Elliot Tapper Profile picture
Hepatologist @michiganliver @vaannarbor; #cirrhosis; encephalopathy; frailty; quality improvement; father; husband. #livertwitter
Anil Gopinath Profile picture Pedro Ochoa-Allemant Profile picture salah salahi Profile picture medicalmoe Profile picture Moaz Alhamedy Profile picture 23 added to My Authors
Jan 7 12 tweets 2 min read
some memories from liver clinic that make me happy when I think about them in this challenging year

#livertwitter "I'm me again!"
- A text from a patient after I prescribed lactulose
Dec 9, 2021 4 tweets 4 min read
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Tomorrow is the last meeting of the @AASLDtweets Practice Metrics Committee (PMC) chaired by @AsraniSumeet

He is the kindest, most committed collaborator and has done so much to shape and support the future of #cirrhosis quality

#livertwitter @serperm 2/
Sumeet was chair of this committee after Michael Volk and @KanwalFasiha. Under their leadership, we:

1. Defined the key PROs in #cirrhosis: pubmed.ncbi.nlm.nih.gov/29272043/
2. Developed quality metrics for #cirrhosis that included the patient voice: pubmed.ncbi.nlm.nih.gov/30586188/
and
Oct 15, 2021 19 tweets 10 min read
The hepatitis B vaccine is amazing.

It also has a wild backstory
Want to hear it?

A #tweetorial

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#livertwitter #MedTwitter Image First:

Hepatitis B sucks
1⃣About 3-4 in every 100 people have it
2⃣It causes liver cancer, #cirrhosis

But the vaccine rocks!
1⃣Prevents liver cancer!
2⃣Was first recombinant vaccine!

So let's get into it

2/ ImageImageImage
Jul 3, 2021 4 tweets 3 min read
#livertwitter I don’t get the vitamin k thing. There is no known benefit (pubmed.ncbi.nlm.nih.gov/23080365/). And the harm is that It sends mixed signals. It undoes the teaching about the #cirrhosis coagulopathy. Because iv vit k is special and novel, it’s a consult rec that sticks. Needs reconsidering
Jun 29, 2021 17 tweets 10 min read
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WHY are steroids used for alcoholic hepatitis?
SHOULD we?
WHAT is the deal with prednisolone vs prednisone?
WHERE did the discriminant function come from?
ARE you ready for a #tweetorial

#livertwitter #medtwitter #meded #cirrhosis 2/

Alcoholic hepatitis is a life-threatening acute liver injury featuring a liver full of necrotic cells, "Mallory bodies" of cellular junk, & severe inflammation (neutrophils)

Fig1: Mallory's original description
Fig2: Alc hep Mortality in 1966 according to bilirubin
Jun 17, 2021 18 tweets 8 min read
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Why do we use NAC (n-acetylcysteine) for tylenol overdose?

A #tweetorial

tylenol is also known as paracetamol, acetaminophen, APAP
#livertwitter #meded #medtwitter 2/

Every year in the US alone, >50,000 acetaminophen overdoses are reported to poison centers, causing >110 deaths. Overdose can be intentional, though often accidental, always tragic.

There's an antidote: NAC. It saves lives.

Want to know how it was discovered?
Jun 1, 2021 4 tweets 3 min read
We wanted to⬆️engagement with @JHepatology research
🤔Hypothesis: people are ⬆️ likely to connect with the people behind the research than the research itself
🧐Plan: Randomize papers to personal story tweets or graphical abstracts
🧐Primary Outcome: paper downloads
#livertwitter We found that story tweets garnered more downloads and tweet impressions

We conclude that showcasing the authors and their motivations in paired tweets is an effective strategy for research engagement

journal-of-hepatology.eu/article/S0168-…
May 18, 2021 10 tweets 3 min read
Here is some unsolicited #TipsForNewDocs advice on the job search

#medtwitter #livertwitter #GITwitter
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Wrong: You'll have "all the resources you need"
What are these? Stats, research cores, coordinator pools...
These are...people!
You cant promise a person!

Right: Meet X, 25% of their effort will be directed towards your work if you gel. Or here is $$$ to hire Y.
Apr 20, 2021 22 tweets 13 min read
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WHY is there a BABOON in my room?

A #tweetorial about the outcomes of hepatic coma, how far we have come, and how wild things got along the way
#livertwitter 2/

Up first: the lingo

Hepatic encephalopathy (HE) presents as a spectrum with subtle cognitive/motor deficits at one end (AKA "Covert HE") and coma at the other

HE/Coma can be caused by #cirrhosis (Type C, more common) and acute liver failure (Type A)
Mar 31, 2021 13 tweets 8 min read
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WHAT the heck is GGT?

#tweetorial #livertwitter #medtwitter 2/

GGT = gamma-glutamyl transpeptidase

It’s an enzyme that transfers amino acids to proteins. It's found anywhere things need transferring (liver cells, bile ducts, kidneys, heart....)

No big deal, right?

Wrong!
Mar 28, 2021 14 tweets 10 min read
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HOW long do you live with #cirrhosis?
WHERE did MELD Score come from?
WHAT is a "TIPS"?
ARE you ready for re-#tweetorial

#livertwitter #medtwitter #meded 2/

Imagine you are a patient with variceal bleed in 1940

🚫EGDs
🚫Banding
🚫hope

Then came portosystemic shunt surgery. A treatment!

The catch?

