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Doctors, APPs, residents & fellows: Do you know which abdomen CT protocol to choose when ordering? If not, read this quick #tweetorial to ensure that your orders optimize patient care quality, safety & value. @mmahesh1 @RadiologyACR @guptaarjun90 @m_e_nielsen @aapmHQ @ImageWisely 
1/
Quick question to gauge your understanding.
What is abdominal CT with & without IV contrast?
Quick question to gauge your understanding.
What is abdominal CT with & without IV contrast?
2/
Abdomen CT with & without contrast involves a non-contrast scan (no IV, no PO) followed by 1 or more scans after IV contrast infusion. This protocol delivers 2⃣-4⃣x more radiation vs abdomen CT with IV contrast & is more expensive for patients & payers.
jacr.org/article/S1546-…
Abdomen CT with & without contrast involves a non-contrast scan (no IV, no PO) followed by 1 or more scans after IV contrast infusion. This protocol delivers 2⃣-4⃣x more radiation vs abdomen CT with IV contrast & is more expensive for patients & payers.
jacr.org/article/S1546-…
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)
#Tweetorial on #Diagnostics and #Screening interpretation.
An otherwise healthy 40 year old woman comes to you after reading on the internet about a terrible disease that one in a thousand women get, and a highly accurate test that can save her life.
An otherwise healthy 40 year old woman comes to you after reading on the internet about a terrible disease that one in a thousand women get, and a highly accurate test that can save her life.
The test is over 99% accurate in people with the disease. For those without disease, the test is only wrong 5% of the time.
You order this test and it comes back positive. The woman anxiously asks you, do I have the disease? What is the chance this woman has the disease?
You order this test and it comes back positive. The woman anxiously asks you, do I have the disease? What is the chance this woman has the disease?
Assuming they weren't immediately fooled by the "test is only wrong 5 % of the time," most I've asked correctly recognize the stats provided are Sensitivity = 99% and Specificity = 95%, and that the objective is to determine the Positive Predictive Value.
1/Welcome to our first OCT #Tweetorial! We'll cover a few key
concepts and share a step-by-step guide on the basics of image
interpretation 🤓 #imagefirst #OCTimaging
Important Safety Info: abbo.tt/2GyBrZ1
concepts and share a step-by-step guide on the basics of image
interpretation 🤓 #imagefirst #OCTimaging
Important Safety Info: abbo.tt/2GyBrZ1
2/First things first, what is OCT?
OCT stands for optical coherence tomography which is an imaging modality that uses near-infrared light to provide high definition images of the artery.
Important Safety Info: abbo.tt/2GyBrZ1
OCT stands for optical coherence tomography which is an imaging modality that uses near-infrared light to provide high definition images of the artery.
Important Safety Info: abbo.tt/2GyBrZ1
3/What are the basic elements of an OCT image? Here's what you see in a radial cross-sectional view:
