Discover and read the best of Twitter Threads about #livertwitter

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Hace ya 5 semanas que @ECDC_EU activó la alerta por los casos de #hepatitis agudas graves en niños de causa desconocida

¿Qué hay de nuevo?

📈 Más de 400 casos en estudio
📉 Caída de casos en 🇬🇧
🤔 Información sobre la posible causa
⁉️ Muchas preguntas

#livertwitter #COVID19
Antes de seguir puedes revisar donde estábamos hace unas semanas


El número de casos compatibles ha aumentado, en parte porque se han ampliado los criterios de búsqueda, era esperable:

🇬🇧 163
🇪🇺 106
🇺🇸 109

Llama la atención el "bajo" número de casos sospechosos (para la población) de la UE y USA 🤔

Read 20 tweets
Grateful to @AASLDFoundation,@AASLDtweets for recognizing our work @DDWMeeting & choosing us as one among ten to receive the prized Foundation Fellow Award globally

AASLD's recognition has been instrumental in progression of our clinical research in our State & Nation+
Our featured works to be presented at the @DDWMeeting, San Diego May 21-24 include:

A. Use of high dose probiotics in patients with severe alcohol-liver disease where we discuss novel findings associated with intestinal microbiome and their interactions after probiotic therapy +
& B. The changes in fungal communities in intestines of patients with severe alcohol-liver disease treated with high dose probiotics (Poster of Distinction)

Were the changes beneficial?
How did bacterial communities interact with fungal communities?

#medtwitter #livertwitter +
Read 4 tweets
Do Bone Marrow Haematopoietic Stem and Progenitor Cells (#stemcells) influence #fattyliver, Core Liver Networks, and liver cancer?

Very happy to share our findings in this (5 min read) Tweetorial🧵
More details on bioRxiv:

#livertwitter Schematic depicts a plausible and novel mechanism linking fa
2. In our previous publication in @CellSystemsCP, we used network analysis (#WGCNA) to identify the preserved liver networks (Core-Modules) between species and screened for their genetic regulators (module-eQTLs).
Infographic by Misaki Ouchida:
3. Here you can find a concise review/commentary on our previous paper on core liver networks in @CellRepMed…
Read 22 tweets
As promised, here's my slide set on "Landmark trials in Hepatology 2021"
A lot of great research got left out due to ⏰(15min!)
Tx to #livertwitter #GITwitter.
A 🧵below
(Animations removed!)
Scheme of presentation
Final cut pro☺
Read 12 tweets
🔴🟠🟢 Hepatology Bedside Pearls

Curvoisier-Terrier Sign!

(Arun's Gastro Aphorism☺
It's unlikely that you have finished Gastro rotation and never heard of this!)
🟠What's in a name?
❌a.k.a Curvoisier's Law (well hey, there ain't any laws in medicine!)

✔Curvoisiers gallbladder ( A Verghese, Lancet 1986)

✔Curvoisiers Sign

✔✔Curvoisier-Terrier Sign ( personal preference!)
🟠 What exactly is it?
"In a patient with painless jaundice, a palpable gallbladder is unlikely due to stones"
Most likely malignancy
Read 16 tweets
some memories from liver clinic that make me happy when I think about them in this challenging year

"I'm me again!"
- A text from a patient after I prescribed lactulose
My patient getting married in a ceremony officiated by the hospitalist when admitted
Read 12 tweets
🔴🟡🟢 Hepatology Bedside Pearls!

I was pleasantly surprised by the overwhelming response to a tweetorial posted yday.

So here's one for those who want more. Do let me know if you like similar tweetorials in Clin Med/Hepat/GE.

This time, Spider Naevi! Image
🟡 What's a spider nevus?

Aka Nevus araneus/ spider angiomata

It has 5 components: cutaneous arterial net, central arteriole, subepidermal ampulla, ⭐ shaped afferents & capillaries (J Am Acd Dermatol 1997)
0.1- 1cm, sometimes huge
Warmer than surrounding
🟡 Associations?
✔10-15% healthy children
✔Pregnancy, OCP
✔Liver ds esp Alcohol >>HCV rel
Read 14 tweets
🔴🟡🟢Hepatology Bedside Pearls!

Abdominal Veins in liver disease🧵 ImageImage
🟠Normal veins and drainage: The absolute basic!

