#livertwitter#GITwitter#MedTwitter#tweetorial
❓#Cirrhosis, right lobe atrophied, relative hypertrophy of left lobe
📌Splenic/superior mesenteric vein blood flow changes👉distortion of liver structure, re-routing hepatotropic substances to left, less to right➡️ Rt atrophy 1/
❓But in #BuddChiari#Syndrome, caudate lobe enlarged
📌"#laminar flow’ theory"👉 larger redistribution of nutritients,hormones,hepatotropic factors to left hemi-liver at caudate level, most portal branches supplying caudate lobe from left portal vein #MedStudentTwitter 2/
❓Where does ascites, commonest decompensation in cirrhosis, come from
📌Protein rich lymph forced from the #plasma from sinusoids of liver and exit through 2 ways👉weeping from #liver surface from Disse space to Mall space via Glisson free channels, or hepatic lymphatics
4/
❓Hypokalemia is a common cause of precipitated #hepatic#encephalopathy (#HE)
📌Low K+👉increased glutamine in proximal tubule. Low K+ in collecting tubules, more hydrogen ions👉relative intracellular acidosis. Kidney ammonia forms, bicarbonate 2 balance acid/base👉 HE
5/
❓Spontaneous bacterial peritonitis (SBP) diagnosis requires absolute neutrophil count of 250 cells or above on ascites examination
📌This cut off because most sensitive in diagnosis, previous recommendation 500 cells/cm3 was most specific.
Paper: bit.ly/2QvKRHw
6/
❓Cirrhosis patient's INR 3.5. FFP transfusion before diagnostic bedside fluid tap?
❌No prophylactic use of fresh frozen plasma or platelets. Worsens outcomes, inc portal pressure (PP). Every 100mL blood volume expansion mean PP inc by 1.03 mmHg (Zimmon&Kessler, 1974) 7/
❓Spur cell anaemia in advanced liver disease👉presence of ≥ 5% spurcells (5 to 10 irregularly spaced spiculations on RBC surface)
📌Mechanism👉inc lecithin-cholesterol-acyltransferase, exces free cholesterol in RBCmembrane,fluidity defects,distortion, impaired deformability 8/
❓Flapping tremor or asterixis, grading?
📌0 – no flapping motions; 1 – rare flapping motion, one to two/sec; 2 – occasional irregular flaps, three to four per 30s; 3 – frequent flaps, 5-30 / 30s and 4 – almost continuous flapping motions>30/30s
9/END #MedStudents#teaching
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The most powerful 'treatment' for non-alcohol related fatty liver (and also the best for longevity and even beating recurrence of cancer as per a new NEJM study)
1/13
Good morning. Here is a weekend breakfast special. This post is for general population/ public, not for highly active athletes, body builders and powerlifters.
1/15
A probiotics company called GoodBug that sells a variety of products containing various strains of bacteria with claims that their products promote weight loss, reduce PCOD symptoms, "cleanse the gut," improve IBS and "balance" hormones. They are lying.
Here is how...
2/15
Their products claims are based on "fictional" data, weak science or possible falsification of data. This is classically: "fringe science."
"Ideas that challenge established scientific views, considered unproven or speculative. Encompass theories that deviate significantly from mainstream science, lack empirical evidence, based on flawed premises."
3/15
Akin to other nutraceutical companies, the products display terms like "SCIENCE," "EVIDENCE," "SCIENTIFIC," etc... without actually providing any data to back those claims. Some do provide data, but mostly preclinical studies and never solid human studies that are rigorous.