Thread by @theliverdoc

#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
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❓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
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❓#Fatigue primary biliary cholangitis (#PBC)
📌cholestasis, #endotoxemia, systemic #Inflammation👉dysautonomia, central/peripheral neurovascular dysfunction, sympathetic overactivity, impaired baroreflexes, low peripheral #muscle perfusion, lactic acid mishandling, fatigue
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❓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
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❓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
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❓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
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❓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)
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❓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
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❓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
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