Discover and read the best of Twitter Threads about #GItwitter

Most recents (24)

⭐️New-pub alert!!
@APASLnews guidelines on management of #ascites in liver disease.
Salient features covered which are different from other guidelines👇🏻
✅Diagnostic approach to mixed ascites
✅Role of low-dose albumin (1/n)

link.springer.com/article/10.100… Image
✅Recommendations on use of ACE inhibitors/ARBs
✅Diagnostic approach to management of pleural effusion
✅Recommend ICA definition for defining renal dysfunction in refractory ascites
✅Start with low-dose diuretics and gradually increase dose to increase tolerability (2/n)
⭐️Diagnostic algorithm for workup of new onset #ascites 👇🏻

✅SAAG - diagnosis of portal hypertension
✅High SAAG, high protein ascites - use BNP, 2D echo, SPA doppler and thyroid profile
✅Low SAAG, high protein ascites - use ascitic fluid ADA, amylase and TG (3/n) Image
Read 10 tweets
1/ Collated thread for new GI fellows

⭐️GI Fellow Resources ⭐️

▪️Websites
▪️Guidelines
▪️Apps
▪️Podcasts
▪️Textbooks
▪️Board study
▪️Social media

📲 bit.ly/3KwqCVG (hyperlinked 📄)

#GITwitter Image
2/ Advice for First Year Fellows

▪️Build management algorithms
▪️Read on 🔦, 🔬, 🩻
▪️Use 📚 study resources
▪️Register for ASGE first yr course
▪️Review basic anatomy
▪️Invest in GI endoscopy atlas
▪️Develop system of 🔬 tracking
▪️Mentor & network

🔗 giejournal.org/article/S0016-… Image
3/ Survive consult blocks!

▪️Have a system!
▪️Checklist for each 🆕 consult
▪️Talk to the consulting team
▪️Be brief
▪️Give specific recs
▪️Provide contingency plans

Art of Being a Consultant
🔗 jamanetwork.com/journals/jamai… @JAMA_current

See @Dr_Oubre for more documentation tips! ImageImage
Read 10 tweets
💊Drug Induced pancreatitis (DIP) by @AshkarMotaz from @WUGastro soon returning as @MayoClinicGIHep staff #IMPACT #gitwitter

🥇See tweet 5 for the current classification dx!

📚Hx of DIP: Understanding of DIP has evolved since it was first described in 1950s-60s on case reports ImageImage
🥇First drug-induced acute pancreatitis (AP) classification came out in '96

Subclassified as - definitive, probable, and possible DIP

Limitations of '96 classification:

1⃣DIP is UNCOMMON
2⃣DIP NOT different from AP 2/2 other causes
4⃣Drug re-challenge often not possible Image
🌟DIP classification was updated again in 2006 based on evidence & pattern of clinical presentation.

New challenges‼️

1⃣Inadequate dx criteria for AP
2⃣? ruling our common causes of AP
3⃣Lack of rechallenge
4⃣Idiopathic, microlithiasis, genetic causes intersecting with DIP dx
Read 5 tweets
🔮Pancreatic cysts: What's in the Juice by #YanBi from #MayoFL #IMPACT #gitwitter

🎯Pancreatic Cysts Incidence 📈with ↑imaging

🌟90% of P-Cysts are IPMNs (Intraductal Papillary Mucinous Neoplasms)
-70% IPMNs are BD-IPMN (branch duct)
-30% IPMNs are MD-IPMN (main duct) ImageImage
🔮Benign cysts (observation/drainage/sx)
- Pseudocyst
- Serous cystadenoma

⁉️Pre-malignant (observation/sx)
- IPMN
- MCN (mucinous cystic neoplams)

🦀Malignant (sx)
- Cystic neuroendocrine tumor (CNET)
- Solid pseudopapillary neoplasm (SPN)
- Cystic degeneration of PDAC
🎯Cyst fluid CEA >192 distinguishes between mucinous vs. non-mucinous BUT not malignant vs. non-malignant ($$$)

