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Ever notice temporal wasting, thin extremities and increasing weakness in your patients with cirrhosis?
Check out this tweetorial on #sarcopenia.
Thread 1/9
#PAGastro #medtwitter #livertwitter
Content provided by: @VivianOrtizMD
Check out this tweetorial on #sarcopenia.
Thread 1/9
#PAGastro #medtwitter #livertwitter
Content provided by: @VivianOrtizMD
What is it anyway? Loss of muscle mass and function.
-Recognized in the elderly, but very important in cirrhosis where estimated to be present in anywhere from 30 to 70% of them. Not accounted by MELD-Na score. https://pubmed.ncbi.nlm.nih.gov/24935609/
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#PAGastro
-Recognized in the elderly, but very important in cirrhosis where estimated to be present in anywhere from 30 to 70% of them. Not accounted by MELD-Na score. https://pubmed.ncbi.nlm.nih.gov/24935609/
Thread 2/9
#PAGastro
Etiology?
-Nutritional imbalance from inadequate protein/calorie intake
-Malabsorption leading to vitamin/micronutrient deficiency
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#PAGastro
-Nutritional imbalance from inadequate protein/calorie intake
-Malabsorption leading to vitamin/micronutrient deficiency
Thread 3/9
#PAGastro
Etiology (continued)?
-lower testosterone so lose the anabolic effect in muscle
-Role of microbiome?
-Higher inflammatory cytokines that increase protein degradation?
Thread 4/9
…https://pubmed-ncbi-nlm-nih-gov.proxy.library.upenn.edu/31632663/
#PAGastro
-lower testosterone so lose the anabolic effect in muscle
-Role of microbiome?
-Higher inflammatory cytokines that increase protein degradation?
Thread 4/9
…https://pubmed-ncbi-nlm-nih-gov.proxy.library.upenn.edu/31632663/
#PAGastro
Let me show you why it’s important. Studies have shown its association with hepatic encephalopathy and ascites ( https://pubmed.ncbi.nlm.nih.gov/30668935/ )
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#PAGastro
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#PAGastro
Also, it has been associated with higher waitlist mortality https://pubmed.ncbi.nlm.nih.gov/32240717/ , and can also indicate functional decline.
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#PAGastro
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#PAGastro
How to diagnose? a. Subject Global Assessment.
b. Liver Frailty Index (LFI) entering them in calculator https://liverfrailtyindex.ucsf.edu/ using:
+Grip strength
+Timed chair stands
+Balance testing
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#PAGastro
b. Liver Frailty Index (LFI) entering them in calculator https://liverfrailtyindex.ucsf.edu/ using:
+Grip strength
+Timed chair stands
+Balance testing
Thread 7/9
#PAGastro
How to make this better?
+Physical activity (increase exercise capacity on 6-min test (DigDisSci.2014 Aug;59(8):1966-75)
+Nutrition -ensure protein consumption (may need to adjust for encephalopathy)
-Branch Chain Amino Acid supplementation
-Consider home safety evaluation
8/9
+Physical activity (increase exercise capacity on 6-min test (DigDisSci.2014 Aug;59(8):1966-75)
+Nutrition -ensure protein consumption (may need to adjust for encephalopathy)
-Branch Chain Amino Acid supplementation
-Consider home safety evaluation
8/9
That’s it folks! Hopefully I showed you how important is to evaluate for frailty in patients with cirrhosis. Check back next time for other tweetorial. As always, feel free to add anything further below.
9/9
#PAGastro #medtwitter
Content provided by: @VivianOrtizMD
9/9
#PAGastro #medtwitter
Content provided by: @VivianOrtizMD
Check out this thread on #sarcopenia above ^^^
@RuchitShahDO @RaviGhanta5 @mosesmedlaw @FITWITMD @BriannaShinn @KeerthiShahDO
@shanny_DO @GIStern3 @Neena_MD @austinchiangMD
@RuchitShahDO @RaviGhanta5 @mosesmedlaw @FITWITMD @BriannaShinn @KeerthiShahDO
@shanny_DO @GIStern3 @Neena_MD @austinchiangMD
