Discover and read the best of Twitter Threads about #LiverTwitter
Most recents (24)
Hepatocellular Carcinoma (HCC): a 🧵
Inspired by the recently developed @AASLDtweets guidance, available in preprint format (most images take from preprint)
🔗DOI.org/10.1097/HEP.00…
Inspired by the recently developed @AASLDtweets guidance, available in preprint format (most images take from preprint)
🔗DOI.org/10.1097/HEP.00…
Screen in high risk patients (see picture) q6 mo using:
✅ RUQ U/S
✅ AFP
⚠️ AASLD does NOT recommend routine use of CT/MRI for screening
Stop screening if:
🛑 CPT C cirrhosis not eligible for transplant
🛑 Life limiting comorbidities
✅ RUQ U/S
✅ AFP
⚠️ AASLD does NOT recommend routine use of CT/MRI for screening
Stop screening if:
🛑 CPT C cirrhosis not eligible for transplant
🛑 Life limiting comorbidities
HCC screening in HCV s/p SVR:
🛑AASLD does not recommend screening for stage 3 fibrosis
👍 Screen patients with cirrhosis
@gnioannou, et al., showed continued HCC risk in:
🔹 Cirrhotics
🔹 If FIB-4 >3.25 at the time of SVR, with or without cirrhosis
🔗doi.org/10.1053/j.gast…
🛑AASLD does not recommend screening for stage 3 fibrosis
👍 Screen patients with cirrhosis
@gnioannou, et al., showed continued HCC risk in:
🔹 Cirrhotics
🔹 If FIB-4 >3.25 at the time of SVR, with or without cirrhosis
🔗doi.org/10.1053/j.gast…
WHAT is the deal with Milk Thistle?
WHY is it used to treat liver disease?
HOW does it work?
DOES it work?
ARE you ready for a #tweetorial?
🧵
#medtwitter #livertwitter
WHY is it used to treat liver disease?
HOW does it work?
DOES it work?
ARE you ready for a #tweetorial?
🧵
#medtwitter #livertwitter
Milk Thistle, a history:
1⃣Use to treat snake bites (Dioscorides)
2⃣To carry off bile (Pliny the Elder)
3⃣Great for liver disease (1500's: Otto Brunfels)
4⃣In 19th Century 🇺🇸, the 'Eclectics' popularized herbology, especially milk thistle, for the liver
1⃣Use to treat snake bites (Dioscorides)
2⃣To carry off bile (Pliny the Elder)
3⃣Great for liver disease (1500's: Otto Brunfels)
4⃣In 19th Century 🇺🇸, the 'Eclectics' popularized herbology, especially milk thistle, for the liver
Fast forward to today:
1⃣Herbal supplements are a multibillion dollarindustry
2⃣A quarter of the population takes an herbal supplement
3⃣~5% of the US population is using Milk Thistle, including 12% of people with liver disease
What do they get out of it?
1⃣Herbal supplements are a multibillion dollarindustry
2⃣A quarter of the population takes an herbal supplement
3⃣~5% of the US population is using Milk Thistle, including 12% of people with liver disease
What do they get out of it?
An older man comes to the ED with abrupt onset nausea, & diarrhea
He is joined by her daughter whom he is visiting from abroad
Testing is below
The diagnosis is unclear
Until his daughter got just as sick too
🧵
#livertwitter #liverstory #MedTwitter
He is joined by her daughter whom he is visiting from abroad
Testing is below
The diagnosis is unclear
Until his daughter got just as sick too
🧵
#livertwitter #liverstory #MedTwitter
ALT >1000 has a narrow differential diagnosis
There's lots of tests you can order.
But most diagnoses are made in the H+P
Like this one
In fact, in this case, my attending said the diagnosis was obvious from the beginning
Just not to me
There's lots of tests you can order.
But most diagnoses are made in the H+P
Like this one
In fact, in this case, my attending said the diagnosis was obvious from the beginning
Just not to me
When I meet someone with ALT>1000, I think:
1⃣Ischemic hepatitis. Right 🫀failure? 🫀-genic shock? Cool legs?
