Ever notice temporal wasting, thin extremities and increasing weakness in your patients with cirrhosis?
Check out this tweetorial on #sarcopenia.

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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/ ">https://pubmed.ncbi.nlm.nih.gov/24935609/...

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Etiology?
-Nutritional imbalance from inadequate protein/calorie intake
-Malabsorption leading to vitamin/micronutrient deficiency

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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/ )">https://pubmed.ncbi.nlm.nih.gov/30668935/...

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Also, it has been associated with higher waitlist mortality https://pubmed.ncbi.nlm.nih.gov/32240717/ ,">https://pubmed.ncbi.nlm.nih.gov/32240717/... and can also indicate functional decline.

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How to diagnose? a. Subject Global Assessment.
b. Liver Frailty Index (LFI) entering them in calculator https://liverfrailtyindex.ucsf.edu/ ">https://liverfrailtyindex.ucsf.edu/">... using:
+Grip strength
+Timed chair stands
+Balance testing

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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

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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.

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Content provided by: @VivianOrtizMD
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