TheLiverDoc Profile picture
Jul 13, 2020 15 tweets 13 min read Read on X
#crazy Useless #patient

1/n
Middle-aged man, loves his #family, #farming, drives a cab, #happy. Son & wife at #home. Father-son relationship strong as rock. One #morning, son finds father mumbling to self. Mother says he hardly slept
Mumbling becomes angry ramblings. #Clinical LAENNEC WAS TAUGHT THE IMPO...
2/n
Has very little #breakfast. Walks excessively. Goes and lies down, only to get up and walk again. Family interactions little. Sleeps well for 2 hours from 12 to 2PM. Lunchtime. Groggy #father gets on the lunch table and defecates near plates and food. Son and mother aghast.
3/n
Father has gone mad. Calls the friendly neighbor, brings his car, rushes to #Medical specialty #clinic nearby. Father disoriented. Son gets the Fword from his own father multiple times, he is shocked! Then comes hurling of abuses after which they restrain him in the car.
4/n
In the clinic, #young duty-doc LOOKS at the patient, diagnoses #psychosis, advises observation and sedatives. After 2mg lorazepam, patient knocked out, later wakes up confused. Starts gibberish talk again. In between he identifies the wife, not son. This is devastating.
5/n
The young #Doctor is called again. He says this needs advanced #treatment. Psychosis is ‘refractory’ - he tells the #nurse – like a bloody crazy useless mad person (son overhears). Saddened by the fact that his father is driven to crazy for what reason?
6/n
So, they rush him in an ambulance to a bigger General #hospital nearby where an elderly #emergencymedicine doc sees the confused, groggy, occasionally abusive patient in restraints. He LOOKS attentively, but also #touch and #EXAMINE the patient.
7/n
Lesson 1: don’t #practice visual medicine. CLINICALLY EXAMINE the patient. The patient and family are gladdened by this. They get a sense that there is #care and #comfort is on the way if a doctor places her/his hands on the patient. Don’t be shy. #MedicalStudents The Doctor, 1891 painting b...
8/n
He finds a firm liver, enlarged spleen and spider angioma signs of cirrhosis. Son says father used alcohol heavily, stopped a year ago after #Blood vomiting after binge&retching. Doc says looks like he has cirrhosis and issues – needs gastro/liver doc. #Medical #examination
9/n
Our evaluation confirms #cirrhosis and portal hypertension (PHT; increase in liver pressure when liver shrinks). PHT is like a block in the highway. Cars get to take service roads and bypasses. These service roads/bypasses for #Portal venous blood are called #collaterals
10/n
Some collaterals are huge – called shunts, drawing blood away from liver, increasing #ammonia waste, resulting in brain failure – hepatic encephalopathy. In patient, blood ammonia levels were >300 and patient diagnosed with hepatic encephalopathy. #CT #Scans show large shunt
11/n
What was done? Lower ammonia. Look if patient candidate for liver #Transplant (using #MELD score and if not a transplant candidate, then block the shunts. How? Simple non-surgical #interventional #radiology procedure – shunt embolization by @SRajesh_IR
#irad #GITwitter
12/n
See what happens in the image below. Large shunts are taken care of. Ammonia reduction brings patient back to senses. Discharged a week later; CT scan done 3 months later showed shunts are gone. #Sedatives and #hypnotics worsen #encephalopathy in cirrhosis. Image
13/End
Do not forget to examine. Examine. Examine.
‘A good physician treats the disease but a great physician treats the patient who has the disease’
Not every cirrhosis patient is a goner at diagnosis.
“Diagnosis is not the end, but the beginning of practice”

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with TheLiverDoc

TheLiverDoc Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @theliverdr

Jul 27
We recently published our independent analysis of Homeopathic practitioner commonly prescribed and popular over-the-counter 134 Homeopathy products marketed and sold as "medicine."

The Placebo Project: An observational study and comprehensive analysis of 134 commonly prescribed homeopathic remedies in India uncovers potential for hepatotoxicity: journals.lww.com/md-journal/ful…

Here is our plain language and visual abstract summary of what these Homeopathy products are and what we found in them.

1/3 - Classical (Diluted) Homeopathy ProductsImage
2/3 - Homeopathic Mother Tinctures Image
3/3 - Homeopathic Proprietary Products Image
Read 4 tweets
Jul 19
Ok. Let's properly study Ayurveda.
1/16 Image
2/16 Image
3/16 Image
Read 16 tweets
Jul 17
Dear friends, the most important update from our Citizens Protein Project 2. Please read and understand. This is on "amino spiking," a fraudulent practice... 1/8 Image
2/8 Image
3/8 Image
Read 8 tweets
Jul 16
1/4: AN UPDATE: The Citizens Protein Project 2 Image
2/4: Image
3/4: Image
Read 4 tweets
Jul 13
Here we go. Results of Citizens Protein Project 2. Please read, share max. We have to bring in change. Thank you for your contributions. Huge thanks to @arifhussaintm who led clinical research division on behalf of Mission for Ethics and Science in Healthcare to do this...1/15Image
2/15 Image
3/15 Image
Read 15 tweets
Jul 10
A new patient who came to me said he was promised a liver detox to 'improve functions' of cirrhosis liver. He spent ~ 200,000 INR (2333 USD) for 20 days of Ayurvedic therapy. And luckily escaped severe complications.

So, here is a...Public Service Announcement
1/17 Image
2/17 Image
3/17 Image
Read 17 tweets

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/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

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

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(