2⃣Biliary 🪨. Pain? imaging!
3⃣Drug induced liver injury. Tylenol? Run every med through livertox.gov
4⃣Viral hep. Hep A/B/C
But these weren’t the answers
1⃣Ischemic hepatitis. Right 🫀failure? 🫀-genic shock? Cool legs?
2⃣Biliary 🪨. Pain? imaging!
3⃣Drug induced liver injury. Tylenol? Run every med through livertox.gov
4⃣Viral hep. Hep A/B/C
But these weren’t the answers
⭐️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)
link.springer.com/article/10.100…
@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)
link.springer.com/article/10.100…
✅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 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)
✅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)
1/4
🚨El comité asesor de @US_FDA vota en contra (12/16) de la aprobación del obeticólico para el tratamiento del #NASH
⚠️Balance beneficio-riesgo desfavorable
No es definitivo, la FDA se pronunciará el 22 de junio ... pero no pinta bien
#livertwitter
bit.ly/3OKSQj8
🚨El comité asesor de @US_FDA vota en contra (12/16) de la aprobación del obeticólico para el tratamiento del #NASH
⚠️Balance beneficio-riesgo desfavorable
No es definitivo, la FDA se pronunciará el 22 de junio ... pero no pinta bien
#livertwitter
bit.ly/3OKSQj8
2/4
El que iba a ser el primer fármaco para tratar a personas con #NASH publicó los datos preliminares del ensayo clínico pivotal en el 2019!
▶️ Beneficio modesto en términos de eficacia y problemas en cuanto al perfil de seguridad
📰 bit.ly/3q7LfRn
#LiverTwitter
El que iba a ser el primer fármaco para tratar a personas con #NASH publicó los datos preliminares del ensayo clínico pivotal en el 2019!
▶️ Beneficio modesto en términos de eficacia y problemas en cuanto al perfil de seguridad
📰 bit.ly/3q7LfRn
#LiverTwitter
3/4
Un aspecto positivo: la gran cantidad de información pública que facilita la @US_FDA, en la que ha basado el comité asesor su resolución negativa:
🔓 bit.ly/438Zd4h
#LiverTwitter
Un aspecto positivo: la gran cantidad de información pública que facilita la @US_FDA, en la que ha basado el comité asesor su resolución negativa:
🔓 bit.ly/438Zd4h
#LiverTwitter
👴🏼con #cirrosishepática y #HTP, cólicos biliares de repetición ¿colecistectomía electiva?
Que los pacientes con cirrosis hepática tienen mayor #riesgoquirúrgico que no hay duda,pero
¿Tienen todos los pacientes el mismo riesgo? 🤔
Dentro 🧵👇🏻 e infografía 📸 #liverTwitter
Que los pacientes con cirrosis hepática tienen mayor #riesgoquirúrgico que no hay duda,pero
¿Tienen todos los pacientes el mismo riesgo? 🤔
Dentro 🧵👇🏻 e infografía 📸 #liverTwitter
🌍 Cada vez hay más pacientes con cirrosis hepática
👴🏼👵🏼 Cada vez sobreviven más
De modo que cada vez es más frecuente que pacientes de estas características puedan precisar una 🛠 cirugía
Son pacientes frágiles ⚠️
Veamos cómo abordarlo antes⏳, durante y después ⌛️
👴🏼👵🏼 Cada vez sobreviven más
De modo que cada vez es más frecuente que pacientes de estas características puedan precisar una 🛠 cirugía
Son pacientes frágiles ⚠️
Veamos cómo abordarlo antes⏳, durante y después ⌛️
ANTES
Valoración del riesgo:
🔸 Cirugía:
⁃⏰ Electiva vs emergente (alta mortalidad)
⁃Tipo: Abdominal abierta y cardiotorácica mayor riesgo
⁃Preferible abordaje laparoscópico y centro con experiencia
🔸Paciente:fragilidad, sarcopenia, ASA, despistaje de cirrosis/HTP👇🏻
Valoración del riesgo:
🔸 Cirugía:
⁃⏰ Electiva vs emergente (alta mortalidad)
⁃Tipo: Abdominal abierta y cardiotorácica mayor riesgo
⁃Preferible abordaje laparoscópico y centro con experiencia
🔸Paciente:fragilidad, sarcopenia, ASA, despistaje de cirrosis/HTP👇🏻
👨⚕️¡X fin voy a empezar el proyecto que tanta ilusión me hace!
