Discover and read the best of Twitter Threads about #mondaynightibd

Most recents (24)

@MondayNightIBD @AaronBlocker_ 1/2 #IBDPoll1️⃣:
📊If you are/were a caregiver for an adolescent/young adult (AYA) with #IBD or are an AYA who transitioned from #PedsGI to adult GI for your #IBD care, how was that transition?

Pls share your #PatientExperience with #MondayNightIBD!!
@MondayNightIBD @AaronBlocker_ 2/2 #IBDPoll2️⃣ #MondayNightIBD

Adolescent & young adults (& caregivers) who transtioned from #PedsGI to adult GI for #IBD care:

🚧 What did you find most difficult in the transition?
#Crohns #UlcerativeColitis
@MondayNightIBD @AaronBlocker_ Just to share my personal story, I found my biggest barrier was navigating the different care coordination style amidst a major life transition that coincided with my #PedsGI to adult GI transition! 1/5
Read 11 tweets
@MondayNightIBD 4/#MondayNightIBD
19M presents to GI clinic as a new patient w his grandma. He was dx’d with pan-UC at 12 & has been on adalimumab with reported 6 BMs/day, occasionally with 🩸, but reports this is “his normal”. He has not had any labs, endoscopy, or imaging done in the past…
@MondayNightIBD 5/#MondayNightIBD
year since moving. He is running low on adalimumab so his grandma scheduled this appointment for him to get refills.
This patient has transitioned to an adult provider, but is early in his transition process. 👀the Transitional care (TC) in IBD🧵👇to learn more
@MondayNightIBD 6/#MondayNightIBD
TC is a PROCESS that occurs throughout adolescence. It is not a singular event. During this process, patients are:
✅ Developing an identity
✅ Becoming 💵 independent
✅ Acquiring skills needed for adult relationships and roles including abstract reasoning
Read 16 tweets
@MondayNightIBD 1/Differential of Non-infectious Non -IBD colitis:
🔆 Drug-induced
🔆 Common Variable Immunodeficiency
🔆 Behcet disease
🔆 Segmental Colitis Associated w/ Diverticulosis
🔆 Ischemic Colitis
🔆 Radiation Colitis
🔆 Malignancy

🤔Can you think of other dx?
@MondayNightIBD 2/Immune Checkpoint Inhibitor Enterocolitis
📌ICI = monoclonal antibodies that reactivate immune response to tumor cells
📌Activation of T‐cells can cross‐react with host antigens
📌Enterocolitis ⬆️anti‐CTLA‐4 > anti‐PD‐1/PD‐L1 agents
⬆️risk perforation if unrecognized Image
@MondayNightIBD @SanjeevaniTomar @halesj126 @JosephHabibi_MD @RomyChamoun @MarcelYibirin @ifrahfatima @GroverDheera @dunleavy_katie @drsophiadar @Spencerkelley7 3/ICI + Diarrhea:
📐R/o infection
🔦C-Scope: appearance of IBD; but mucosa can look normal -> always biopsy; consider EGD +Bx
🔬Path can have chronic IBD changes, crypt apoptosis
💊Depends on severity: budesonide -> IV steroids-> Biologic
Read 16 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
@MondayNightIBD 1) Recurrencia Post-Quirúrgica (RPQ): Frecuencia
Características tras resección ileocólica y anastomosis:
- Localiz + frecuente: anastomosis o proximal
- Patrón = inicial
RPQ endo: 1a 70%; 3a 85%
RPQ clínica: 1a 20%, 3a 34%; ⏫10% cada año.… #MondayNightIBD Image
@MondayNightIBD 2/ Factores de riesgo

✅Características paciente.
✅Características enfermedad… Image
@MondayNightIBD 3/ Tabaco 🚭🚭

Fumadores tras CIR:
➡️RPQ clínica ✖️2⃣
➡️RPQ quirúrgica a 10 años ✖️2⃣.5⃣

⚠️⚠️ DEJAR EL TABACO ⚠️⚠️… #MondayNightIBD
Read 24 tweets
@MondayNightIBD 2/📣#IBD & meds carry an⬆️risk of #Malignancies, including lymphomas

🔺Who is at risk?
🔺Is it IBD-mediated or drug-related?
🔺What is our prevention & screening🔎strategy?

