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John Damianos, M.D.

@john_damianosMD

Oct 23, 2022 • 17 tweets • 8 min read • Read on X

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Disorders of the hepatic and mesenteric
circulation

#MedTwitter #LiverTwitter #GITwitter #Liver #ACG2022

⚠️Remember your anatomy!

Where do clots occur?

Diagnosis of portal/superior mesenteric vein thrombosis

Acute or chronic?

ACUTE PVT radiology findings

Workup of acute PVT

Anticoagulation in PVT
💊6-12 months if cause is reversible; otherwise, lifelong

Large varices– NSBB

PVT summary

Portal and mesenteric vein thrombosis *in cirrhosis*

Budd-Chiari syndrome

Imaging findings of Budd-Chiari

🕸️🕸️🕸️

Treatment of Budd-Chiari syndrome

Algorithms for:
🩸 acute portal vein thrombosis
🩸 chronic PVT
🩸 PVT in cirrhosis
🩸 Budd-Chiari syndrome

Dr. Kamath on thrombophilia screening:
Myeloproliferative neoplasms (JAK2)
Factor V Leiden
Prothrombin gene mutations
Protein C & S
Consider hematology consult

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More from @john_damianosMD

John Damianos, M.D.

@john_damianosMD

Mar 14

A master class on prokinetics from @NGMJournal! Here is a summary! 🧵👇

⚡️🎈〽️🪠🫀💩🚄🧠✳️🗯️💊📰🚽🔌🧪💡🧲📊🔎

#MedTwitter #GITwitter #motility #pharmacology

onlinelibrary.wiley.com/doi/full/10.11…

Pyridostigmine & neostigmine
⚡️cholinesterase inhibitors
🧠pyrido should not cross the blood-brain barrier
🚽evidence in chronic idiopathic constipation and acute colonic pseudo-obstruction
🫄pregnancy class C; excreted in breastmilk
🫀cholinergic side effects, esp bradycardia

Acotiamide
⚡️inhibits cholinesterase and enhances ACh release via muscarinic receptors
🎈enhances gastric emptying and accommodation
🔥NERD & FD
🫄no safety data
💊side effects: nausea, abdominal distension, constipation

Read 20 tweets

John Damianos, M.D.

@john_damianosMD

Dec 15, 2022

@YaleMed

I gave a talk on inpatient bowel regimens today for the @YaleMed @YaleIMed residents and students, with additional 💎s on outpatient #constipation. Here are the slides!

💩 💩 💩

#MedTwitter #GITwitter #motility #MedEd @YaleIM_Chiefs @MayoClinicGIHep

Most inpatients require a bowel regimen. Our patients typically have most of the risk factors for #constipation!

#Constipation is more about symptoms than frequency! 🚽

It’s also a *symptom* (like chest pain), so need to figure out what’s causing it and treat accordingly.

Read 20 tweets

John Damianos, M.D.

@john_damianosMD

Dec 13, 2022

Diet, gas, and the #microbiome 💨

#MedTwitter #GITwitter #diet #nutrition #IBS #SIBO

sciencedirect.com/science/articl…

💨The gut microbiota generates ~0.2L–1.5L of gas per day
💨>99%: hydrogen (H2), carbon dioxide (CO2), & methane (CH4)– *odorless*
💨foul smell of gas from <1%: sulfur–containing gases hydrogen sulfide (H2S), methanethiol (CH3SH), dimethyl sulfide [(CH3)2S] + volatile compounds

🦠bacteria in the colon ferment substrates that are not digested or absorbed in the upper GI tract (e.g. carbohydrates, proteins, fats)
🦠produce short-chain fatty acids, branched-chain fatty acids, ammonia, N-nitro compounds, phenolic and indolic compounds, and various gases

Read 15 tweets