Arun Valsan Profile picture
Feb 2 12 tweets 13 min read
As promised, here's my slide set on "Landmark trials in Hepatology 2021"
A lot of great research got left out due to ⏰(15min!)
Tx to #livertwitter #GITwitter.
A 🧵below
(Animations removed!)
Scheme of presentation
Final cut pro☺
CONFIRM trial (Florence Wong, Arun Sanyal)
#NephroJC
ATTIRE trial
@DrLChina
Semaglutide in NASH
@phil_newsome7 @VladRatziu
Great research, excluded due to want of time

NATIVE @VladRatziu @QAnstee
EVIDENCES IV @nagachalasani
RIFsys @VishCPatel @DebbieShawcros1
SURFASA DeMatin, Philip Mathurin
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More from @DrArunKValsan

Jan 8
🔴🟠🟢 Hepatology Bedside Pearls

Curvoisier-Terrier Sign!

(Arun's Gastro Aphorism☺
It's unlikely that you have finished Gastro rotation and never heard of this!)
🟠What's in a name?
❌a.k.a Curvoisier's Law (well hey, there ain't any laws in medicine!)

✔Curvoisiers gallbladder ( A Verghese, Lancet 1986)

✔Curvoisiers Sign

✔✔Curvoisier-Terrier Sign ( personal preference!)
🟠 What exactly is it?
"In a patient with painless jaundice, a palpable gallbladder is unlikely due to stones"
Most likely malignancy
Read 16 tweets
Dec 18, 2021
🔴🟡🟢 Hepatology Bedside Pearls!

I was pleasantly surprised by the overwhelming response to a tweetorial posted yday.

So here's one for those who want more. Do let me know if you like similar tweetorials in Clin Med/Hepat/GE.

This time, Spider Naevi! Image
🟡 What's a spider nevus?

Aka Nevus araneus/ spider angiomata

It has 5 components: cutaneous arterial net, central arteriole, subepidermal ampulla, ⭐ shaped afferents & capillaries (J Am Acd Dermatol 1997)
0.1- 1cm, sometimes huge
Warmer than surrounding
🟡 Associations?
✔10-15% healthy children
✔Pregnancy, OCP
✔Thyrotoxicosis
✔Liver ds esp Alcohol >>HCV rel
✔HPS
✔Malnourishment
Read 14 tweets
Dec 16, 2021
🔴🟡🟢Hepatology Bedside Pearls!

Abdominal Veins in liver disease🧵 ImageImage
🟠Normal veins and drainage: The absolute basic!

Umbilicus is the watershed. Hence flow is cephalad (towards head) above umbilicus and caudad(towards feet) below umbilicus

(Intern Med2019) Image
🟡 ldentifying the dilated veins on the trunk

(epos.myers.org) Image
Read 17 tweets
Nov 21, 2021
🔴Hepatology Bedside Pearls!

📢 The Traube's Space!

(Pic: Yang JC, West J Med 1991)
(1/n)
🟣Historical Snippet

🆔 Ludwig Traube(1818-1876) 🇩🇪
✔Under Josef Skoda & Carl Rokitansky
✔ 👫 of Virchow, Frerichs& Osler
Primary ❤- Resp, kidney & ❤
✔described in Lt pleural eff(esp TB)
✖Name it/ associate with splenomeg
(Arch Int Med 1992) (2/n)
🟡Boundaries
Original: med-liver, lat-spleen, sup-lower border heart

☑ Barkuns method(Am J Med 1989)
Med-6th CC jn
Lat- 9th rib AAL. (Some ref MAL)
Inf- subcostal plane
(Se 62%, Sp 72% 4 splenomeg)

(Fig: Adapted ref 2) (3/n)
Read 13 tweets
Nov 18, 2021
🔴 Hepatology Bedside Pearls!

📢Asterixis or "Liver palms" tweetorial!

1st described in HE by Adams RD & Foley JM
(Trans Am Neurol Assoc 1949)
(1/n) Image
🟣Historical snippet
✔1st observed at Boston City Hospital.
✔Foley described it to a Jesuit scholar, Father Cardigan over a 🥂
✔Called it "An-iso-sterixis"
✔Tongue twister> abbreviated to asterixis
✔Adams on Harrisons editorial bd⏩popular
🔵 Definition
✔brief, arrythmic lapses in sustained voluntary contraction
✔3-5Hz
(3/n)
Read 10 tweets

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