Discover and read the best of Twitter Threads about #GITwitter

Most recents (24)

⭐️New-pub alert!!
@APASLnews guidelines on management of #ascites in liver disease.
Salient features covered which are different from other guidelines👇🏻
✅Diagnostic approach to mixed ascites
✅Role of low-dose albumin (1/n)… Image
✅Recommendations on use of ACE inhibitors/ARBs
✅Diagnostic approach to management of pleural effusion
✅Recommend ICA definition for defining renal dysfunction in refractory ascites
✅Start with low-dose diuretics and gradually increase dose to increase tolerability (2/n)
⭐️Diagnostic algorithm for workup of new onset #ascites 👇🏻

✅SAAG - diagnosis of portal hypertension
✅High SAAG, high protein ascites - use BNP, 2D echo, SPA doppler and thyroid profile
✅Low SAAG, high protein ascites - use ascitic fluid ADA, amylase and TG (3/n) Image
Read 10 tweets
1/ Collated thread for new GI fellows

⭐️GI Fellow Resources ⭐️

▪️Board study
▪️Social media

📲 (hyperlinked 📄)

#GITwitter Image
2/ Advice for First Year Fellows

▪️Build management algorithms
▪️Read on 🔦, 🔬, 🩻
▪️Use 📚 study resources
▪️Register for ASGE first yr course
▪️Review basic anatomy
▪️Invest in GI endoscopy atlas
▪️Develop system of 🔬 tracking
▪️Mentor & network

🔗… Image
3/ Survive consult blocks!

▪️Have a system!
▪️Checklist for each 🆕 consult
▪️Talk to the consulting team
▪️Be brief
▪️Give specific recs
▪️Provide contingency plans

Art of Being a Consultant
🔗… @JAMA_current

See @Dr_Oubre for more documentation tips! ImageImage
Read 10 tweets
💊Drug Induced pancreatitis (DIP) by @AshkarMotaz from @WUGastro soon returning as @MayoClinicGIHep staff #IMPACT #gitwitter

🥇See tweet 5 for the current classification dx!

📚Hx of DIP: Understanding of DIP has evolved since it was first described in 1950s-60s on case reports ImageImage
🥇First drug-induced acute pancreatitis (AP) classification came out in '96

Subclassified as - definitive, probable, and possible DIP

Limitations of '96 classification:

2⃣DIP NOT different from AP 2/2 other causes
4⃣Drug re-challenge often not possible Image
🌟DIP classification was updated again in 2006 based on evidence & pattern of clinical presentation.

New challenges‼️

1⃣Inadequate dx criteria for AP
2⃣? ruling our common causes of AP
3⃣Lack of rechallenge
4⃣Idiopathic, microlithiasis, genetic causes intersecting with DIP dx
Read 5 tweets
🔮Pancreatic cysts: What's in the Juice by #YanBi from #MayoFL #IMPACT #gitwitter

🎯Pancreatic Cysts Incidence 📈with ↑imaging

🌟90% of P-Cysts are IPMNs (Intraductal Papillary Mucinous Neoplasms)
-70% IPMNs are BD-IPMN (branch duct)
-30% IPMNs are MD-IPMN (main duct) ImageImage
🔮Benign cysts (observation/drainage/sx)
- Pseudocyst
- Serous cystadenoma

⁉️Pre-malignant (observation/sx)
- MCN (mucinous cystic neoplams)

🦀Malignant (sx)
- Cystic neuroendocrine tumor (CNET)
- Solid pseudopapillary neoplasm (SPN)
- Cystic degeneration of PDAC
🎯Cyst fluid CEA >192 distinguishes between mucinous vs. non-mucinous BUT not malignant vs. non-malignant ($$$)

🌟Cyst fluid glucose <50 costs significantly ↓ & does the same as CEA

🎖️CEA and glucose can be combined for even higher sensitivity and specificity
Read 8 tweets
🌟Pancreatic cancer (PC) Screening by @MajumderShounak #IMPACT #gitwitter

Why care about screening for PC?
10th leading cancer 🦀diagnosis in 🇺🇸 but 3rd leading cancer☠️with 5-year survival is only 11%

🎯Current recommendations suggest against PC screening unless "high-risk" ImageImage
Define "High-risk individual" (HRI)?
2⃣Fam hx of PC (dx age, relationship)
3⃣Germline mutations

‼️Familial PC = ≥2 first-degree relatives (FDR)
☠️If 2 FDR 6x risk
☠️If 3 FDR 32x risk