🌟Cyst fluid glucose <50 costs significantly ↓ & does the same as CEA

🎖️CEA and glucose can be combined for even higher sensitivity and specificity
Read 8 tweets
🌟Pancreatic cancer (PC) Screening by @MajumderShounak #IMPACT #gitwitter

Why care about screening for PC?
10th leading cancer 🦀diagnosis in 🇺🇸 but 3rd leading cancer☠️with 5-year survival is only 11%

🎯Current recommendations suggest against PC screening unless "high-risk" ImageImage
Define "High-risk individual" (HRI)?
1⃣Age
2⃣Fam hx of PC (dx age, relationship)
3⃣Germline mutations

‼️Familial PC = ≥2 first-degree relatives (FDR)
☠️If 2 FDR 6x risk
☠️If 3 FDR 32x risk

🦀Genetic mutations assoc with PC (5.5% cases) - CDKN2A, TP53, MLH1, BRCA2, ATM,
BRCA1
🔍Begin screening age 50 or 10 years younger than the earliest relative affected by PC

Peutz-Jeghers Syndrome (STK11/LKB1)—Age 35
Hereditary Pancreatitis (PRSS1)—Age 40
Familial atypical multiple mole melanoma syndrome (CDKN2A)—Age 40
Read 7 tweets
1/📣#GITwitter last but not least
#ShortBowelSyndrome #MNIBDTweetorial🧵w @valcohranmd @DCharabaty

🤝Role of MDT 4 strongest 💪team
🏥Intestinal rehab. program breakdown

🏆#CME ℹ️bit.ly/40OZTdp
Support by an edu grant from @TakedaPharma

📌Where r u in your career?
2/#MondayNightIBD #ShortBowelSyndrome #MedTwitter #GITwitter #MedPeds #BonumCE

🟠Earn #CME 🏆on Twitter!
🟠Full CME ℹ️ 🔗bit.ly/40OZTdp

📸 Faculty disclosures & important CME info 👇 Image
3/#MondayNightIBD
#IBDPoll 1️⃣

➡️50-yo pt w 1y hx of SBS after multiple short bowel resections for stricturing Crohn’s
Labs show dehydration & nutrient deficiencies
U discuss initiating #ParenteralNutrition

➡️You focus on educating pt on which of the possible complications...
Read 21 tweets
MEGA 🧵‼️

#Ramadan and #IBD: Should folks with IBD fast?

This one is a 5-part tweetorial because it deserves due diligence

A data desert 🌵 so I’ll do my best & apologies in advance for what I forget or omit

Let’s dive in! @southasianIBD @ibdtweets @ibddoctor

🧵
1/
One way to try and understand the relationship between Ramadan fasting & IBD is by subgroups:

1️⃣ patients with IBD in remission
2️⃣ hospitalized with active disease
3️⃣ undifferentiated IBD patients
4️⃣ animal models of fasting & IBD
5️⃣ extrapolations from rheumatology

2/
1️⃣ #IBD PATIENTS IN REMISSION

⬇️

Available data from 🇮🇷 suggests
🥁🥁🥁

this group is NOT at risk of ⬆️ symptom burden while fasting ‼️🤷🏽

shorturl.at/GSU48

3/
Read 23 tweets
[World #IBSAwarenessMonth] Dear #HCPs👩‍⚕️ & #Microbiota community👨‍🔬, April is dedicated to raising awareness about #IrritableBowelSyndrome

During the month, @Microbiota_Inst will provide you with content about #IBS, a common & complex #disease

#GutHealth #LetsTalkIBS #thread👇 Image
[World #IBSAwarenessMonth]

🔎 You will:
👉better understand the🔗between #IBS & #microbiota
👉discover potential ways to manage the #disease
👉learn to make a #diagnosis with our #CME courses, #videos & a professionally designed #tool
👉improve communication with your #patients
[World #IBSAwarenessMonth]

1️⃣ In this sequence, learn more about the link between #microbiota and #IrritableBowelSyndrome.