Important Safety Info: abbo.tt/2GyBrZ1 #OCTImaging #imagefirst
Important Safety Info: abbo.tt/2GyBrZ1 #OCTImaging #imagefirst
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
#FITSurvivalGuide: CV disease in Pregnancy #CardioObstetrics
#Tweetorial for new #CardiologyFIT by @MonSangh and @JennLewey @Penn
1⃣CV Physiology
2⃣Peripartum CM
3⃣SCAD
4⃣Valve Dz
5⃣Aortopathy
6⃣Arrhythmias
7⃣HTN Disorders of 🤰
8⃣🤰& Future CV Risk
9⃣Drug Safety
#Tweetorial for new #CardiologyFIT by @MonSangh and @JennLewey @Penn
1⃣CV Physiology
2⃣Peripartum CM
3⃣SCAD
4⃣Valve Dz
5⃣Aortopathy
6⃣Arrhythmias
7⃣HTN Disorders of 🤰
8⃣🤰& Future CV Risk
9⃣Drug Safety
1⃣CV Physiology
**Major changes occur to meet metabolic & circulatory needs of 🚼.
🔸Hemodynamic: ⬇️SVR/BP ⬆️HR/CO ⬆️Plasma ↔️Filling pressure
🔸Structural: ⬆️Chamber/LV mass ⬆️Aortic Compliance
🔸Cardiometabolic: ⬆️Insulin resistance ⬆️Lipid/Trig
**Major changes occur to meet metabolic & circulatory needs of 🚼.
🔸Hemodynamic: ⬇️SVR/BP ⬆️HR/CO ⬆️Plasma ↔️Filling pressure
🔸Structural: ⬆️Chamber/LV mass ⬆️Aortic Compliance
🔸Cardiometabolic: ⬆️Insulin resistance ⬆️Lipid/Trig
2⃣Peripartum Cardiomyopathy
🔸Epi: Blacks>>White
🔸Cause: Double-hit hypothesis
🔸Dx: Idiopathic, EF < 45%, ~ 1 m prior or 5 m after delivery
🔸Rx: HF tx; metoprolol/enalapril safe for lactation; ?bromocriptine, ?lactation
🔸LVEF recovery 👍 future risk
🔸Anticoagulation
🔸Epi: Blacks>>White
🔸Cause: Double-hit hypothesis
🔸Dx: Idiopathic, EF < 45%, ~ 1 m prior or 5 m after delivery
🔸Rx: HF tx; metoprolol/enalapril safe for lactation; ?bromocriptine, ?lactation
🔸LVEF recovery 👍 future risk
🔸Anticoagulation
Curious about how #POCUS is taught? This #Tweetorial is for U
#Preview for #ASEchoJC 🔜9/4 8pm EST
Point-of-Care Cardiac Ultrasound POCUS: State-of-the-Art in Medical School Education bit.ly/2wxD4PZ by @amerjohri
#POCUS not 🐇🎩, not short #TTE
#Preview for #ASEchoJC 🔜9/4 8pm EST
Point-of-Care Cardiac Ultrasound POCUS: State-of-the-Art in Medical School Education bit.ly/2wxD4PZ by @amerjohri
#POCUS not 🐇🎩, not short #TTE
2/ Current #goals #Cardiac #POCUS #MedEd
(1) introduce concepts of ultrasound- common imaging views, correlate with anatomy, & physical examination skills
(2) develop scanning techniques➡️ basic competence
(3) recognize & differentiate b/w normal anatomy & basic pathology
(1) introduce concepts of ultrasound- common imaging views, correlate with anatomy, & physical examination skills
(2) develop scanning techniques➡️ basic competence
(3) recognize & differentiate b/w normal anatomy & basic pathology
3/ When Do We Start? Prerequisite knowledge for #POCUS teaching
"priming effect" of preclinical education
Big machine 1st over handheld Martinez et al bit.ly/2wzCcJB @UMMC
Start 1st year @Hoppmann et al bit.ly/2Q4ECsO @UofSCSOM
"priming effect" of preclinical education
Big machine 1st over handheld Martinez et al bit.ly/2wzCcJB @UMMC
Start 1st year @Hoppmann et al bit.ly/2Q4ECsO @UofSCSOM
Now that the #epibookclub is over, my weekends are free for reading #RCTs. So, how about a #tweetorial about #pragmatic trials, causal questions, and #landmark analyses, inspired by the #SCOTHEART trial?
#epimethodsclub #cardiotwitter
#epimethodsclub #cardiotwitter
If we’re going to talk about #pragmatic trials, then we need to start with a definition. The simplest definition I’ve seen is from a trialist I interviewed for my recent @JClinEpi paper (authors.elsevier.com/a/1XS1b3BcJPuv…)
pRCTs “...attempt to address effectiveness in real world settings”
pRCTs “...attempt to address effectiveness in real world settings”
Sure, it’s a bit vague but it’s useful because, like Tolstoy’s unhappy families, #pragmatic trials are all different.
So, what makes me think #SCOTHEART is pragmatic?
My 2¢: lack of blinding, inclusion criteria based on symptoms not diagnoses, & standard care as comparator.
So, what makes me think #SCOTHEART is pragmatic?
My 2¢: lack of blinding, inclusion criteria based on symptoms not diagnoses, & standard care as comparator.
THREAD Friday mini #tweetorial! Despite having a learner w me in #periopmedicine clinic the last two days, I neglected to tweet any #postitpearls (though lots of great learning + pt care!). BUT had 2 back-to-back cases raising questions of weight we place on self-reported pt info
2/ will be intentionally vague to protect PHI without diluting learning value...for all the talk re #EHR clutter, EHRs helping propagate accurate info but also "chart lore" false info, #backtobedside, #patientsbeforepaperwork...when can you "take a pt's word for it" in preop?