🦀Genetic mutations assoc with PC (5.5% cases) - CDKN2A, TP53, MLH1, BRCA2, ATM,
🔍Begin screening age 50 or 10 years younger than the earliest relative affected by PC

Peutz-Jeghers Syndrome (STK11/LKB1)—Age 35
Hereditary Pancreatitis (PRSS1)—Age 40
Familial atypical multiple mole melanoma syndrome (CDKN2A)—Age 40
Read 7 tweets
1/📣#GITwitter last but not least
#ShortBowelSyndrome #MNIBDTweetorial🧵w @valcohranmd @DCharabaty

🤝Role of MDT 4 strongest 💪team
🏥Intestinal rehab. program breakdown

🏆#CME ℹ️
Support by an edu grant from @TakedaPharma

📌Where r u in your career?
2/#MondayNightIBD #ShortBowelSyndrome #MedTwitter #GITwitter #MedPeds #BonumCE

🟠Earn #CME 🏆on Twitter!
🟠Full CME ℹ️ 🔗

📸 Faculty disclosures & important CME info 👇 Image
#IBDPoll 1️⃣

➡️50-yo pt w 1y hx of SBS after multiple short bowel resections for stricturing Crohn’s
Labs show dehydration & nutrient deficiencies
U discuss initiating #ParenteralNutrition

➡️You focus on educating pt on which of the possible complications...
Read 21 tweets
MEGA 🧵‼️

#Ramadan and #IBD: Should folks with IBD fast?

This one is a 5-part tweetorial because it deserves due diligence

A data desert 🌵 so I’ll do my best & apologies in advance for what I forget or omit

Let’s dive in! @southasianIBD @ibdtweets @ibddoctor

One way to try and understand the relationship between Ramadan fasting & IBD is by subgroups:

1️⃣ patients with IBD in remission
2️⃣ hospitalized with active disease
3️⃣ undifferentiated IBD patients
4️⃣ animal models of fasting & IBD
5️⃣ extrapolations from rheumatology



Available data from 🇮🇷 suggests

this group is NOT at risk of ⬆️ symptom burden while fasting ‼️🤷🏽

Read 23 tweets
[World #IBSAwarenessMonth] Dear #HCPs👩‍⚕️ & #Microbiota community👨‍🔬, April is dedicated to raising awareness about #IrritableBowelSyndrome

During the month, @Microbiota_Inst will provide you with content about #IBS, a common & complex #disease

#GutHealth #LetsTalkIBS #thread👇 Image
[World #IBSAwarenessMonth]

🔎 You will:
👉better understand the🔗between #IBS & #microbiota
👉discover potential ways to manage the #disease
👉learn to make a #diagnosis with our #CME courses, #videos & a professionally designed #tool
👉improve communication with your #patients
[World #IBSAwarenessMonth]

1️⃣ In this sequence, learn more about the link between #microbiota and #IrritableBowelSyndrome.

#IBS #MedTwitter #GITwitter #GutHealth #LetsTalkIBS #DGBI #FGID #GIfellows #TakeIBSSeriously

Take a look! 👇 Image
Read 17 tweets
☪️ #4 and #5!
One of my personal favorite intersections: #Ramadan and #NAFLD

Things that are established: Ramadan fasting does not make fatty liver disease worse

But does it make it better?
The empiric answer would be YES, but how? let’s dive into the nuance
Observational data suggest that in patients with #fattyliverdisease, Ramadan tends to ⬇️ LFTs and ⬆️glycemic function

Retrospective data seems to agree with this:

These changes involve ⬇️ in A1c, BMI, and FIB4 scores❗️

So the available data (though limited) establishes that Ramadan fasting seems to improve LFTs and leads to valuable reductions in disease-related indices like fibrosis scores

The more interesting question though, is


Read 9 tweets
80 yo M. Known cardiovascular disease and anemia. Acute abdominal pain and vomit.

Diagnosis? Only ONE answer is correct 😉

#radres #futureradres #FOAMrad #FOAMed #GITwitter #Endoscopy #GIpath

1. Ischemic colitis
2. IBD
3. Tumor
4. None of the above
Correct answer: None of the above. Why?

This is a case of ischemic colitis AND colon cancer⬇️

Were you able to pick up both? Can you see the difference?
Learning points
🌟Satisfaction of search bias (CAREFUL!)

🌟There is a known ASSOCIATION between is ischemic colitis and tumor. Different patterns can be seen.

Old but useful paper to check out if you would like to learn more 🤓
Read 3 tweets
Do you have an undiagnosed patient despite exome sequencing? 🤔

It could be a repeat expansion disorder.