👩⚕️¡Qué bien!¡Enhorabuena!
👨⚕️Ufff, pero es tan difícil diseñarlo.. No sé por dónde empezar!
👩⚕️Sabes q #LiverAI te puede ayudar MUCHO,¿verdad?
👨⚕️¡Imposible! Si nunca me da lo que le pido🥲
👩⚕️Igual este🧵te ayuda🤭
(1/x)
👩⚕️¡Qué bien!¡Enhorabuena!
👨⚕️Ufff, pero es tan difícil diseñarlo.. No sé por dónde empezar!
👩⚕️Sabes q #LiverAI te puede ayudar MUCHO,¿verdad?
👨⚕️¡Imposible! Si nunca me da lo que le pido🥲
👩⚕️Igual este🧵te ayuda🤭
(1/x)
👩⚕️Lo primero que tienes que saber es que en #LiverAI existen dos opciones
- LiverAI Turbo
- LiverAI Advanced
👨⚕️¿Y qué diferencia hay?
👩⚕️¡Pregúntaselo tú mismo!
(2/x)
- LiverAI Turbo
- LiverAI Advanced
👨⚕️¿Y qué diferencia hay?
👩⚕️¡Pregúntaselo tú mismo!
(2/x)
👨⚕️¡Qué guapo! Es decir:
🏎️ #LiverAI turbo para respuestas rápidas y simples
🧠 LiverAI advanced para información más estructurada y compleja. Un pelín más lenta.
👩⚕️¡Sí!
(3/x)
🏎️ #LiverAI turbo para respuestas rápidas y simples
🧠 LiverAI advanced para información más estructurada y compleja. Un pelín más lenta.
👩⚕️¡Sí!
(3/x)
Tony Ferrante MD PhD of @ColumbiaMed providing an excellent systems based overview of the "metabolic" complications of #obesity and potential mechanisms: lipotoxicity, inflammation, adipokines
Some highlights:
1/
Some highlights:
1/
Neurology:
Check out this relationship where higher BMI is associated with ↑ risk of #dementia EXCEPT in age >70 when it's better to be in "overweight" category
👉Aiming for a "normal BMI" is not the best goal for everyone
2/
Check out this relationship where higher BMI is associated with ↑ risk of #dementia EXCEPT in age >70 when it's better to be in "overweight" category
👉Aiming for a "normal BMI" is not the best goal for everyone
2/
1/
Breaking: Our new peer-reviewed paper is out. It may anger you, make you sad or even numb you.
During the start of the pandemic, various governments published national guidelines on management of #COVID19
Guidelines from India was unique.
Breaking: Our new peer-reviewed paper is out. It may anger you, make you sad or even numb you.
During the start of the pandemic, various governments published national guidelines on management of #COVID19
Guidelines from India was unique.
2/
Apart from featuring science-based data, it also featured prevention and treatment options for Covid from The Ministry of Ayush, the apex pseudoscience promoter in the country.
Ayush stands for Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy.
Apart from featuring science-based data, it also featured prevention and treatment options for Covid from The Ministry of Ayush, the apex pseudoscience promoter in the country.
Ayush stands for Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy.
3/
None of these "guidelines" were based on empirical evidence, none based on clinical trials & efficacy/safety of traditional practices against a pandemic of extreme proportions remained unknown.
Because it was promoted by major authorities, people fell for it.