3/ pt A-early 50s, elective ortho surgery (though pain affecting QOL & activity levels), VERY vague "MI" and "CAD" history in chart from decade ago, no immediately available records, some risk factors for premature CAD (tobacco) but no interval events...
1/
As #ESCCongress nears, I thought I would do a #tweetorial on amyloidosis. Exciting times for the field and new data/treatments expected next week.
#FITSurvivalGuide #CardioTwitter @tony_breu @rodney_falk @marthagrogan1 @amyloidosisfdn @AmyloidosisSupp @Amyloidosis_ARC
As #ESCCongress nears, I thought I would do a #tweetorial on amyloidosis. Exciting times for the field and new data/treatments expected next week.
#FITSurvivalGuide #CardioTwitter @tony_breu @rodney_falk @marthagrogan1 @amyloidosisfdn @AmyloidosisSupp @Amyloidosis_ARC
2/
What is amyloidosis?
A protein misfolding disorder in which one of thirty-five distinct proteins pathologically misfolds and aggregates extracellularly as insoluble amyloid fibrils, ultimately leading to organ dysfunction.
What is amyloidosis?
A protein misfolding disorder in which one of thirty-five distinct proteins pathologically misfolds and aggregates extracellularly as insoluble amyloid fibrils, ultimately leading to organ dysfunction.
3/
You can see that other diseases like Alzheimer’s involve amyloid deposition. We will focus on two types of amyloidosis that affect the heart and nervous system: immunoglobulin light chain (AL) and transthyretin (ATTR) amyloidosis.
You can see that other diseases like Alzheimer’s involve amyloid deposition. We will focus on two types of amyloidosis that affect the heart and nervous system: immunoglobulin light chain (AL) and transthyretin (ATTR) amyloidosis.
Last night I posted this lovely gross picture; I’m now adding a couple of histologic images. Kudos to @kriyer68 and @DrAldehyde for being the first to submit the correct answer- this is indeed a synovial sarcoma! Not a bad time for a #Tweetorial #BSTPath
Synovial sarcoma is actually uncommon in joint cavities & does not recapitulate synovium in any way. Its rare amongst soft tissue sarcomas, representing only 5-10% of the cases. The disease is most prevalent in teenagers & young adults; 50% of cases are seen in pediatric patients
These most commonly present as pain in the affected site with an associated mass. In many cases the duration of symptoms is 2-5 years. They are seen most commonly in the extremities and are often associated with tendons. #BSTPath
Why is your pt's ALT (or AST) >1000?
A #livertwitter #tweetorial
Take-homes:
1. Top 3 causes of acute liver injury
2. I always say it's ischemic hepatitis; 50% of the time, I'm right every time
Brought to u by:
@tonybreu et al. What causes severe ALI?
cghjournal.org/article/S1542-…
A #livertwitter #tweetorial
Take-homes:
1. Top 3 causes of acute liver injury
2. I always say it's ischemic hepatitis; 50% of the time, I'm right every time
Brought to u by:
@tonybreu et al. What causes severe ALI?
cghjournal.org/article/S1542-…
The liver is awesome.
Yet its vocabulary is ... limited.
We can all tell when it is upset - high ALT, AST.
But that could mean anything!
So what's your specific patient's specific reason for high ALT?
Yet its vocabulary is ... limited.
We can all tell when it is upset - high ALT, AST.
But that could mean anything!
So what's your specific patient's specific reason for high ALT?
First - a poll:
What's the most common cause of severe acute liver injury
(ALT or AST > 10xULN)?
What's the most common cause of severe acute liver injury
(ALT or AST > 10xULN)?