Umbilicus is the watershed. Hence flow is cephalad (towards head) above umbilicus and caudad(towards feet) below umbilicus

(Intern Med2019) Image
🟡 ldentifying the dilated veins on the trunk

( Image
Read 17 tweets
Tomorrow is the last meeting of the @AASLDtweets Practice Metrics Committee (PMC) chaired by @AsraniSumeet

He is the kindest, most committed collaborator and has done so much to shape and support the future of #cirrhosis quality

#livertwitter @serperm
Sumeet was chair of this committee after Michael Volk and @KanwalFasiha. Under their leadership, we:

1. Defined the key PROs in #cirrhosis:
2. Developed quality metrics for #cirrhosis that included the patient voice:
3. Developed quality metrics for liver cancer diagnosis and management:

Soon you will hear from the committee on PROs in liver cancer, metrics for liver transplant, and metrics for the management of #cirrhosis coagulopathy
Read 4 tweets
Alguna vez te has preguntado el origen de la palabra cáncer? Sirva este colangiocarcinoma para resolver la pregunta. Spolier alert si vas directo al tweet 5 de este hilo.
#livertwitter #GItwitter #medEd #cancer #cholangiocarcinoma #tweetorial #hilo Image
Cáncer es una palabra que proviene del griego "karkinos", que significa "cangrejo". Esta, a su vez, proviene de "karkah", cangrejo en sánscrito y de su raíz "kar" que significa duro. Image
Los primeros en denominar a los tumores y otras lesiones ulcerosas como "karkinos" fueron los griegos. Del griego también deriva "carcinoma" ya que el sufijo "oma" hace referencia al tumor, y significa tumor duro o maligno. Image
Read 5 tweets
Part 1⃣ of Session 3⃣ of #BavenoVII

Preventing (first) decompensation
🪑 Chaired by Profs. @jaumebosch9 and @crisripol

🦸 Panelists: R. Bañares, @Calvar1Vincenza, A. Dell’Era, @RodriguesSu24, @dtrip2015 and C. Villanueva 📸

📜 Follow this thread for major statements 👇
Definition of decompensation
▪️The panel performed a systematic review for definition of 1⃣ decompensation

▪️Previous landmark study

▪️Slides and statements 📜
🦠 Role of infections in 1⃣ decompensation

▪️Relevant articles

Read 5 tweets
Part 3⃣ of Session 2⃣ of #BavenoVII

Impact of non-etiological therapies
🪑 Chaired by Profs. A. Albillos and @JonelTrebicka

🦸 Panelists: @JasmohanBajaj, @JSGracia, @AleksanderKrag

📜 Major statements await for #LiverTwitter 👇
Role of statins and aspirin in patients with CLD

📚 Relevant related-articles


📜 Slides and statements 👇
Role of anticoagulation in patients with CLD

📚 Previous landmark study

📜 Slide and statements 👇
Read 4 tweets
Part 2⃣ of Session 2⃣ of #BavenoVII

Impact of etiological therapies
🪑 Chaired by Profs. @MattiasMandorf1 and E. Tsochatzis

🦸 Panelists: @FrancqueSven, J. Jia, @SaSi_Lens and H. Yoshiji

📜 Once again, major statements for #Livertwitter have been announced‼️
🦸 The panel performed an individual patient data-based meta-analysis of the #BavenoVII cooperation, repeating NIT (LSM & PLT) post-treatment to assess the probability of CSPH in a cACLD patient after SVR (📸 1 and 2)

📜 Relevant statements followed 👇
🏋️ Let´s test now #LiverTwitter

What is the probability of CSPH in a cACLD patient who has a platelet count of 100 and a TE of 20 kPa after SVR ❓
Read 5 tweets
Part 1⃣ Session 1⃣ of #BavenoVII

HVPG as a gold standard
🪑 Chaired by Profs. @jcgarciapagan and H. Ferral

🦸 Panelists: R. Gaba, F. Schepis

📜 Major statements and relevant articles for #Livertwitter 👇
Quality Metrics in HVPG and PPG
▪️Balloon vs straight catheter for HVPG…

▪️Hepatic-atrial PG…

▪️Accuracy of HVPG technique…

▪️Impact of Intrahepatic Venovenous Shunt on HVPG
Usefulness of HVPG in different settings
▪️Agreement of wedged hepatic and portal pressure in NAFLD


