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)

Screen in high risk patients (see picture) q6 mo using:
⚠️ AASLD does NOT recommend routine use of CT/MRI for screening

Stop screening if:
🛑 CPT C cirrhosis not eligible for transplant
🛑 Life limiting comorbidities Image
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

🔗… ImageImage
Read 10 tweets
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 Image
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 ImageImageImageImage
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? ImageImage
Read 12 tweets
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 Image
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
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
4⃣Viral hep. Hep A/B/C

But these weren’t the answers
Read 16 tweets
⭐️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
🚨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

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


#LiverTwitter Image
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:


#LiverTwitter Image
Read 4 tweets
👴🏼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 Image
🌍 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 ⌛️
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👇🏻
Read 12 tweets
👨‍⚕️¡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) Image
👩‍⚕️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) Image
👨‍⚕️¡Qué guapo! Es decir:

🏎️ #LiverAI turbo para respuestas rápidas y simples
🧠 LiverAI advanced para información más estructurada y compleja. Un pelín más lenta.

Read 18 tweets
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/ Image
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/ Image
Unsurprising relationships between #CVD and #obesity
3/ Image
Read 6 tweets
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.
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.
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.
Read 16 tweets
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)
Read 4 tweets
Excelente ponencia de la Dra. Helena Cortez-Prieto en la #AEEH2023 #LiverTwitter

¿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.
🍷 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.
Read 5 tweets
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.
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.
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,"...
Read 38 tweets
Recommendations to enable and optimize a multidisciplinary approach in #NAFLD care. #livertwitter @AlinaAllenMD @AlkhouriNaim @JVLazarus…
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.…
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.
Read 7 tweets
🔦Endoscopic Diagnosis & Management of Esophagogastric Variceal Hemorrhage

16 Keys:

1⃣Pts w compensated advanced CLD & >10mmHg portalHT➡️NSBB (carvedilol) therapy💊

@ESGE_news #LiverTwitter #MedEd #GITwitter #MedTwitter @ASGEendoscopy @endoscopyjrnl
🧵👇 Image
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 Image
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 Image
Read 11 tweets
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…
Type 2 #diabetes and #NAFLD have a reciprocally injurious relationship mediated through common pathophysiology magnifying the risk for #CVD events. @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
Read 9 tweets
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
...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


compared them with a group on stool transplant
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..
Read 6 tweets
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!
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..
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..
Read 13 tweets
📽️Watch NOW & Summit #HCC Mts🏔---🧗🏽AEs w AA ICIs & combos--- 🧗‍♂️Practical approaches & nuances---🧭w @MarkYarchoan @marinabaretti @MPishvaian---🆓#CME BonumCE🔗… by edu grants from Eisai & @Merck---#TumorBoardTuesday…
🪂BEFORE diving in 🪂…
🔗👇open link below (right click🖱️> open in 🆕tab)
✅ Answer #PreTest polls
🔁Retweet & tag colleagues
3/ #TumorBoardTuesday #HCC #OncTwitter #GITwitter #LiverTwitter

🟠Earn 🆓 #CME 🏆
🟠#CME ℹ️🔗

📸 Faculty disclosures & important CME info 👇 Image
Read 10 tweets
Disorders of the hepatic and mesenteric

#MedTwitter #LiverTwitter #GITwitter #Liver #ACG2022
⚠️Remember your anatomy!
Where do clots occur?
Read 17 tweets
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
✅Mitochondrial biogenesis
✅Cholesterol metabolism
✅Carbohydrate metabolism
#livertwitter #endotwitter
Thyroid hormone receptor-β agonism has demonstrated clinical benefits on hepatic lipid metabolism.…
Read 12 tweets
HBV: Easy to understand, difficult to treat!😄
@norahterrault: Functional cure, novel therapies
@SengGeeLim1: qHBsAg for stopping NUCs
Goals of Rx
Preferred Rx
Read 11 tweets
Who else but @ajay_duseja to deliberate on NASH pharmacotherapy
Brilliant as always!
Who needs pharmacotherapy?
What is the standard of care?
Read 7 tweets
Thrombophilia evaluation: @drshalimar
Ac PVT: Dr Puneeta Tandon
Key takeaways
Read 8 tweets
INASL 2022

Decompensation prevention: @JasmohanBajaj
Recompensation: Prof Yogesh Chawla
Key takeaways
✓ BB everyone without CI
✓Statin in all ex DC
✓Antibiotic prophylaxis
✓PPIs only if strong indications
✓Vaccinate all
Recompensation definition
Read 5 tweets

Related hashtags

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!