Here are 5 scenarios that should make you think of a repeat expansion disorder in adults. 🧵

#GeneChat #MedTwitter
A 21 y man with slurred speech who is experiencing difficulty with coordination and balance over the last several years. He fatigues easily.

Diagnosis: Friedreich's ataxia
Genetics: GAA repeat expansion in the 1st intron of FXN
Inheritance: Autosomal recessive

A 25 y woman with hot flashes and irregular menses over the last several months (early menopause).

Diagnosis: Fragile X-associated primary ovarian insufficiency (FXPOI)
Genetics: CGG repeat expansion in the 5' UTR of FMR1
Inheritance: X-linked

Read 7 tweets

📢The recent ACG Guidelines on biliary strictures

👉Focus on DRAINAGE principles

🔥A Tweetorial #GITwitter @AmJGastro
Goals of drainage

▶️to alleviate symptoms (when present),

▶️to reduce serum bilirubin for chemotherapy can be safely administered (typically 2.5–3.5 mg/dL) and

▶️to optimize surgical outcome
Extrahepatic stricture due to a benign condition,

👉fcSEMS over multiple plastic stents(MPS)

▶️12 months MPS or
▶️6 months fcSEMS,
🔥some evidence suggests 12 months of fcSEMS therapy is advantageous (exchange at 6 months).
Read 16 tweets
A 44-YO♂️, stayed in a rural cottage of France 2 weeks previously: cramping upper abdominal pain with watery diarrhea.
He had passed what he thought were worms in his feces
#GITwitter #IDtwitter #microbiology “Worm” specimen brought to clinic by patient (petri dish
The specimens: identified as the larvae of the drone fly, Eristalis tenax
These larvae are 2.5–3 cm in length; the posterior tube gives them the name of “rat-tailed maggots”

#parasites #GIPath #Doctor “Worm” specimen brought to clinic by patient (petri dish
Myiasis caused by E. tenax:
✔️rare but have been
✔️reported from various countries including Europe
✔️most often intestinal myiasis, but cases of infestation of the nasal cavity, urinary tract, and vagina have been described.

#Doctor #MedStudentTwitter
Read 6 tweets
A 57-YO Mexican♀️, works on a farm has several pets, including dogs, at home: epigastric fullness, and a 15-pound weight loss.

CT: complex cystic left liver mass.
#gastroenterology #radiology #medicine
Resection: Cyst wall (red➡️), daughter cysts (*) normal liver tissue (yellow⬅️)
🔬acellular laminated wall (*), inner germinal layer (black⬅️), & protoscoleces surrounded by a broad capsule (green⬅️). Refractile hooklets (blue⬅️) & calcareous bodies (red⬅️)
#GIPath #IDtwitter

The patient underwent total excision of the cyst followed by albendazole therapy for 4 weeks.

#microbiology #GITwitter #MedStudentTwitter
Read 5 tweets
🔥Crohn’s Perianal Fistula - #MondayNightIBD w all🌟faculty 🔥 CME 👉 🔸Supported by an edu grant from @TakedaPharma 🔸…
2/#MondayNightIBD #Crohns #PerianalFistula #MedTwitter #GITwitter

✅Answer #IBDPolls👇
🗓 Mark your calendar - Live Q&A @ 8p ET/5p PT
📲Tweet your❓to be addressed Monday!

📸 Faculty disclosures & important CME info👇 Image
Read 11 tweets
A 29-YO♂️, 6 months before, HIV + & non–drug-resistant pulmonary tuberculosis, antiretroviral & 4-drug antituberculous therapy initiated but soon reduced to rifampin & isoniazid only: abdominal pain on the L side
CT: ?

DOI: 10.1056/NEJMicm2206174
#radiologist #GITwitter
CT: an enlarged spleen with numerous hypodense lesions (A).
CD4 cell count: 119/mm3
VIH viral load: 1778 copies/mm3

A splenectomy was performed to evaluate for cancer:
numerous necrotic nodules with purulent discharge (B).

#microbiology #gastroenterology #IDtwitter
🔬granulomatous inflammation with caseous necrosis (C) and acid-fast bacilli (D, arrowheads).
A tissue🧫: ➖

PCR: ➕for Mycobacterium tuberculosis


#bacteriology #MedTwitter #GIPath
Read 5 tweets
Been a while since I’ve done one of these.

A recent personal health related saga motivated me to put this one together. 👇

A 🧵

First off, I am now fully recovered.

Thankful to the fantastic clinical teams @WRBethesda for the excellent and timely care provided. 🙏

3 months ago, I began having post-prandial epigastric abdominal pain lasting 30-90 mins would resolve spontaneously…until one night, it just didn’t.