▪️Acute hemodynamic response:

▪️Test-retest reliability:
Read 4 tweets
Early recognition of cirrhosis is important Image
Read 26 tweets
Some cases!
Two flavors of DILI

🔺Intrinsic: intrinsically hepatotoxic (e.g., acetamionophen)

🔻Idiosyncratic: unpredictable ❔
Read 16 tweets
A case!
⚠️11% of patients with incidentally discovered steatosis may be at risk for advanced hepatic fibrosis!
Read 16 tweets
That was fun! my first "Twinterview". Thanks @Zucmanrossi for being a Pro Tweeter!

We will now launch our mini Journal Club.

Telomere length is key to hepatocellular carcinoma diversity and telomerase addiction is an actionable therapeutic target…
A picture is a worth a thousand words!

Here is a graphical abstract that succinctly summarizes the main findings.
#livertwitter #gitwitter
Read 4 tweets
The hepatitis B vaccine is amazing.

It also has a wild backstory
Want to hear it?

A #tweetorial


#livertwitter #MedTwitter Image

Hepatitis B sucks
1⃣About 3-4 in every 100 people have it
2⃣It causes liver cancer, #cirrhosis

But the vaccine rocks!
1⃣Prevents liver cancer!
2⃣Was first recombinant vaccine!

So let's get into it

2/ ImageImageImage
Did you know that the discovery of hepatitis B was recognized with the 1976 @NobelPrize for Dr. Baruch Blumberg?

His studies over the course of 5 years 1964-1969 changed the world.

Let's take a look

3/ Image
Read 19 tweets
I don’t get the vitamin k thing. There is no known benefit ( And the harm is that It sends mixed signals. It undoes the teaching about the #cirrhosis coagulopathy. Because iv vit k is special and novel, it’s a consult rec that sticks. Needs reconsidering
For my #livertwitter friends replying about vit K deficiency in malnutrition, I am not mad at ya, I have nothing but love for you! I see - and address - malnutrition in every patient I meet! I am pro-food, pro-vitamin! I am happy we can still talk this out
Read 4 tweets

WHY are steroids used for alcoholic hepatitis?
WHAT is the deal with prednisolone vs prednisone?
WHERE did the discriminant function come from?
ARE you ready for a #tweetorial

#livertwitter #medtwitter #meded #cirrhosis

Alcoholic hepatitis is a life-threatening acute liver injury featuring a liver full of necrotic cells, "Mallory bodies" of cellular junk, & severe inflammation (neutrophils)

Fig1: Mallory's original description
Fig2: Alc hep Mortality in 1966 according to bilirubin

Where did we get the idea for steroids in alc hep?

Everyone in 1950's France was using steroids to treat #cirrhosis. As in the examples below, Prednisone/prednisolone were said to resolve ascites, edema, jaundice, and fevers. They made patients hungry and happy too
Read 17 tweets
Why do we use NAC (n-acetylcysteine) for tylenol overdose?

A #tweetorial

tylenol is also known as paracetamol, acetaminophen, APAP
#livertwitter #meded #medtwitter

Every year in the US alone, >50,000 acetaminophen overdoses are reported to poison centers, causing >110 deaths. Overdose can be intentional, though often accidental, always tragic.

There's an antidote: NAC. It saves lives.

Want to know how it was discovered?

In the 1970's, Drs. Laurie Prescott & Roger Williams showed people were dying of APAP overdose in the UK
Then Mitchell et al released 6 papers showing why & what to do. Their 1st paper confirmed APAP dosing was key & showed that liver injury was due to p450 metabolism
Read 18 tweets
1/12 The jump from classroom teaching to clinical rotations is made tougher by the fact that physicians have illness-specific frameworks for presentations and documentation. Let's explore a bunch of them (feedback is most welcome)!

#MedTwitter #MedEd #FOAMed
2/12 Let's start with anemia. It is ideal if you report the baseline Hgb and an interpretation of the MCV. #HemeTwitter Image
3/12 For VTEs, it is helpful to tell the listener/reader if you think it is provoked vs. unprovoked. A hypercoagulable work-up should not be sent routinely. Image
Read 12 tweets

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