None of these "guidelines" were based on empirical evidence, none based on clinical trials & efficacy/safety of traditional practices against a pandemic of extreme proportions remained unknown.
Because it was promoted by major authorities, people fell for it.
Muy interesante lo que cuenta el Dr.Hugo López: La importancia del abordaje Psico social en los pacientes con trastorno por consumo de alcohol (TCA) #AEEH2023 #LiverTwitter @AEEHLiver
🗣Hasta un 30% de los pacientes con T.C. alcohol tienen un trastorno mental asociado
🧠Entre un 30 y un 70% de los pacientes con TCA tienen deterioro cognitivo (la mayoría leve, solo un 10% grave)
Excelente ponencia de la Dra. Helena Cortez-Prieto en la #AEEH2023 #LiverTwitter
¿Sabias qué es el Minimum Unit Pricing (MUP? #MUP
¿Sabias qué es el Minimum Unit Pricing (MUP? #MUP
🏴 Se implementó en Escocia en 2018
💷 El precio unitario mínimo establece un precio mínimo (50 peniques) por unidad de alcohol (8g) lo que significa que el alcohol no se puede vender legalmente por menos de ese precio.
💷 El precio unitario mínimo establece un precio mínimo (50 peniques) por unidad de alcohol (8g) lo que significa que el alcohol no se puede vender legalmente por menos de ese precio.
🍷 Cuanto más alcohol contiene una bebida, mayor es el precio unitario mínimo.
🏛El precio unitario mínimo no es un impuesto; es una forma específica de asegurarse de que el alcohol se venda a un precio razonable.
🏛El precio unitario mínimo no es un impuesto; es una forma específica de asegurarse de que el alcohol se venda a un precio razonable.
1/38 "Next patient is a nun referred from DM Hospital"
My OPD staff tells me
"Severe hepatitis without a cause"
I sit up excited, also terrified
Excited, I get to serve people who bought me into this world Terrified, as they were competent to diagnose hepatitis, but couldn't.
My OPD staff tells me
"Severe hepatitis without a cause"
I sit up excited, also terrified
Excited, I get to serve people who bought me into this world Terrified, as they were competent to diagnose hepatitis, but couldn't.
2/38 Nuns at DM hospital ensured my mother was taken care of when she delivered me, many decades before.
They were pleasant, caring, comforting. DM hospital was well known for its services; it catered to a lot of patients, many very sick
A direct referral was always challenging.
They were pleasant, caring, comforting. DM hospital was well known for its services; it catered to a lot of patients, many very sick
A direct referral was always challenging.
3/38 I watch as two nuns enter my room and seating in front, they show me a liver test - the enzymes - AST & ALT were in 2000's with a hind of jaundice - the bilirubin was 3.2 mg/dl (clinical jaundice is when bilirubin is >3)
"I was a young nun, the time when you were born,"...
"I was a young nun, the time when you were born,"...
Recommendations to enable and optimize a multidisciplinary approach in #NAFLD care. #livertwitter @AlinaAllenMD @AlkhouriNaim @JVLazarus nature.com/articles/s4385…
Evaluate benefit and cost-effectiveness of multidisciplinary models of care based on NITs, which should be adopted by first-line providers, such as PCPs and endocrinologists, and monitor their use. nature.com/articles/s4385…
Implement context-specific (prevention, screening, risk-stratification, treatment) and resource-specific (for low-, middle- and high-income settings) models of care and always report their effectiveness.