Thank you for joining this special #MondayNightIBD #Back2Basics @DuekerJeffrey Image
@MondayNightIBD @DuekerJeffrey @amelia_kellar @DCharabaty @IBD_Afzali @drdani23 @ibddoctor @EdithHoMD @fgomollon @IBD_DrEMF @ibdgijami @MaiaKayalMD 3/ 🔥IBD may carry a unique risk of primary intestinal lymphoma (PILD), but NO🔼risk of extra-intestinal NHL

In CESAME population,
▪️Crude IR of PILD was 0.12/1000 patient-years (py)
▪️All B-cell NH LD
▪️79% ♂️, 11 CD, 3 UC
▪️86% arose in IBD lesions
▪️45% were EBV positive Image
@MondayNightIBD @DuekerJeffrey @amelia_kellar @DCharabaty @IBD_Afzali @drdani23 @ibddoctor @EdithHoMD @fgomollon @IBD_DrEMF @ibdgijami @MaiaKayalMD @JChristieMD @KDeFelice_IBD @dunleavy_katie @IBDMD @MN_GIMD @SaraElOualiMD @nloganmd @KrugCleveland @PDulaiMD @PriSantiagoMD 4/ Lymphoma in #IBD is mostly linked to IBD therapy, particularly #Thiopurines (6MP, AZA)

🔺⬆️Risk in CD, less evidence with UC
🔺Risk increases with exposure⏲️, particularly >2 years
🔺Risk decrease after cessation of AZA Image
Read 9 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
📣#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
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
🙌 @my_ueg X #MondayNightIBD 🙌◦◦◦◦◦◦◦◦◦◦◦◦🎯 Best of #UEGWeek ◦◦◦◦ CME🔗 ◦◦◦◦◦◦◦◦◦◦◦◦◦◦◦◦◦◦◦◦◦◦◦ Support by edu grants from @abbvie & BMS…
2/#MondayNightIBD #UEGWeek

📲Tweet your❓for Mon LIVE Q&A @ 2p ET/ 7p GMT/ 8p CEST

📍Where are you in your career?
3/ #MondayNightIBD X #UEGWeek 2022 Best in #IBD

✨Faculty @Iris_Dotan, @CharlieMuz, @MRegueiroMD, & @DCharabaty

🤝 In collab w/ @my_ueg, @BonumCe


📲Tweet you questions👇🏽to be answered LIVE by the experts Monday Jan 30 2pmET/ 7pmGMT/ 8pmCEST
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
@MondayNightIBD 1/Welcome back to #MondayNightIBD with our #Back2Basics team! ⭐️🔆📚
We will talk about #Obesity#IBD
w help from #IBDAdvocates🦸‍♀️🦸‍♂️
@MondayNightIBD @BassiMehak @ifrahfatima 2/🎯35% of the 🇺🇸 population is obese= BMI>30, leading to rising healthcare 💲💲.
🎯20-40% of patients with #IBD are obese.
🎯#Obesity assoc. with 34%⬆️ risk of CD, but not UC
🎯Each 5kg/m2 ⬆️ in BMI ➡️with 16% ⬆️ risk of CD Image
@MondayNightIBD @BassiMehak @ifrahfatima @kzhuangmd @agoldowskymd @IBD_FloMD @IBD_Afzali @babudayyeh @BolandBrigid @amjohnsonMD @PopovVioleta @RobertoSimonsMD @LauraChiuMD 3/ ☸️Outcomes of pts with #Obesity & #IBD
⚠️ Little data & conflicting results, but overall: ⬇️ IBD outcomes
⬇️Remission rates
⬆️Unplanned healthcare utilization.
⬇️Time to 1st surgery in CD
⬆️ Risk of surgery & hospitalization in UC
Read 4 tweets
@MondayNightIBD 1. Welcome back to #MondayNightIBD with our #Back2Basics team! ⭐️

