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Elliot Tapper @ebtapper.bsky.social · 30/08/2025

1 in 5 Greek puppies with chronic kidney disease have advanced liver disease and it is the liver disease that is most linked to poor quality of life

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Elliot Tapper @ebtapper.bsky.social · 14/07/2025

doi:10.1001/jamanetworkopen.2025.19426

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Elliot Tapper @ebtapper.bsky.social · 09/07/2025

Wake up new cause of liver enzyme elevation just dropped

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Elliot Tapper @ebtapper.bsky.social · 28/06/2025

They are establishing upper limits of normal for ammonia in pets Thank you for your attention to this matter!

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Elliot Tapper @ebtapper.bsky.social · 14/06/2025

Here's how I put it together And if you treat based on poor quality of life you can go back and ask "do you feel better" "are you falling less" and that helps a lot! (BABS - a score with bilirubin, albumin; OGTT - a physiological test / glutamine challenge)

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Elliot Tapper @ebtapper.bsky.social · 14/06/2025

It turns out that the answer to the question "What is the impact of cirrhosis on your daily activity" predicts overt HE! Even more so when you combine with disease severity and frailty.

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Elliot Tapper @ebtapper.bsky.social · 14/06/2025

So what can we do about it? Think about WHY people develop HE Disease severity, Sarcopenia, and so on Find the high risk group and then treat them? Studies are ongoing For now we need to make sure our decisions are based on something where we know the patient is benefiting.

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Elliot Tapper @ebtapper.bsky.social · 14/06/2025

It turns out that comorbidities, specific causes of liver disease, and demographics impact performance on cognitive testing The problem is that the cutoff for 'disease' is not based on the risk of overt HE. And it is based on selected patients without many comorbidities!

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Elliot Tapper @ebtapper.bsky.social · 14/06/2025

Second, a cutoff diagnostic of covert HE is just ... a number. And it is based on cognitive performance Cognitive performance is impacted by so many things! Cutoffs on one validated test from Wisconsin would classify CONTROLS as sick in Virginia! WHY????

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Elliot Tapper @ebtapper.bsky.social · 14/06/2025

But there are problems First, many people withOUT covert HE can get overt HE

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Elliot Tapper @ebtapper.bsky.social · 14/06/2025

And abnormal values are bad! We call this covert hepatic encephalopathy They predict overt hepatic encephalopathy (the delirium, the coma), and identify patients with unmet needs

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Elliot Tapper @ebtapper.bsky.social · 14/06/2025

Many people know about cognitive testing to predict hepatic encephalopathy The classic is a collection of timed paper-pencil tests. There are easier tools like the EncephalApp Stroop or animal naming test. You get a number and determine abnormal values by comparison to controls

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Elliot Tapper @ebtapper.bsky.social · 14/06/2025

Hepatic encephalopathy is horrible It can present as disorientation and coma. But often causes poor quality of life, falls, and other trauma We want to prevent it. How can we predict it?

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Elliot Tapper @ebtapper.bsky.social · 05/06/2025

DDAVP for bleeding with incisions. Meh pubmed.ncbi.nlm.nih.gov/3513867/

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Elliot Tapper @ebtapper.bsky.social · 29/05/2025

There are two articles in NEJM this year that say naltrexone is 'contraindicated for cirrhosis'. This saddens me. It is not supported by an evidence. Alcohol is 'contraindicated for cirrhosis'. That is supported by evidence

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Elliot Tapper @ebtapper.bsky.social · 07/05/2025

We have work to do!!! journals.lww.com/hepcomm/full...

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Elliot Tapper @ebtapper.bsky.social · 12/04/2025

A study by Perez-campuzano and @juanc60.bsky.social that randomizes patients with portal hypertension to two terlipressin strategies and octreotide and shows no significant change in portal pressure #liversky

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Elliot Tapper @ebtapper.bsky.social · 04/04/2025

Let’s talk about sex journals.lww.com/hepcomm/full... #liversky

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Elliot Tapper @ebtapper.bsky.social · 04/04/2025

An early look at how resmetirom is being used and impacts patients with MASH journals.lww.com/hepcomm/full... #liversky

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Elliot Tapper @ebtapper.bsky.social · 31/03/2025

Congrats to Thailand for nearly eliminating vertical transmission of hepatitis B The vaccine works doi.org/10.12932/ap-...

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Elliot Tapper @ebtapper.bsky.social · 26/03/2025

“Moderate” alcohol-associated hepatitis MELD < 20 journals.lww.com/hepcomm/full... #liversky

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Elliot Tapper @ebtapper.bsky.social · 23/03/2025

Australia has so many beautiful animals This guy just walked up to me

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Elliot Tapper @ebtapper.bsky.social · 23/03/2025

When the bilirubin is high (or goes higher), I worry first about infection In this study, the ATTIRE team shows that bilirubin predicts infection in hospitalized patients journals.lww.com/hepcomm/full...

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Elliot Tapper @ebtapper.bsky.social · 22/03/2025

Went to Sydney, saw one of the most innovative GI units in the world (led by Amany Zekry), met the trainees at the St George (future of Australian GI) and got tips on being a journal editor from a world class human (Emad El-Omar)

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Elliot Tapper @ebtapper.bsky.social · 22/03/2025

The Burger King gets a shout out from Dr Penny Hey journals.lww.com/ctg/fulltext...