#IBS #MedTwitter #GITwitter #GutHealth #LetsTalkIBS #DGBI #FGID #GIfellows #TakeIBSSeriously

Take a look! 👇 Image
Read 17 tweets
☪️ #4 and #5!
One of my personal favorite intersections: #Ramadan and #NAFLD

Things that are established: Ramadan fasting does not make fatty liver disease worse

But does it make it better?
The empiric answer would be YES, but how? let’s dive into the nuance
🧵1/
Observational data suggest that in patients with #fattyliverdisease, Ramadan tends to ⬇️ LFTs and ⬆️glycemic function

tinyurl.com/bdctcav8

Retrospective data seems to agree with this:

tinyurl.com/2nwd5zhc

These changes involve ⬇️ in A1c, BMI, and FIB4 scores❗️

2/
So the available data (though limited) establishes that Ramadan fasting seems to improve LFTs and leads to valuable reductions in disease-related indices like fibrosis scores

The more interesting question though, is

HOW❓🧐

3/
Read 9 tweets
80 yo M. Known cardiovascular disease and anemia. Acute abdominal pain and vomit.

Diagnosis? Only ONE answer is correct 😉

#radres #futureradres #FOAMrad #FOAMed #GITwitter #Endoscopy #GIpath

1. Ischemic colitis
2. IBD
3. Tumor
4. None of the above
Correct answer: None of the above. Why?

This is a case of ischemic colitis AND colon cancer⬇️

Were you able to pick up both? Can you see the difference?
Learning points
🌟Satisfaction of search bias (CAREFUL!)

🌟There is a known ASSOCIATION between is ischemic colitis and tumor. Different patterns can be seen.

Old but useful paper to check out if you would like to learn more 🤓
Read 3 tweets
Do you have an undiagnosed patient despite exome sequencing? 🤔

It could be a repeat expansion disorder.

Here are 5 scenarios that should make you think of a repeat expansion disorder in adults. 🧵

#GeneChat #MedTwitter
1/5
A 21 y man with slurred speech who is experiencing difficulty with coordination and balance over the last several years. He fatigues easily.

Diagnosis: Friedreich's ataxia
Genetics: GAA repeat expansion in the 1st intron of FXN
Inheritance: Autosomal recessive

#Neurology
2/5
A 25 y woman with hot flashes and irregular menses over the last several months (early menopause).

Diagnosis: Fragile X-associated primary ovarian insufficiency (FXPOI)
Genetics: CGG repeat expansion in the 5' UTR of FMR1
Inheritance: X-linked

#OBGYN
Read 7 tweets
1/15

📢The recent ACG Guidelines on biliary strictures

👉Focus on DRAINAGE principles

🔥A Tweetorial #GITwitter @AmJGastro
2/15
Goals of drainage

▶️to alleviate symptoms (when present),

▶️to reduce serum bilirubin for chemotherapy can be safely administered (typically 2.5–3.5 mg/dL) and

▶️to optimize surgical outcome
3/15
Extrahepatic stricture due to a benign condition,

👉fcSEMS over multiple plastic stents(MPS)

▶️12 months MPS or
▶️6 months fcSEMS,
🔥some evidence suggests 12 months of fcSEMS therapy is advantageous (exchange at 6 months).
Read 16 tweets
A 44-YO♂️, stayed in a rural cottage of France 2 weeks previously: cramping upper abdominal pain with watery diarrhea.
He had passed what he thought were worms in his feces
Eosinophilia
1/6

doi.org/10.1093/cid/ci…
#GITwitter #IDtwitter #microbiology “Worm” specimen brought to clinic by patient (petri dish
The specimens: identified as the larvae of the drone fly, Eristalis tenax
These larvae are 2.5–3 cm in length; the posterior tube gives them the name of “rat-tailed maggots”

INTESTINAL MYASIS CAUSED BY ERISTALIS TENAX LARVA
2/6

doi.org/10.1093/cid/ci…
#parasites #GIPath #Doctor “Worm” specimen brought to clinic by patient (petri dish
Myiasis caused by E. tenax:
✔️rare but have been
✔️reported from various countries including Europe
✔️most often intestinal myiasis, but cases of infestation of the nasal cavity, urinary tract, and vagina have been described.
3/6

#Doctor #MedStudentTwitter
Read 6 tweets
A 57-YO Mexican♀️, works on a farm has several pets, including dogs, at home: epigastric fullness, and a 15-pound weight loss.