Pain 10/10. Could not sit still, constant with intermittently colicky. Went to the nearest ED.

Read 18 tweets
Join⚕️@DCharabaty @AmyLightnerMD #DrMarlaDubinsky+ Brandon Pomish 4 #Crohns #PerianalFistula

🗓️#CPF #MNIBDWebinar Sat 2/11
🎯MultiD Mgmt
🎯Stem Cell Therapy

🔸Supported by an edu grant @TakedaPharma ImageImage
2/#PreConvo #IBDPoll 1️⃣
#MNIBDWebinar #Crohns #PerianalFistula #CPF


🟢The addition of which of the following to an anti-TNF agent is associated with a higher rate of #Crohns #PerianalFistula CPF healing vs the anti-TNF agent alone?
Read 7 tweets
📣#GITwitter #PedsGI

⚕️Join experts @valcohranmd @Subramanian1MD ⚕️& @DCharabaty addressing the long & the short of:

🎯Optimizing care of #ShortBowelSyndrome

🏆🆓 #CME 🔗
Supported by an edu grant @TakedaPharma
2/#MondayNightIBD #GITwitter #PedsGI #MedEd #MedTwitter #MNIBDWebinar #BonumCE

Earn 🆓 #CME 🎫
ℹ️ 🔗

📸 Faculty disclosures & important CME info 👇 Image
3/#MondayNightIBD #GITwitter #PedsGI #MedEd #MedTwitter #MNIBDWebinar #BonumCE

🟠Full CME ℹ️ 🔗
🟠Make sure you answer the pre-polls! 👉

🔴 Where are you in your career?
Read 12 tweets
👋#PedsGI #GITwitter
🗓️Feb 6-Join @Subramanian1MD @valcohranmd @DCharabaty

⬆️⬇️ Safety & efficacy of med tx
🔑4 your practice

Support by an edu grant from @TakedaPharma

🗳️#PreConvo #IBDPolls👇
🟢Where are u in ur career?
#PreConvo #IBDPoll 1️⃣


🟢The GLP-2 analog teduglutide was shown in clinical studies to be associated w/ which of the following outcomes?
#PreConvo #IBDPoll 2️⃣


🟢Young adult pt w/ SBS is experiencing significant diarrhea (≥20 BM/day) despite tx w 8 mg/day loperamide.

Appropriate mgmt includes _____
Read 5 tweets
Live Q&A: Best of UEG Week 2022…
#GITwitter #MondayNightIBD
⭐️⭐️⭐️NOW - Best of #IBD @ #UEGWeek Q&A w all-star faculty ⭐️⭐️⭐️
In collab w @my_ueg
TWEET your❓❓❓below ⬇️
Supported by edu grants from @abbvie & BMS⭐️⭐️⭐️

Join now w/ @CharlieMuz @DCharabaty @Iris_Dotan @MRegueiroMD

📲Tweet your❓below Image
3/#MondayNightIBD #UEGWeek

📍Where are you in your career?
Read 8 tweets
@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma 2/ #MondayNightIBD #ShortBowelSyndrome #MedTwitter #GITwitter #MedPeds @BonumCe

🟠Earn #CME 🏆on Twitter!
🟠Full CME ℹ️ 🔗

📸 Faculty disclosures & important CME info 👇 Image
@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma 3/#MondayNightIBD

💊💉Meds = important 🛠 in mgmt of #ShortBowelSyndrome

💎Antimotility & antisecretory agents frequently used to control stool loss
💎Incl loperamide, diphenoxylate w atropine, codeine, & tincture of opium
💎Most effective ~30 min B4 meals & @ bedtime 🛏
@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma 4/Growth factors also available for #ShortBowelSyndrome
🚦Somatropin (rhGH) approved in SBS
🛑Use largely discontinued due to unacceptable toxicity & modest long-term efficacy

Read 23 tweets
🔥 Emoroid Digest 🔥

Happy New Year! Starting off the new year with Dr. Vachaparambil's @CicilyVachaMD summary of the @AmerGastroAssn guidelines on systemic therapy for HCC!

#EmoroidDigest #GITwitter #MedTwitter ImageImage
💊 systemic tx in🧑‍🤝‍🧑with preserved liver function
📈 AFP impacts 💊 choice
🤮 side effects & tx response guide 💊

Dr. Grace Su, Dr. Osama Altayar, Dr. Robert O’Shea, @Jarshah4, Dr. Bassam Estfan, Dr. Candice Wenzell, @sultanshaz, Dr. Yngve Falck-Ytter
Read 4 tweets

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