1/
Are you new to Twitter? Are you a pathology resident or a pathologist? Are you wondering what to tweet about or where to start? This brief tutorial is for you. Pathology on Twitter is awesome 👍🏾❤️✅
#Tweetorial = Tutorial of tweets
#pathtweetorial = Pathology version
Are you new to Twitter? Are you a pathology resident or a pathologist? Are you wondering what to tweet about or where to start? This brief tutorial is for you. Pathology on Twitter is awesome 👍🏾❤️✅
#Tweetorial = Tutorial of tweets
#pathtweetorial = Pathology version
2/
First step, check out this awesome guide to social media for newcomers. SUPER useful.
pathinfo.wikia.com/wiki/Social_Me…
It had great tips, like this one: ALWAYS include a picture of yourself on your profile. He’s right: please do it NOW! It’s essential. Just use a selfie 😊
First step, check out this awesome guide to social media for newcomers. SUPER useful.
pathinfo.wikia.com/wiki/Social_Me…
It had great tips, like this one: ALWAYS include a picture of yourself on your profile. He’s right: please do it NOW! It’s essential. Just use a selfie 😊
3/
Follow a few pathologists. Use this handy guide created by @RoseannIWu to begin with, and then just follow people whose tweets you like. Following is a friendly gesture on Twitter, and conveys that you are interested that person’s tweets.
Follow a few pathologists. Use this handy guide created by @RoseannIWu to begin with, and then just follow people whose tweets you like. Following is a friendly gesture on Twitter, and conveys that you are interested that person’s tweets.
1/n #Tweetorial: As an Assistant PD for @OHSUIMRes focused on scholarship, #medtwitter, & #hcsm (health care social media), I’m often guide residents and colleagues on how to best use Twitter for academics, networking, learning, etc...
2/n recently, while welcoming newbies (esp students) and “onboarding” them to #medtwitter & #hcsm, I was asked to put together advice for IM applicants on how to best use social media during application/interview season. I think this advice is applicable beyond IM, too.
3/n First, tell me about yourself:
1/11
A #tweetorial on Syncope #FITsurvivalguide
Definition:
Sudden transient loss of consciousness with associated loss of postural tone, spontaneous recovery without neurologic deficits
The key is in the H&P
A good H&P can provide a dx in up to 50% of cases.
A #tweetorial on Syncope #FITsurvivalguide
Definition:
Sudden transient loss of consciousness with associated loss of postural tone, spontaneous recovery without neurologic deficits
The key is in the H&P
A good H&P can provide a dx in up to 50% of cases.
2
Goals.
1. Determine specific cause; this will direct therapy, prevent recurrences, ⬇️ expensive evaluations, and improve outcome.
2. Determine presence of cardiac syncope which portends ⬆️ mortality and sudden death.
3. Identify those who will benefit Inpt 🆚 outpt eval
Goals.
1. Determine specific cause; this will direct therapy, prevent recurrences, ⬇️ expensive evaluations, and improve outcome.
2. Determine presence of cardiac syncope which portends ⬆️ mortality and sudden death.
3. Identify those who will benefit Inpt 🆚 outpt eval
3/11
History
- Most important >> circumstance of syncope (ie. Prodrome), associated with particular activity? Exertion? change in position?
- Assess for sx of vasovagal syncope (most common cause)
- Duration of event
- Residual symptoms
History
- Most important >> circumstance of syncope (ie. Prodrome), associated with particular activity? Exertion? change in position?
- Assess for sx of vasovagal syncope (most common cause)
- Duration of event
- Residual symptoms
1/ Thread: This morning I gave Dept of Medicine #GrandRounds @OHSUSOM @OHSUNews. In #medtwitter’s spirit of sharing & learning, here is my first #Tweetorial summarizing highlights & crediting #hcsm’s incredible contributors & source material
2/ 4 months ago EBM & cardiology expert Dr. Milton Packer published a blog post detailing how he found Twitter uninformative and emotion/opinion driven
Is this the reality of #medtwitter??
medpagetoday.com/blogs/revoluti…
Is this the reality of #medtwitter??
medpagetoday.com/blogs/revoluti…
A #tweetorial on Perioperative risk assessment for Non-cardiac surgeries for #FITsurvivalguide
⚠️NOT "clearance"!
Purpose of consult
-Evaluate pt`s medical status
-Risk assessment
-Management recs
-Treat modifiable risk factors
-"Team" approach for shared decision making
⚠️NOT "clearance"!