🔦Endoscopic Diagnosis & Management of Esophagogastric Variceal Hemorrhage
🗒️ESGEGuidelines2022
16 Keys:
1⃣Pts w compensated advanced CLD & >10mmHg portalHT➡️NSBB (carvedilol) therapy💊
@ESGE_news #LiverTwitter #MedEd #GITwitter #MedTwitter @ASGEendoscopy @endoscopyjrnl
🧵👇
🗒️ESGEGuidelines2022
16 Keys:
1⃣Pts w compensated advanced CLD & >10mmHg portalHT➡️NSBB (carvedilol) therapy💊
@ESGE_news #LiverTwitter #MedEd #GITwitter #MedTwitter @ASGEendoscopy @endoscopyjrnl
🧵👇
2⃣ Patients unable to receive NSBB therapy with a screening upper endoscopy 🔦that demonstrates high risk esophageal varices ➡️ endoscopic band ligation (EBL). Repeat after 2-4 weeks until eradication
🕵️♂️Surveillance every 6 months in the first year
🕵️♂️Surveillance every 6 months in the first year
3⃣ In hemodynamically stable patients with acute upper GI hemorrhage and no ❤️ disease ➡️Restrictive red blood cell transfusion strategy:
🕑When? ▶️ Hemoglobin threshold ≤ 70 g/L
🎯Post Transfusion target: 70–90 g/L
🕑When? ▶️ Hemoglobin threshold ≤ 70 g/L
🎯Post Transfusion target: 70–90 g/L
Bart Staels, PhD of Univ of Lille, France gave an outstanding talk on Interplay Between #NAFLD & #CVD at the #WCIRDC. CVD is the leading cause of death not liver disease. Fibrosis severity correlates with higher CVD risk. @WCIRDC @YHandelsmanMD
healio.com/news/endocrino…
healio.com/news/endocrino…
Type 2 #diabetes and #NAFLD have a reciprocally injurious relationship mediated through common pathophysiology magnifying the risk for #CVD events.
pubmed.ncbi.nlm.nih.gov/33015726/ @zilbermint @AlinaAllenMD
pubmed.ncbi.nlm.nih.gov/33015726/ @zilbermint @AlinaAllenMD
#NAFLD is considered the hepatic manifestation of the metabolic syndrome and is closely linked to:
✅#Obesity, especially visceral adiposity
✅Insulin resistance
✅Chronic inflammation
✅#Lipotoxicity
nature.com/articles/s4141…
✅#Obesity, especially visceral adiposity
✅Insulin resistance
✅Chronic inflammation
✅#Lipotoxicity
nature.com/articles/s4141…
1/6
2022 is coming to an end, glad to share 15th publication from our department for the year
Severe alcohol hepatitis has no approved treatment
Recommended treatment is steroids
Some patients dont respond to steroids
They are offered other options...
#livertwitter #medtwitter
2022 is coming to an end, glad to share 15th publication from our department for the year
Severe alcohol hepatitis has no approved treatment
Recommended treatment is steroids
Some patients dont respond to steroids
They are offered other options...
#livertwitter #medtwitter
2/6
...such as Pentoxifylline.
But even Pentoxifylline therapy does not improve survival in patients with severe alcohol hepatitis
In this study, we looked at how intestinal bacteria affect patients on Pentoxifylline therapy
and
compared them with a group on stool transplant
...such as Pentoxifylline.
But even Pentoxifylline therapy does not improve survival in patients with severe alcohol hepatitis
In this study, we looked at how intestinal bacteria affect patients on Pentoxifylline therapy
and
compared them with a group on stool transplant
3/6
Very interestingly, we found that more dangerous groups of bacteria increased in patients on Pentoxifylline therapy
while those receiving healthy donor stool transplant developed good bacteria that reduced liver disease
Central influencer bacteria after Pentoxifylline..
Very interestingly, we found that more dangerous groups of bacteria increased in patients on Pentoxifylline therapy
while those receiving healthy donor stool transplant developed good bacteria that reduced liver disease
Central influencer bacteria after Pentoxifylline..
1/This is absolute nonsense of a tweet from senior doc, endangering public
This is proof that docs too are poor in analyzing scientific evidence, lack expertise in reading a scientific paper
Also bcoz #CardioTwitter aint doing anything abt it, #LiverTwitter is doing it pro-bono!
This is proof that docs too are poor in analyzing scientific evidence, lack expertise in reading a scientific paper
Also bcoz #CardioTwitter aint doing anything abt it, #LiverTwitter is doing it pro-bono!