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Elliot Tapper @ebtapper.bsky.social · 22/03/2025

Ascites is like carrying around a hot tub: Huge energy bill! 1⃣Kilocalorie= energy to 🔥1L by 1°C 2⃣Ascites=Heating ~5-10L to 36°C 24hrs/day 3⃣Energy comes from body breakdown (sarcopenia) If you⬇️ascites➡️the energy bill falls Help patients. ⬇️the ascites!!! #liversky

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Elliot Tapper @ebtapper.bsky.social · 15/03/2025

Deceit, as this study shows, is one way to maximize the placebo effect doi.org/10.1053/j.ga... But there is a better way That way is caring, empathy, and connection - slow down the visit by 1 minute and make a big difference (some evidence in next slide)

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Elliot Tapper @ebtapper.bsky.social · 14/03/2025

Hot take on hepatic encephalopathy Is encephalopathy without an elevated ammonia not hepatic at all? Editorial by ADR and Montagnese: pubmed.ncbi.nlm.nih.gov/40073275/ Original pubmed.ncbi.nlm.nih.gov/39879584/ #liversky

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Elliot Tapper @ebtapper.bsky.social · 12/03/2025

A cascade of unnecessary tests - and their harms Patient with ALL and stem cell txp has varices But HVPG was ⬇️ So had EUS-PPG with ⬆️ HVPG but caused portal thrombosis Eventually starts carvedilol Rewind 1. Classic story for NRH 2. Found varices, pressures not needed 3. Just start coreg #liversky

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Elliot Tapper @ebtapper.bsky.social · 09/03/2025

From @usatoday.com: Some protein recommendations In #cirrhosis clinic, you need to know simple and cheap sources of protein. Eggs used to be a go-to but the world is changing #liversky

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Elliot Tapper @ebtapper.bsky.social · 09/03/2025

The connection between heart rate and propranolol effectiveness for variceal bleeding prevention has always been weak to nonexistent for nearly 40 years A zombie myth, even here’s another study showing that doi.org/10.1111/cts.... #liversky

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Elliot Tapper @ebtapper.bsky.social · 09/03/2025

This is an interesting letter to the editor that highlights the pitfalls of poorly validated ICD-10 codes and confirms my growing concerns with the increasingly popular but alarmingly weak TriNetX database and platform @zachsmithgi.bsky.social #gisky #liversky

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Elliot Tapper @ebtapper.bsky.social · 04/03/2025

Spicy! Adding lasix to the management of hepatorenal syndrome might be ok if you bump the MAP with pressors @juancarlosqvelez.bsky.social doi.org/10.1016/j.ek... #nephsky #liversky

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Elliot Tapper @ebtapper.bsky.social · 03/03/2025

Itching sucks If your patient with PBC is suffering from itch, it is time to kick it up a notch There are too many options these days to let people continue scratching themselves sick journals.lww.com/hepcomm/full... #liversky

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Elliot Tapper @ebtapper.bsky.social · 02/03/2025

One need not worry about bleeding when banding varices in patients with low platelets I am not sure why this study excluded people with platelets less than 30 Nevertheless … doi.org/10.3390/dise... #liversky

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Elliot Tapper @ebtapper.bsky.social · 02/03/2025

When I treat autoimmune hepatitis, I start at 20mg of prednisone and then I taper super slowly while the azathioprine (or MMF) takes effect What do you do, #liversky? Here’s a study that looks at rapid vs non-rapid tapers (retrospectively) doi.org/10.1016/j.ja...

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Elliot Tapper @ebtapper.bsky.social · 02/03/2025

Kidney experts recommend tracking symptoms for patients on dialysis and incorporating nurses www.kireports.org/action/showP... I recommend that #nephsky involve patients to help prioritize specific symptoms And to push limited surveys to people through the EMR

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Elliot Tapper @ebtapper.bsky.social · 02/03/2025

Sarcoid of the liver Interesting pictures Most of us use urso, and makes enzymes better. Outcomes?! Would like to know #liversky doi.org/10.1111/liv....

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Elliot Tapper @ebtapper.bsky.social · 02/03/2025

Have always been a sucker for remote ischemic preconditioning trials Don’t know why but I love them This one did it for hepatectomy to prevent reperfusion injury #liversky doi.org/10.1111/liv....

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Elliot Tapper @ebtapper.bsky.social · 02/03/2025

Interesting case report: A colon cancer is found. Biopsies show dysplasia but a snares fragment shows cancer. I like the idea of snaring more tissue But I 100% disagree that I would do another colonoscopy if I didn’t prove cancer. What you see is what you get #gastrosky

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Elliot Tapper @ebtapper.bsky.social · 02/03/2025

Other sites are down (eRA commons) but have used pubmed

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Elliot Tapper @ebtapper.bsky.social · 01/03/2025

Even better @laurennephewmd.bsky.social is actively building interventions to reduce disparities by involving the patients in their design journals.lww.com/hepcomm/full...

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