Purpose of consult
-Evaluate pt`s medical status
-Risk assessment
-Management recs
-Treat modifiable risk factors
-"Team" approach for shared decision making
2/ Triggers for perioperative myocardial injury
-Inflammatory state
-Hypercoagulable state
-Stress state
-Hypoxic state
All predispose to ischemia and coronary thrombosis.
-Inflammatory state
-Hypercoagulable state
-Stress state
-Hypoxic state
All predispose to ischemia and coronary thrombosis.
3/ Think about- 🤔
-Should pt have surgery? Emergent or not?
-Type of surgery and type of anesthesia?
-Functional status of the pt?
-Relevant medical hx and any ongoing cardiac sx?
-Review the meds.
-Prior cardiac w/u.
Focus on good history and PE, can save a lot of tests & 💸
-Should pt have surgery? Emergent or not?
-Type of surgery and type of anesthesia?
-Functional status of the pt?
-Relevant medical hx and any ongoing cardiac sx?
-Review the meds.
-Prior cardiac w/u.
Focus on good history and PE, can save a lot of tests & 💸
#FITSurvivalGuide: #HeartFailure management — a #tweetorial for #ACCFIT
1️⃣ Non-pharmacologic
2️⃣ Acute HF
3️⃣ Staging
4️⃣ HFrEF
5️⃣ HFpEF
6️⃣ Devices
7️⃣ Advanced Tx
8️⃣ Misc
Resources: @HFSA @ishlt @AHAScience @JACCJournals @HRSonline
1️⃣ Non-pharmacologic
2️⃣ Acute HF
3️⃣ Staging
4️⃣ HFrEF
5️⃣ HFpEF
6️⃣ Devices
7️⃣ Advanced Tx
8️⃣ Misc
Resources: @HFSA @ishlt @AHAScience @JACCJournals @HRSonline
1️⃣ Non-pharmacological therapies for HF:
➖Cardiac rehabilitation can improve functional capacity, exercise duration & mortality
➖Diet: Low Na (2-3 g/day) diet to reduce congestive symptoms
➖Biomarkers have an important role in diagnosis and prognosis of patients with HF
➖Cardiac rehabilitation can improve functional capacity, exercise duration & mortality
➖Diet: Low Na (2-3 g/day) diet to reduce congestive symptoms
➖Biomarkers have an important role in diagnosis and prognosis of patients with HF
2️⃣ Acute Heart Failure Treatment agenda:
➖ Stabilize condition based on hemodynamics profile
➖ Establish dx, etiology and precipitating factor
➖ Initiate therapy for symptom relief
➖ Preload/afterload reduction
➖ Inhibition of neurohormonal activation for long term mgmt
➖ Stabilize condition based on hemodynamics profile
➖ Establish dx, etiology and precipitating factor
➖ Initiate therapy for symptom relief
➖ Preload/afterload reduction
➖ Inhibition of neurohormonal activation for long term mgmt
#FITSurvivalGuide #tweetorial Diagnosis of Heart failure: HF is a complex clinical syndrome related to structural or functional impairment of ventricular filling or contraction. HF can be classified into HFrEF and HFpEF based on assessment of LVEF.
Typical HF symptoms are dyspnea, fatigue, edema, orthopnea, PND. NYHA system used to indicate symptom severity. Essential to inquire about onset, duration & progression of symptoms, risk factors for HF (MI, HTN, DM), FH of HF, drug or alcohol abuse, radiation/chemotherapy.
HF is a largely clinical diagnosis. Physical exam must include careful assessment of vital signs, signs of volume overload (JVD, edema, S3, rales on lung exam) and assessment of perfusion (cyanosis, cool extremities).
#FITSurvivalGuide #ACCFIT
Topic - Ventricular Tachycardia!
Agenda:
1- Approach to evaluating #VT
2- Management of #VT
3- Practice Cases
Please share your thoughts & input to this #tweetorial!
@ACCCardioEd @ACCinTouch #FOAMed @MichiganACC
Topic - Ventricular Tachycardia!
Agenda:
1- Approach to evaluating #VT
2- Management of #VT
3- Practice Cases
Please share your thoughts & input to this #tweetorial!
@ACCCardioEd @ACCinTouch #FOAMed @MichiganACC
#FITSurvivalGuide #ACCFIT
1/10 – Ventricular Tachycardia
Simplified approach to evaluate tachycardia:
Rule #1 – If HD unstable ➡️ shock!