2/First the study:
This is from 2016
No standard treatment arm
No sample calculation for 4 groups
Excluded vegetarians
No detail on non-vegetarian diet of 8wk follow-up
Only previous 3d diet recall/ physical activity done
No proof that participants actually consumed garlic..
This is from 2016
No standard treatment arm
No sample calculation for 4 groups
Excluded vegetarians
No detail on non-vegetarian diet of 8wk follow-up
Only previous 3d diet recall/ physical activity done
No proof that participants actually consumed garlic..
3/..the use of other medications in among study participants are also not mentioned especially with respect to diabetes, hypertension and hypothyroidism
The authors did not actually look at any proper cardiac outcomes, except measure fibrinogen level - this is cherry picking..
The authors did not actually look at any proper cardiac outcomes, except measure fibrinogen level - this is cherry picking..
📽️Watch NOW & Summit #HCC Mts🏔---🧗🏽AEs w AA ICIs & combos--- 🧗♂️Practical approaches & nuances---🧭w @MarkYarchoan @marinabaretti @MPishvaian---🆓#CME BonumCE🔗bit.ly/3D2O60S---Supp… by edu grants from Eisai & @Merck---#TumorBoardTuesday twitter.com/i/broadcasts/1…
🪂BEFORE diving in 🪂…
🔗👇open link below (right click🖱️> open in 🆕tab)
✅ Answer #PreTest polls
🔁Retweet & tag colleagues
🔗👇open link below (right click🖱️> open in 🆕tab)
✅ Answer #PreTest polls
🔁Retweet & tag colleagues
3/ #TumorBoardTuesday #HCC #OncTwitter #GITwitter #LiverTwitter
🟠Earn 🆓 #CME 🏆
🟠#CME ℹ️🔗bit.ly/3D2O60S
📸 Faculty disclosures & important CME info 👇
🟠Earn 🆓 #CME 🏆
🟠#CME ℹ️🔗bit.ly/3D2O60S
📸 Faculty disclosures & important CME info 👇
Disorders of the hepatic and mesenteric
circulation
#MedTwitter #LiverTwitter #GITwitter #Liver #ACG2022
circulation
#MedTwitter #LiverTwitter #GITwitter #Liver #ACG2022
⚠️Remember your anatomy!
Where do clots occur?
Thyroid hormones regulate liver enzymes via thyroid hormone receptors. When the liver is steatotic, hepatic thyroid hormone receptors don’t respond effectively. This results in an intrahepatic hormonal milieu where the liver is essentially hypothyroid. #livertwitter #endotwitter
Thyroid hormone receptor-β plays a key role in hepatic homeostasis including:
✅De novo lipogenesis
✅Fatty acid β-oxidation
✅Mitophagy
✅Mitochondrial biogenesis
✅Cholesterol metabolism
✅Carbohydrate metabolism
#livertwitter #endotwitter
✅De novo lipogenesis
✅Fatty acid β-oxidation
✅Mitophagy
✅Mitochondrial biogenesis
✅Cholesterol metabolism
✅Carbohydrate metabolism
#livertwitter #endotwitter
Thyroid hormone receptor-β agonism has demonstrated clinical benefits on hepatic lipid metabolism.
frontiersin.org/articles/10.33…
frontiersin.org/articles/10.33…
HBV: Easy to understand, difficult to treat!😄
@norahterrault: Functional cure, novel therapies
@SengGeeLim1: qHBsAg for stopping NUCs
@norahterrault: Functional cure, novel therapies
@SengGeeLim1: qHBsAg for stopping NUCs
Goals of Rx
Preferred Rx
Who needs pharmacotherapy?
What is the standard of care?
Key takeaways
✓ BB everyone without CI
✓Statin in all ex DC
✓Antibiotic prophylaxis
✓PPIs only if strong indications
✓Vaccinate all
✓ BB everyone without CI
✓Statin in all ex DC
✓Antibiotic prophylaxis
✓PPIs only if strong indications
✓Vaccinate all
Recompensation definition