Let’s prepare for the HOLIDAY season!! 🎉✈️

#TravelingWithIBD #TravelingWithOstomy #IBDHolidays with @GroverDheera @MarcelYibirin #MakeitSimple
w help from #IBDAdvocates Image
@MondayNightIBD @MarcelYibirin @Empoweringpts9 @aboutIBD @ownyourcrohns @Youcantmakethi4 @Spencerkelley7 @RomyChamoun @ibdtweets @JosephHabibi_MD @dunleavy_katie @yaransarkis 2. ✈️Why is it important to talk about this
🗳️In a survey of #IBD pts in 2018
⚠️47% ✈️abroad w/o health insurance
⚠️63% didnt’ know to avoid live virus vaccine
⚠️92% didnt know high altitude can➡️flare
⚠️Most unaware of resources like “Can’t wait card” & Image
@MondayNightIBD @MarcelYibirin @Empoweringpts9 @aboutIBD @ownyourcrohns @Youcantmakethi4 @Spencerkelley7 @RomyChamoun @ibdtweets @JosephHabibi_MD @dunleavy_katie @yaransarkis @BassiMehak @snehadave98 @Clin_Med @IBDPassport @ibdesis @IBD_FloMD @ibdgijami @mlatorremd @MadhuraB_ @nataliesparacio 3. ✈️Why is it important to talk about this?
🧑‍🍳Change in diet & alcohol 🍸consumption & sleep 😴habits, missing meds can ➡️ GI symptoms or a flare 🔥
🥳Holidays can trigger or⬆️ anxiety & depression☹️
🔑Prepping ahead of time and advice from the medical team can go a long way!
Read 9 tweets
@MondayNightIBD @DCharabaty @TakedaPharma 2/ #MedTwitter #GITwitter #MedPeds @BonumCE

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

📸 Faculty disclosures & important CME info 👇
@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut 3/ #Parenteralnutrition is used in cases w GI dysfunction
➡️replace nutrients ➡️essential components pt would otherwise be unable to absorb from their 🥪🍜🍱

In pts w #ShortBowelSyndrome, PN is given @ home🏠 usually @ nt🌛
@MondayNightIBD @DCharabaty @TakedaPharma @BonumCe @jantchou @NavreetChowlaMD @BattatMD4IBD @dr_rdvenkatesh @StacyKahn_MD @ashishpatelpch @ConradCole10 @Leicnut 4/@AmerGastroAssn Clin Practice Update on #ShortBowelSyndrome #ParenteralNutrition

🌟Best practices
💎 Pref of tunneled CVCs
💎Micronutrient deficiencies monitoring
💎PN volume/contents based on pt weight, labs, stool/ostomy & urine output, signs of dehydration
Read 21 tweets
@MondayNightIBD 1/ 📣 #GITwitter #IBDTwitter
It’s a new🔥#Back2Basics session with #GI #Fellow @JosephHabibi_MD

Let’s talk AZA/6-MP in IBD

#IBDPolls 1️⃣&2️⃣👆🏽
✅Role as Mono/combo therapy
✅Escalation consideration
✅TPMT & NUDT15 testing
✅Side effects & counseling Image
@MondayNightIBD @NavreetChowlaMD @MilestoneIBD @IBD_FloMD @tinahamd @DrCoreySiegel @HorstIBDDoc @MLongMD @LauraRaffalsMD @doc_ibd @IBDBen 2/ AZA trials in IBD:

🔹Corticosteroids needed to induce remission
🔹Takes ~12 wks for AZA/6MP to become effective, so taper steroids accordingly
🔹AZA/6-MP effective for maintenance of remission (mainly in UC); Not effective for induction ImageImage
@MondayNightIBD @NavreetChowlaMD @MilestoneIBD @IBD_FloMD @tinahamd @DrCoreySiegel @HorstIBDDoc @MLongMD @LauraRaffalsMD @doc_ibd @IBDBen @IBDHorizons @IBD_Houston @IrisWangMD @LoriPlung @vaibhav_manu @KatieFalloonMD @amneethansmd @ManuelBragaMD @Chatterjee_MD @SuhaAbushamma 3/ AZA in today’s practice

1⃣CS-sparing monotherapy for maintenance of moderate IBD
2⃣Combo w/ TNFi to
↑ TNFi levels
↓ Ab formation
2nd MOA for severe/complex IBD not responsive to mono💉
Perianal Crohn’s

Read 18 tweets
@MondayNightIBD 1/ Hello and Welcome to today's #MondayNightIBD #Back2Basics!