CT: complex cystic left liver mass.
1/5

doi.org/10.1093/cid/ci…
#gastroenterology #radiology #medicine
Resection: Cyst wall (red➡️), daughter cysts (*) normal liver tissue (yellow⬅️)
🔬acellular laminated wall (*), inner germinal layer (black⬅️), & protoscoleces surrounded by a broad capsule (green⬅️). Refractile hooklets (blue⬅️) & calcareous bodies (red⬅️)
2/5
#GIPath #IDtwitter
ECHINOCOCCAL CYST

The patient underwent total excision of the cyst followed by albendazole therapy for 4 weeks.
3/5

doi.org/10.1093/cid/ci…

#microbiology #GITwitter #MedStudentTwitter
Read 5 tweets
🔥Crohn’s Perianal Fistula - #MondayNightIBD w all🌟faculty 🔥 CME 👉 bit.ly/CPF2 🔸Supported by an edu grant from @TakedaPharma 🔸 twitter.com/i/broadcasts/1…
2/#MondayNightIBD #Crohns #PerianalFistula #MedTwitter #GITwitter

✅Answer #IBDPolls👇
🗓 Mark your calendar - Live Q&A @ 8p ET/5p PT
📲Tweet your❓to be addressed Monday!

📸 Faculty disclosures & important CME info👇 Image
Read 11 tweets
A 29-YO♂️, 6 months before, HIV + & non–drug-resistant pulmonary tuberculosis, antiretroviral & 4-drug antituberculous therapy initiated but soon reduced to rifampin & isoniazid only: abdominal pain on the L side
CT: ?
1/5

DOI: 10.1056/NEJMicm2206174
#radiologist #GITwitter
CT: an enlarged spleen with numerous hypodense lesions (A).
CD4 cell count: 119/mm3
VIH viral load: 1778 copies/mm3

A splenectomy was performed to evaluate for cancer:
numerous necrotic nodules with purulent discharge (B).
2/5

#microbiology #gastroenterology #IDtwitter
🔬granulomatous inflammation with caseous necrosis (C) and acid-fast bacilli (D, arrowheads).
A tissue🧫: ➖

PCR: ➕for Mycobacterium tuberculosis

SPLENIC TUBERCULOSIS
3/5

#bacteriology #MedTwitter #GIPath
Read 5 tweets
Been a while since I’ve done one of these.

A recent personal health related saga motivated me to put this one together. 👇

A 🧵

1/
First off, I am now fully recovered.

Thankful to the fantastic clinical teams @WRBethesda for the excellent and timely care provided. 🙏

2/
3 months ago, I began having post-prandial epigastric abdominal pain lasting 30-90 mins would resolve spontaneously…until one night, it just didn’t.

Pain 10/10. Could not sit still, constant with intermittently colicky. Went to the nearest ED.

3/
Read 18 tweets
📣#GITwitter
Join⚕️@DCharabaty @AmyLightnerMD #DrMarlaDubinsky+ Brandon Pomish 4 #Crohns #PerianalFistula

🗓️#CPF #MNIBDWebinar Sat 2/11
🎯MultiD Mgmt
🎯Stem Cell Therapy
🎯#PatientExperience

🆓#CME👉bit.ly/CPF-MNIBD-CME
🗳️#IBDPolls👇
🔸Supported by an edu grant @TakedaPharma ImageImage
2/#PreConvo #IBDPoll 1️⃣
#MNIBDWebinar #Crohns #PerianalFistula #CPF

🆓#CME🔗bit.ly/CPF-MNIBD-Pre2

🟢The addition of which of the following to an anti-TNF agent is associated with a higher rate of #Crohns #PerianalFistula CPF healing vs the anti-TNF agent alone?
Read 7 tweets
📣#GITwitter #PedsGI

⚕️Join experts @valcohranmd @Subramanian1MD ⚕️& @DCharabaty addressing the long & the short of:

🎯Optimizing care of #ShortBowelSyndrome

🏆🆓 #CME 🔗bit.ly/3wLGPzF
Supported by an edu grant @TakedaPharma
2/#MondayNightIBD #GITwitter #PedsGI #MedEd #MedTwitter #MNIBDWebinar #BonumCE

Earn 🆓 #CME 🎫
ℹ️ 🔗 bit.ly/3wLGPzF

📸 Faculty disclosures & important CME info 👇 Image
3/#MondayNightIBD #GITwitter #PedsGI #MedEd #MedTwitter #MNIBDWebinar #BonumCE

🟠Full CME ℹ️ 🔗bit.ly/3wLGPzF
🟠Make sure you answer the pre-polls! 👉 bit.ly/3JOd7BU

🔴 Where are you in your career?
Read 12 tweets
👋#PedsGI #GITwitter
🗓️Feb 6-Join @Subramanian1MD @valcohranmd @DCharabaty

🔦#ShortBowelSyndrome
⬆️⬇️ Safety & efficacy of med tx
🔑4 your practice

🆓#CME👉bit.ly/3wLGPzF
Support by an edu grant from @TakedaPharma

🗳️#PreConvo #IBDPolls👇
🟢Where are u in ur career?
#PreConvo #IBDPoll 1️⃣

🆓#CME🔗bit.ly/3kN8m0Y

🟢The GLP-2 analog teduglutide was shown in clinical studies to be associated w/ which of the following outcomes?
#PreConvo #IBDPoll 2️⃣

🆓#CME🔗bit.ly/3kN8m0Y

🟢Young adult pt w/ SBS is experiencing significant diarrhea (≥20 BM/day) despite tx w 8 mg/day loperamide.

Appropriate mgmt includes _____
Read 5 tweets
Live Q&A: Best of UEG Week 2022 twitter.com/i/broadcasts/1…
#GITwitter #MondayNightIBD
⭐️⭐️⭐️NOW - Best of #IBD @ #UEGWeek Q&A w all-star faculty ⭐️⭐️⭐️
In collab w @my_ueg
TWEET your❓❓❓below ⬇️
Supported by edu grants from @abbvie & BMS⭐️⭐️⭐️

Join now w/ @CharlieMuz @DCharabaty @Iris_Dotan @MRegueiroMD

📲Tweet your❓below Image
3/#MondayNightIBD #UEGWeek

📍Where are you in your career?
Read 8 tweets
@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma 2/ #MondayNightIBD #ShortBowelSyndrome #MedTwitter #GITwitter #MedPeds @BonumCe

🟠Earn #CME 🏆on Twitter!
🟠Full CME ℹ️ 🔗bit.ly/3Hgnpcf

📸 Faculty disclosures & important CME info 👇 Image
@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma 3/#MondayNightIBD

💊💉Meds = important 🛠 in mgmt of #ShortBowelSyndrome

💎Antimotility & antisecretory agents frequently used to control stool loss
💎Incl loperamide, diphenoxylate w atropine, codeine, & tincture of opium
💎Most effective ~30 min B4 meals & @ bedtime 🛏
@MondayNightIBD @DCharabaty @BonumCe @TakedaPharma 4/Growth factors also available for #ShortBowelSyndrome
🚦Somatropin (rhGH) approved in SBS
🛑Use largely discontinued due to unacceptable toxicity & modest long-term efficacy

#MondayNightIBD
Read 23 tweets
🔥 Emoroid Digest 🔥

Happy New Year! Starting off the new year with Dr. Vachaparambil's @CicilyVachaMD summary of the @AmerGastroAssn guidelines on systemic therapy for HCC!

#EmoroidDigest #GITwitter #MedTwitter ImageImage
🔑🔑🔑:
💊 systemic tx in🧑‍🤝‍🧑with preserved liver function
📈 AFP impacts 💊 choice
🤮 side effects & tx response guide 💊

Dr. Grace Su, Dr. Osama Altayar, Dr. Robert O’Shea, @Jarshah4, Dr. Bassam Estfan, Dr. Candice Wenzell, @sultanshaz, Dr. Yngve Falck-Ytter
Read 4 tweets

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