If HD stable, sit down & think.
Step # 1 - QRS: wide or narrow?
Step # 2 - Rhythm: regular or irregular?
This will narrow DDx!
1/10 – Ventricular Tachycardia
Simplified approach to evaluate tachycardia:
Rule #1 – If HD unstable ➡️ shock!
If HD stable, sit down & think.
Step # 1 - QRS: wide or narrow?
Step # 2 - Rhythm: regular or irregular?
This will narrow DDx!
#FITSurvivalGuide #ACCFIT
2/10 - Wide complex tachycardia
Always consider clinical Scenario!
Look for history of MI and cardiomyopathy ➡️ strongly favor #VT!
* If structural heart disease is present, you will be correct 9/10 times with diagnosis of VT!
2/10 - Wide complex tachycardia
Always consider clinical Scenario!
Look for history of MI and cardiomyopathy ➡️ strongly favor #VT!
* If structural heart disease is present, you will be correct 9/10 times with diagnosis of VT!
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
#FITSurvivalGuide: The Forgotten Valve-#TricuspidRegurgitation (#TR) #tweetorial for the new #ACCFIT!
1⃣ Anatomy
2⃣ Etiologies
3⃣ Classification
4⃣ Diagnosis
5⃣ Treatment
Resources: @ASE360 @JACCJournals @CircAHA @ACCCardioEd @UMNews @Medtronic
1/10
cc: @dr_chirumamilla
1⃣ Anatomy
2⃣ Etiologies
3⃣ Classification
4⃣ Diagnosis
5⃣ Treatment
Resources: @ASE360 @JACCJournals @CircAHA @ACCCardioEd @UMNews @Medtronic
1/10
cc: @dr_chirumamilla
[2/10] Impt to understand #TricuspidValve 1⃣ Anatomy
3 leaflets ⬇️ + fibrous annulus + 2 papillary 💪🏽 + chordae tendinae + RA/RV ❤️
⬛️ Anterior 🍃 (largest)
◾️Posterior
▪️Septal (smallest)
(note: throughout #tweetorial, see image descriptions for more content)
3 leaflets ⬇️ + fibrous annulus + 2 papillary 💪🏽 + chordae tendinae + RA/RV ❤️
⬛️ Anterior 🍃 (largest)
◾️Posterior
▪️Septal (smallest)
(note: throughout #tweetorial, see image descriptions for more content)
[3/10] 2⃣ Etiologies = Structural (1º) vs. Functional (FTR)
Keep chart ⬇️ DDx in mind when reading #EchoFirst
~80% of significant TR = FTR/2º to TA dilatation + leaflet tethering ⬅️ RV remodeling ⬅️ volume and/or pressure overload
Structural (1º) cause = less common
Keep chart ⬇️ DDx in mind when reading #EchoFirst
~80% of significant TR = FTR/2º to TA dilatation + leaflet tethering ⬅️ RV remodeling ⬅️ volume and/or pressure overload
Structural (1º) cause = less common
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!?
1/10 What is chest pain? #FITSurvivalGuide #Tweetorial
- "Pain anywhere in the chest" 🤦♀️
- Many things cause chest pain
- ❤️ vs ❌❤️
- ❤️ - ischemic vs non ischemic
- Life threatening vs not
- "Pain anywhere in the chest" 🤦♀️
- Many things cause chest pain
- ❤️ vs ❌❤️
- ❤️ - ischemic vs non ischemic
- Life threatening vs not
2/10 - Common causes of chest pain (by system) #FITSurvivalGuide
- Cardiac
- Pulmonary
- GI
- MSK
- Infectious
- Psych
- Skin/ soft tissue
- Cardiac
- Pulmonary
- GI
- MSK
- Infectious
- Psych
- Skin/ soft tissue
3/10 Chest pain- The History! #FITSurvivalGuide
- Going back to medical school 👩⚕️👨⚕️🥼😷
- The key to figuring out what type of chest pain the patient has!
- Quality, location, radiation, duration, associated symptoms, relieving factors!
- Going back to medical school 👩⚕️👨⚕️🥼😷
- The key to figuring out what type of chest pain the patient has!
- Quality, location, radiation, duration, associated symptoms, relieving factors!
