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

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/ 

Thread 2/9

#PAGastro

Etiology?
-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

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/ )

Thread 5/9

#PAGastro

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

Thread 6/9

#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

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

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

Check out this thread on #sarcopenia above ^^^
@RuchitShahDO @RaviGhanta5 @mosesmedlaw @FITWITMD @BriannaShinn @KeerthiShahDO
@shanny_DO @GIStern3 @Neena_MD @austinchiangMD