…
#AmJGastro
For what? The answers form a mandatory checklist of sorts
1. Para to r/o SBP. Delay @ your patient's peril. (Fig1)
2. GI Bleeding?
3. UA/Blood Cultures/CXR
3. What's the Cr? Na? K?
review: nature.com/articles/s4139…
#AmJGastro
Introducing the “The Hepatologist’s CBC”
A #cirrhosis #tweetorial all about the platelet
Aims:
- Identify cirrhosis based on blood tests-
- Understand why platelets are low in #cirrhosis
- Describe the plt’s role in the #cirrhotic #coagulopathy
#livertwitter
A #cirrhosis #tweetorial all about the platelet
Aims:
- Identify cirrhosis based on blood tests-
- Understand why platelets are low in #cirrhosis
- Describe the plt’s role in the #cirrhotic #coagulopathy
#livertwitter
The hepatologist's dream:
identify patients with cirrhosis before complications like HCC and variceal bleeding.
Enter the platelet count
Shout out to JAMA's Rational Clin Exam Series & Udell et al's big beautiful systematic review ncbi.nlm.nih.gov/pubmed/22357834
identify patients with cirrhosis before complications like HCC and variceal bleeding.
Enter the platelet count
Shout out to JAMA's Rational Clin Exam Series & Udell et al's big beautiful systematic review ncbi.nlm.nih.gov/pubmed/22357834
Platelets are low in #cirrhosis.
We can use this to our advantage - even sparing biopsies.
Easy to do. E.g. Google: FIB-4
(ref aasldpubs.onlinelibrary.wiley.com/doi/abs/10.100…)
There are many platelet-based scores to help ID cirrhosis.
(review: ncbi.nlm.nih.gov/pubmed/2883446
We can use this to our advantage - even sparing biopsies.
Easy to do. E.g. Google: FIB-4
(ref aasldpubs.onlinelibrary.wiley.com/doi/abs/10.100…)
There are many platelet-based scores to help ID cirrhosis.
(review: ncbi.nlm.nih.gov/pubmed/2883446
What's the deal with Ammonia in hepatic encephalopathy?
A #cirrhosis QI #tweetorial
Aims
Try to answer this question while also showing
1) Ammonia levels dont matter
2) U should not restrict protein in patients with HE
Keywords: "ammonia hypothesis", sarcopenia
A #cirrhosis QI #tweetorial
Aims
Try to answer this question while also showing
1) Ammonia levels dont matter
2) U should not restrict protein in patients with HE
Keywords: "ammonia hypothesis", sarcopenia
First, a poll:
Does Ammonia cause hepatic encephalopathy?
Does Ammonia cause hepatic encephalopathy?
How did NH3 get involved with #HE in the first place?
Step 1: In 1877 Eck develops the first successful vascular anastamosis, a portocaval shunt. ncbi.nlm.nih.gov/pubmed/9186464
Step2: Pavlov improves it
Step3: Dogs get goofy after eating meat:"Meat stupor"
Step4: What's up with meat!?
Step 1: In 1877 Eck develops the first successful vascular anastamosis, a portocaval shunt. ncbi.nlm.nih.gov/pubmed/9186464
Step2: Pavlov improves it
Step3: Dogs get goofy after eating meat:"Meat stupor"
Step4: What's up with meat!?
A celebration of paracentesis: a QI #Tweetorial
For all my twitter friends who care for inpatients with #cirrhosis
Take home messages: paras for all, FFP for none
Keywords: #SBP and the #cirrhotic #coagulopathy
For all my twitter friends who care for inpatients with #cirrhosis
Take home messages: paras for all, FFP for none
Keywords: #SBP and the #cirrhotic #coagulopathy
First - which hospitalized patient needs a diagnostic para?
Patients with ascites and:
Patients with ascites and:
Spontaneous bacterial peritonitis (SBP) is a deadly condition. Appropriate tx can prevent hepatorenal syndrome and death.
How many patients are asymptomatic?
Many.
In this study from Pinzello et al, 1 in 3 patients with SBP were "silent"
aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.10…
How many patients are asymptomatic?
Many.
In this study from Pinzello et al, 1 in 3 patients with SBP were "silent"
aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.10…
