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Keith Siau Profile picture
@drkeithsiau
Sep 20, 2020 • 3 tweets • 11 min read • Read on X
**Tips for obtaining a good cholangiogram during ERCP**

A million thanks to @enrrikke for yet another beautiful #GIRecap and to @helpatologist and #GITwitter for your crowdsourced tips! These have been gold dust! 🙏🙏

Please feel free to share and add any extra tips! ImageImageImageImage
@TrieuMD @PerelmansPearls @CMZavaletaMD @DeMadaria @carolmangas @SyedGerdezi @CarvalloP_MD @FaisalOA @Samir_Grover @GIDrDon @GastronautIan @DCharabaty @MZorniak @RashidLui @Samir_Grover @stevenbollipo @KralJan @drmoutaz @tberzin @ScopingSundays @Marktheliverdoc @SunilAminMD
@SultanMahmoodMD @ginorthshore @RKeswaniMD @VPanellaGIMD @RodriguezParra_ @AustinChiangMD @GWebster_endo @HelenSteed1 @JacquelineChuMD @UmairKamran11 @abdullahaabbasi @endoscopiamx @MISIRG1 @IvetteSLomeli @AsadurRahman87 @SanchezLunaMD @purnie_mae @DrMalSimons @shanilkadir

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More from @drkeithsiau

Keith Siau Profile picture
Dec 22, 2024
Doctors are generally good at ordering investigations but less good at writing a plan.

This generally applies to outpatient clinics, but here is what I think a good PLAN should cover 👇
Too often do I see a plan which solely covers diagnostics. Remember that waiting for diagnostics (sometimes this can be weeks, months or even years) does not generally help a patient.
A good plan should cover:

✅ Diagnostics

Investigations require skill to rationalise. Some are complex.

If you have requested an outpatient test, eg scan / endoscopy, include the expected waiting times to guide the patient or their GP.

Some might be for monitoring, eg 3 monthly blood tests. Indicate if you have requested them!
Read 10 tweets
Keith Siau Profile picture
Dec 20, 2024
“Tell me an example of when you felt humbled at work”

I did a colonoscopy on a 65 year old man with a history of ulcerative colitis for over 10 years who was admitted with a flare. He had confirmed Campylobacter in his stool cultures 4 weeks prior… Image
He had been on escalated dose vedolizumab (failed infliximab previously) and presented with ongoing diarrhoea, lower GI bleeding, CRP 200+, low albumin. Repeat stool cultures were negative. Minimal improvement IV steroids and antibiotics.
Colonoscopy showed patchy deep ulceration more in keeping with Crohn’s colitis. CMV negative.

I continue started ustekinumab as the 3rd line biologic, continued steroids and asked for surgical review.
Read 9 tweets
Keith Siau Profile picture
Dec 9, 2024
Sorry, I turned off social media for a month.

This is why I did it and these are my findings….
Life and parenting took its course, and before I knew it, I reached 40 and my BMI hit a record high.

I replaced my morning social media routine with a 5k run. My obesity has been treated and it feels great to reach peak fitness at 40 % 🏃🏻
Screen time was putting a strain on our marriage.

We talked less and spent time tapping away on separate screens.
Putting down the phone was as effective as marriage counselling. We now chat and watch the same shows, without distraction 👩‍❤️‍👨
Read 11 tweets
Keith Siau Profile picture
Nov 28, 2023
A lesson in life.

Call from a colleague today…

“Keith, I’ve got a 80 year old man with jaundice and fever from a large 2cm gallstone wedged in the bile duct. He’s on anticoagulation for PE. I just have a bad feeling about him and I think he needs an ERCP today.”
“Is he unwell”

Him: He’s sitting out with a NEWS score of 1 (essentially normal observations).

“If he’s not scoring, we can probably wait and do his ERCP when the anticoag has washed out. His bleeding risk is too high to take out the stone.”

He gives a reluctant OK.
As I put the phone down, the realisation dawned on me that this was the sixth sense of an experienced colleague that was going off, much like a nurse’s gut feeling. These are hard to describe but they are often right. Not something to dismiss which I just did 🤦🏻‍♂️
Read 6 tweets
Keith Siau Profile picture
Sep 24, 2020
Here’s a thread summarising the coeliac disease guidelines in @UEGJournal @my_ueg

journals.sagepub.com/doi/pdf/10.117…

1) What is it?

CD is a chronic, multiorgan autoimmune disease that affects the small bowel in genetically predisposed persons exposed to gluten.
2) Who should be testEd?

Coeliac disease is known as the great imitator. It can cause IBS, anaemia, diarrhoea, weight loss, infertility, osteoporosis, severe fatigue, etc etc.

I recommend reading this endocrinologist’s perspective here:
bmj.com/rapid-response…
3) Disorders associated with coeliac disease @theMJA

mja.com.au/system/files/i…
Read 10 tweets
Keith Siau Profile picture
Jul 22, 2020
Pathology in food - a thread inspired by this wonderful paper and the recent discussions on food and pathology on Twitter.

Credit to the GRAPE working group for the paper and all images and captions:
peerj.com/preprints/2147…

Bon appetit!
Grape bunches. Staphylococcus aureus are spherical bacteria known as cocci that grow in clusters that look like grape bunches.
Spaghetti and meatballs appearance. On potassium hydroxide preparation, the filamentous hyphae and round spores of Tinea versicolor resemble spaghetti and meatballs respectively.
Read 14 tweets

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