Lots of people still died after surgery
Mar 16, 2021 16 tweets 11 min read
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WHY does #cirrhosis cause palmar erythema?
HOW is estrogen involved?
WHO is ready for a #tweetorial?

Let's talk hormones, the liver, the impact of imbalanced testosterone/estrogen, & the history of spironolactone
#livertwitter #medtwitter #MedEd 2/

Palmar erythema is:
1⃣Common (3 in 4 with #cirrhosis)
2⃣variably distributed on palm surface
3⃣caused by dilated capillaries

In 1942, Perrera showed the dilated vessels were not present on autopsy. A circulating factor must cause it.

What could it be?
Feb 4, 2021 5 tweets 3 min read
I would like to thank everyone for their kind texts and tweets and thank the @AmerGastroAssn for the Young Investigator award.

It is a dream. As I cannot wait for @DDWMeeting, I would like to call out my appreciation for a few people and say a couple of things First, I have mentors to thank. Dr Michelle Lai who gave me my start and launched me. @SenguptaNeil who taught me everything I know. And the reason I moved my family from Boston to a suburb of Detroit known away from good food, Dr Lok, the greatest mentor I will ever know
Jan 18, 2021 4 tweets 3 min read
Most fun study I have ever done:

We asked clinicians why they tested NH3, their pre-test prob of HE, and what they planned to do while they were blinded to the result

tl/dr: Clinicians are good at diagnosing HE in the ED, so no need for Nh3
doi.org/10.1016/j.cgh.…
#livertwitter We find that a clinicians' pre-test probability of HE is the same as the post-test probability. But! not only does Nh3 add nothing diagnostically, when high it leads to excess lactulose use even when tested in people without #cirrhosis

Now we need to design the QI intervention
Dec 26, 2020 4 tweets 2 min read
Diagnosis?

#livertwitter Image There are many potential causes of high ALT
But what are their pretest probabilities? Everyone is thinking broadly which is good but if you want to go where the money is, you rob banks

And which fall back to normal?

And what prompts multiple tests? A symptom?
Dec 15, 2020 15 tweets 9 min read
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WHERE does ascites come from?
HOW do diuretics treat ascites?
ARE you ready for a #tweetorial?

#livertwitter #medtwitter #MedEd 2/
First, ascites is:
1⃣Fluid in the belly
2⃣Awful
3⃣A cruel trick the liver plays on the heart and kidney

Throw back to my "what is #cirrhosis?" tweetorial
Sep 2, 2020 13 tweets 8 min read
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HOW does gabapentin work?
DOES gabapentin work?
WHY is gabapentin so shady?

Join me for a #tweetorial?

Keywords: Glutatmate, Asterixis, Alcohol-use disorder
#livertwitter #MedTwitter #meded 2/

Admitting a non-#cirrhosis patient with gabapentin overdose as an intern, I saw asterixis

This 🤯

If it caused asterixis (throwback: ), did that mean it causes HE?

Gabapentin has confused me ever since
Aug 12, 2020 5 tweets 5 min read
What is asterixis?

👋Described~60 yrs ago by Adams/Foley
👋Methods:60pts w/impending hepatic coma vs controls
👋Flapping flexion/extension, best @ the🤚but happens even 2 the 👁️lids! Has intervening tremor (mini-asterixis)

Look 4 it while checking handgrip!
#livertwitter
1/4 Why asterixis?

1⃣Adams/Foley:🤷
2⃣Ammonia? Unlikely!(fig1)
3⃣Precipitating factors? Asterixis, like HE itself, is a biomarker of badness: bleeding, infection, sedatives(Fig2)
4⃣They looked @🧠; swollen astrocytes! Particularly in the basal ganglia!(Fig3)
#livertwitter 2/4
Jul 1, 2020 9 tweets 8 min read
HepatoADrenal syndrome

Say WHAT?!

⌚️It's #tweetorial o'clock

Be prepared to:
1⃣Define adrenal insufficiency of critical illness
2⃣never look @ a lipid panel the same
3⃣respect how sick ppl w/#cirrhosis get

#MedTwitter #meded #livertwitter
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First, what is AI (adrenal insufficiency)?

1⃣Critical illness can make the HPA axis😢
Fig1
⬇️Cortisol release
⬇️ACTH response
⬇️Tissue response to cort

2⃣Definition
Fig2-3
➡️Random cort <10➡️AI!
➡️Random cort >9➡️ACTH stim
➡️Cort⬆️<9➡️AI!

2/
Jun 28, 2020 7 tweets 7 min read
Muscle cramps!

We have all had them
But imagine they woke you up every night
For many people with #cirrhosis, that's life!

A #livertwitter #tweetorial featuring:
1⃣Who
2⃣Why
3⃣What to do

#meded #medtwitter #MedStudentTwitter

1/7 Cramps in #cirrhosis

1⃣Mainly @🌙,in the🦵, intense
2⃣Common: 1 in 3 people
3⃣Risk factors? anyone cramps! No diff in labs!
4⃣Turns quality of life into💩

2/
May 22, 2020 4 tweets 4 min read
Ammonia!

This test has such a big footprint in the landscape of liver disease management. But it is just too complicated to deserve its spotlight

Reposting this #tweetorial

NH3 levels:
1⃣a potent biomarker of illness
2⃣unreliable
3⃣only part of the HE story
#livertwitter Since I posted this tweetorial:

1. ISHEN released a consensus, touching on NH3. pubmed.ncbi.nlm.nih.gov/32224704/?from…. This features the fig below