Classifications are💎in IBD‼️Why⁉️:
🔹Clear assessment of disease location/extent/behavior
🔹Objective measure of flare severity
🔹Objective measure of endoscopic activity
➡️Determine treatment and prognosis‼️ Image
@MondayNightIBD @MN_GIMD @JosephHabibi_MD @DCharabaty @RomyChamoun @AllonKahn @drsusankais 2/ Classifications in CD:
1⃣Montreal Classification🟰Clinical Classification:
🔹A=Age at dx, L=Location in GI tract, B=Behavior (cf. Slide)
⚠️Behavior pearls:
🔻B1 can progress into B2 or B3
🔻Pts can present with B2 or B3 or both
🔻Perianal disease possible with any B phenotype Image
@MondayNightIBD @MN_GIMD @JosephHabibi_MD @DCharabaty @RomyChamoun @AllonKahn @drsusankais @AdvaniRashmiMD @DVinsard @SanjeevaniTomar @BassiMehak @GroverDheera 3/ Crohn's disease activity index (CDAI) 🟰 Clinical score
🔹Assess disease activity
🔹Quantify symptoms
🔹8 variables
🔹Index score
🔻<150: Remission
🔻221-450: Mod to Severe Image
Read 6 tweets
@halesj126 @MondayNightIBD @dunleavy_katie @SanjeevaniTomar @yaransarkis @RomyChamoun @BassiMehak @JosephHabibi_MD @DCharabaty @DSTEINGIMD @BeniwalPatelMD #CDI treatment:
💎🚫 oral 💊 metronidazole in #IBD
💎@AmCollegeGastro 👇…
💎IDSA : fidaxo > vanco
💎IBD pts might require a longer course
💊 fidaxo x 10d
💊 vanco x 14-21d
💊 fidaxo x 10d
💊 vanco x 21d
➕/➖ 💉 metronidazole
@halesj126 @MondayNightIBD @dunleavy_katie @SanjeevaniTomar @yaransarkis @RomyChamoun @BassiMehak @JosephHabibi_MD @DCharabaty @DSTEINGIMD @BeniwalPatelMD @AmCollegeGastro #CDI treatment cont’d:
💊 vanco

💉 metronidazole

Vanco enema if ileus
✳️ supportive cares
✳️ 🔪 consult
✳️ 🤔 #FMT 💩🔦
@halesj126 @MondayNightIBD @dunleavy_katie @SanjeevaniTomar @yaransarkis @RomyChamoun @BassiMehak @JosephHabibi_MD @DCharabaty @DSTEINGIMD @BeniwalPatelMD @AmCollegeGastro As the saying goes an algorithm is worth a 1000 words and fortunately, we have the great @wabillin algo on how to approach CDI in IBD Image
Read 5 tweets
@MondayNightIBD @Spencerkelley7 1/

👋 to this week’s #MondayNightIBD with the #Back2Basics #B2B team

🦠 Today we are discussing #Cdifficile infection in #IBD

Stay tuned to 📝 more about #CDI :
➡️ #IBD vs. general 👩👨‍🦱
➡️ diagnosis
➡️ treatment options Image
@MondayNightIBD @Spencerkelley7 @dunleavy_katie @SanjeevaniTomar @yaransarkis @RomyChamoun @BassiMehak @JosephHabibi_MD @DCharabaty @DSTEINGIMD @BeniwalPatelMD 2/

#CDI in #IBD compared to general 👩👨‍🦱

⬆️⬆️ common (5-8x 🔺)
⬆️ community-acquired
⬆️ w/o antibiotic 💊 exposure
⬆️ colonization
⬆️⬆️ recurrence ☹️
⬆️ colectomy risk 🔪

🚨 often no pseudomembranes on 🔦
🚨 can happen post-colectomy 🔪 in #smallbowel or #IPAA
@MondayNightIBD @Spencerkelley7 @dunleavy_katie @SanjeevaniTomar @yaransarkis @RomyChamoun @BassiMehak @JosephHabibi_MD @DCharabaty @DSTEINGIMD @BeniwalPatelMD 3/

Testing for #CDI ⬇️

💩 GDH:
✅ detects organism
⬆️ sensitive
⬇️ specific

💩 PCR:
✅ detects genes that code for toxin
🚫 detect toxin
⬆️ sensitive
⬆️ specific
🚨 can over-diagnose

💩 EIA for toxin A/B:
✅ detects toxin
⬆️ specific
⬇️ sensitive
🚨 can under-diagnose
Read 5 tweets
@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD 1/🏳️‍🌈🏳️‍⚧️#LGBTQ+ includes many diverse groups.

