Discover and read the best of Twitter Threads about #liverstory
Most recents (4)
An older man comes to the ED with abrupt onset nausea, & diarrhea
He is joined by her daughter whom he is visiting from abroad
Testing is below
The diagnosis is unclear
Until his daughter got just as sick too
🧵
#livertwitter #liverstory #MedTwitter
He is joined by her daughter whom he is visiting from abroad
Testing is below
The diagnosis is unclear
Until his daughter got just as sick too
🧵
#livertwitter #liverstory #MedTwitter
ALT >1000 has a narrow differential diagnosis
There's lots of tests you can order.
But most diagnoses are made in the H+P
Like this one
In fact, in this case, my attending said the diagnosis was obvious from the beginning
Just not to me
There's lots of tests you can order.
But most diagnoses are made in the H+P
Like this one
In fact, in this case, my attending said the diagnosis was obvious from the beginning
Just not to me
When I meet someone with ALT>1000, I think:
1⃣Ischemic hepatitis. Right 🫀failure? 🫀-genic shock? Cool legs?
2⃣Biliary 🪨. Pain? imaging!
3⃣Drug induced liver injury. Tylenol? Run every med through livertox.gov
4⃣Viral hep. Hep A/B/C
But these weren’t the answers
1⃣Ischemic hepatitis. Right 🫀failure? 🫀-genic shock? Cool legs?
2⃣Biliary 🪨. Pain? imaging!
3⃣Drug induced liver injury. Tylenol? Run every med through livertox.gov
4⃣Viral hep. Hep A/B/C
But these weren’t the answers
1/38 "Next patient is a nun referred from DM Hospital"
My OPD staff tells me
"Severe hepatitis without a cause"
I sit up excited, also terrified
Excited, I get to serve people who bought me into this world Terrified, as they were competent to diagnose hepatitis, but couldn't.
My OPD staff tells me
"Severe hepatitis without a cause"
I sit up excited, also terrified
Excited, I get to serve people who bought me into this world Terrified, as they were competent to diagnose hepatitis, but couldn't.
2/38 Nuns at DM hospital ensured my mother was taken care of when she delivered me, many decades before.
They were pleasant, caring, comforting. DM hospital was well known for its services; it catered to a lot of patients, many very sick
A direct referral was always challenging.
They were pleasant, caring, comforting. DM hospital was well known for its services; it catered to a lot of patients, many very sick
A direct referral was always challenging.
3/38 I watch as two nuns enter my room and seating in front, they show me a liver test - the enzymes - AST & ALT were in 2000's with a hind of jaundice - the bilirubin was 3.2 mg/dl (clinical jaundice is when bilirubin is >3)
"I was a young nun, the time when you were born,"...
"I was a young nun, the time when you were born,"...
A patient with diabetes and recent NSTEMI treated with stent, clopidogrel, and atorvastatin ~2 months ago is transferred from OSH with ALT 1500, bilirubin 15
The leading diagnosis is statin liver injury
But that's not what it is.
Not at all
🧵
#livertwitter #liverstory
The leading diagnosis is statin liver injury
But that's not what it is.
Not at all
🧵
#livertwitter #liverstory
When she went to OSH, a bunch of tests were ordered
Blood tests (HCV ab, HAV, HBV surface antigen and core IgM, ANA, ASMA, IgG...) - all negative
Imaging (ultrasound, MRI) - nothing, no stones
OSH: It had to be the statin!
Narrator: But it wasn't
Blood tests (HCV ab, HAV, HBV surface antigen and core IgM, ANA, ASMA, IgG...) - all negative
Imaging (ultrasound, MRI) - nothing, no stones
OSH: It had to be the statin!
Narrator: But it wasn't
Statin induced liver injury is super rare. Consider it but dont close your mind to other possibilities.
If you want rates of injury, just ask @bjornsson_s who studied the Swedish national register in this @JHepatology paper. sciencedirect.com/science/articl…
If you want rates of injury, just ask @bjornsson_s who studied the Swedish national register in this @JHepatology paper. sciencedirect.com/science/articl…
A patient with #cirrhosis and hepatic hydrothorax was admitted to an ICU 3 times for severe shortness of breath and hypoxia for urgent thoracentesis and diuretics
So we put in an indwelling catheter
Within weeks the output was minimal
What happened?
🧵
#livertwitter
So we put in an indwelling catheter
Within weeks the output was minimal
What happened?
🧵
#livertwitter
This patient had ascites (weekly paras), hydrothorax, & high MELD including INR of 1.9, and plt 32.
She was small, weak. Sarcopenic.
Her creatinine 1.3.
She was small, weak. Sarcopenic.
Her creatinine 1.3.
Did you know that creatinine over-estimates renal function in women with #cirrhosis?
See MELD-Grail: aasldpubs.onlinelibrary.wiley.com/doi/abs/10.100… @AsraniSumeet
See MELD-Grail: aasldpubs.onlinelibrary.wiley.com/doi/abs/10.100… @AsraniSumeet
