Derek

CIRRHOSIS I urge every #MedTwitter student, graduate and young fellows of Gastroenterology and Hepatology to read this brilliant review on "Diagnosis & Management of Cirrhosis" in @JAMA_current by @ebtapper & @NDP1001 Here are some important & some additional points on cirhosis for non-medical people from the manuscript: 1️⃣ The major cause for cirrhosis is changing - alcohol use and non-alcoholic fatty liver [NAFLD] alone or in combination has surpassed hepatits C in the USA because hepatitis C infection is now curable. In India it is still alcohol, but NAFLD is catching up. 2️⃣ One does not NEED to be an "ALCOHOLIC" to develop cirrhosis. In the presence of other risk factors, such as diabetes, obesity and high blood pressure or even the presence of a specific gene mutation called PNPLA3, even mild to modest amount of alcohol use can promote cirrhosis. The amount of alcohol safest for your liver is zero ml. 3️⃣ The gold standard for cirrhosis diagnosis is a liver biopsy which is invasive, but confirmatory. But this is no more required as newer techniques such as Shearwave scan that measure liver stiffness (value >15) can do the same. 4️⃣ Cirrhosis is no more considered an irreversible disease. Early stages of cirrhosis and stable stages of advanced cirrhosis can undergo regression/reversal with correct treatment of its cause(s). 5️⃣ The major complications of cirrhosis include rupture of large veins (called varices) in the digestive tract that present as blood vomiting or black tarry stools; development of fluid in abdomen (ascites), brain dysfunction (from sleep disorders to confusion and coma, called encephalopathy), life threatening infections, kidney injury and liver cancer. 6️⃣ A large part of management of cirrhosis is still MEDICAL while major life threatening complications and those that are unmanageable with medicines & recurr require transplantation for cure. 7️⃣ Apart from major complications there are minor complications that are STILL major for the patient, resulting in poor quality of life. These need to be asked for, identified and addressed. These include: [treatments based on small, but good quality trials]👇 ➡️Severe recurrent itching ✅️Treatment: Moisturizers, hydroxizine ➡️Severe muscle cramps ✅️Treatment: Sipping pickle brine/juice at onset of cramps, vitamin E+carnitine, prevented using taurine 1000mg per day. ➡️Reversal of sleep, daytime sleepiness ✅️Treatment: Lactulose syrup. ➡️Sexual dysfunction in men, mostly among those who consume alcohol ✅️Treatment: Tadalafil. 8️⃣ Not all patients are diagnosed with cirrhosis at a stable stage. Approximately 40% are diagnosed during the time they present with a major complication. Some are even diagnosed with advanced liver disease and liver cancer on routine testing without any symptoms at all. 9️⃣ Remember alcohol use is an avoidable cause for cirrhosis. Alcohol in mild or modest amounts is also an avoidable cause for cirrhosis in those with additional risk factors and in those diagnosed with cirrhosis, no amount of alcohol is advisable. There should be lifetime abstinence. 🔟 Common concerns/myths⬇️ ➡️Low platelet counts in cirrhosis does not need any treatment and low platelet counts does not lead to any symptoms. A count above 50,000 is adequate in cirrhosis patients. ➡️There is no liver detox. Liver detoxes are wellness frauds that can in all likelihood, harm the liver. ➡️Swelling of the legs in cirrhosis is not a complication of cirrhosis, it is a feature of the disease due to multiple reasons such as low protein/albumin, varicose veins, slow lymphatic drainage from legs etc. ➡️There is no specific diet for liver health. Overall general health also includes good liver health. Any person who prescribes, advertises or sells specific liver health solution only wants your money. ➡️Whey protein does not damage the liver. It is safe for use. ➡️Fruits and veggies combinations as juices or blended infusions or as a predominant dietary component compromising protein in diet does not improve "liver health." There are no specific fruits or vegetables that specifically improve liver health. ➡️Processed and ultraprocessed foods, sugary diets, fructose-based foods (including an overconsumption of fruit in diet) are ours and our children's greatest enemies when it comes to fatty liver disease. FULL PAPER LINK HERE jamanetwork.com/journals/jam…