🔖Helpful reference from @FenwayHealth:…

👥Definitions vary across communities
💬Terms change frequently
⭐️If unsure, ask what terms someone would like you to use.
@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD @FenwayHealth 2/Ask all patients verbally or on registration form:
✅Pts expect to be asked
✅Pts think it's important for HCP to know
✅Gender identity & sexual orientation affect care

⚠️Don't assume pronouns from appearances


#Genderbread👇 Image
@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD @FenwayHealth @theNASEM 3/#LGBTQ+ health #disparities

-13% LGB+ ppl uninsured
-25% trans ppl had insurance deny gender-affirming care in last yr

-33% trans ppl had neg experience/harassment/refusal in healthcare in last yr
-LGBTQ+ ppl delay/avoid care b/c fear of discrimination Image
Read 12 tweets
Read 7 tweets
@MondayNightIBD @DCharabaty 1/12
📣#GITwitter #IBDTwitter

Welcome back to #MondayNightIBD #Back2Basics w @dunleavy_katie @john_damianosMD

🎯How do you approach a pt w #IBD in remission who has new or persistent #GI symptoms?

Check out our review📜…

#NeuroGI #GastroPsych #DGBI
@MondayNightIBD @DCharabaty @john_damianosMD 2/12 #MondayNightIBD #B2B

👩🏼‍⚕️have been studying “IBS-type symptoms” in #IBD for 30 yrs. But there is more work to be done to help characterize cohort & dz mechanism!

It’s important bc:
👨‍👩‍👧‍👦Affects pts QoL, mental health, sleep
🥼Causes ⬆️HC utilization, ⬆️MD visits & 💊narcotics Image
@MondayNightIBD @DCharabaty @john_damianosMD @MarcelYibirin @VictorChedidMD @LauraRaffalsMD @Spencerkelley7 @RomyChamoun @JosephHabibi_MD @ayshaslam999 @GroverDheera @yaransarkis @BassiMehak 3/12 #MondayNightIBD Persistent/New GI Sx in #IBD
1⃣R/o active🔥/#IBD complication (abscess, stricture):🔦, 🩻, CRP, FCP, ⚠️R/o infx like C. Difficile!

2⃣🤔Consequences of✂️: adhesion, bile acid diarrhea

3⃣🤔 #DGBI
🚩25% pts w #IBD in endo remission have #IBS @LancetGastroHep Image
Read 6 tweets
@MondayNightIBD @DCharabaty @abbvie @JanssenUS @TakedaPharma 1/ #IBDPoll1️⃣ 30M non-smoker w stricturing #Crohns ileocolitis dx 1 year ago is now s/p ileocecal resection due to refractory symptoms despite adalimumab.

What would you recommend post-surgery? #MondayNightIBD

🔦= C-scope
🔥= Active disease
Metronid= Metronidazole
@MondayNightIBD @DCharabaty @abbvie @JanssenUS @TakedaPharma 2/ #IBDPoll2️⃣ The pt was started on IFX 4 weeks post-op, but now presents @ 8 weeks post op w #Diarrhea 6-8 loose BM/day, no abdo pain, no blood. Stool Cdiff & Cx negative. FCP, CRP nml,

What’s next ? #MondayNightIBD
@MondayNightIBD @DCharabaty @abbvie @JanssenUS @TakedaPharma 3/ #IBDPoll3️⃣ Pt is dx w #BAD w 7C4 level 80ng/mL, & started cholestyramine. Now presents w abdo pain, MRE multiple SB #Strictures ➡️Sx complicated by leaks & more✂️. Now w foul smelling diarrhea, Wt loss, dry mouth, orthostasis. CLN & Stool studies nml.
What’s next?
Read 5 tweets
Read 6 tweets

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