@ICICIPruLife is the worst insurance company in India. Pls do not be a victim of their harassment. Sharing my personal experience with this bogus company. I tried everyday to co-operate with them. Sharing this so that you guys won't fall prey. A 🧵 I bought term insurance for 5cr in end October 23 online. Immediately, Mr Shadab, a customer relationship manager was assigned. All went smooth till medicals, which I completed on the date allotted

🔴🟠🟢 Hepatology bedside pearls

45M
CIN CKD
Came to the OPD waiting area
Diagnosis was straight forward

How many of you have seen this sign?
A tweetorial 🧵 🟠Labs confirmed my clinical diagnosis of acute pancreatitis( lipase -8000, amylase-3546)
A close DD in CKD would be an aortic aneurysm rupture
☢️Always palpate pulses, EKG

HBV: Easy to understand, difficult to treat!😄
@norahterrault: Functional cure, novel therapies
@SengGeeLim1: qHBsAg for stopping NUCs Goals of Rx

Who else but @ajay_duseja to deliberate on NASH pharmacotherapy
Brilliant as always!
🔥🔥🔥 Who needs pharmacotherapy?

PSVD vs NCPH
For: Dr Christina Ripoll
Against: Dr Akash Shukla
@INASL_Liver #inasl2022
🔥🔥🔥
Hotly debated! Whats PSVD?

SIG: INASL 2022
Thrombophilia evaluation: @drshalimar
Ac PVT: Dr Puneeta Tandon

INASL 2022

Decompensation prevention: @JasmohanBajaj
Recompensation: Prof Yogesh Chawla
🔥🔥🔥 Key takeaways
✓ BB everyone without CI
✓Statin in all ex DC
✓Antibiotic prophylaxis
✓PPIs only if strong indications
✓Vaccinate all

INASL 2022!
I'll be summarising a few talks!
Who better than Prof SK Sarin to deliberate on new drug targets in Portal Hypertension!
🔥🔥🔥 New concepts in Portal Hypertension

Today is World NASH day!
A day to learn, educate and spread awareness about a disease that is assuming epidemic proportions.

A small tutorial 🧵on NAFLD/NASH for general public and primary care colleagues. What is NAFLD/NASH?

Simply put, it is excessive accumulation of fat in ones liver. Over time, the fat causes and inflammation and liver cell death leading to NASH and ultimately liver heals by scarring and stiffening, leading to cirrhosis and liver cancer

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

🔴🟠🟢 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!)

🔴🟡🟢 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! 🟡 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

🔴🟡🟢Hepatology Bedside Pearls!

Abdominal Veins in liver disease🧵 🟠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)

🔴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)

🔴 Hepatology Bedside Pearls!

📢Asterixis or "Liver palms" tweetorial!

1st described in HE by Adams RD & Foley JM
(Trans Am Neurol Assoc 1949)
(1/n) 🟣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