Paul Farkas
@gastropaul.bsky.social
Retired after 44 years of clinical practice but still addicted to GI. Lecturer. Literature nerd. Lakes, canoeing, kayaking are also happy places.
Save the kidneys! Outpt AKI in cirrhosis
🤔Defined AKI with labs up to 1 yr apart
🤔12% developed AKI in 3 year
🤔🔼 with ascites, HCC, ETOH,
👍Need to avoid/modify precpt causes: diuretics, GI losses ie with lactulose, nephrotoxins
Review of AKi emcrit.org/ibcc/aki/#top
#gisky #medsky #imsky
🤔Defined AKI with labs up to 1 yr apart
🤔12% developed AKI in 3 year
🤔🔼 with ascites, HCC, ETOH,
👍Need to avoid/modify precpt causes: diuretics, GI losses ie with lactulose, nephrotoxins
Review of AKi emcrit.org/ibcc/aki/#top
#gisky #medsky #imsky
November 23, 2025 at 1:19 PM
Save the kidneys! Outpt AKI in cirrhosis
🤔Defined AKI with labs up to 1 yr apart
🤔12% developed AKI in 3 year
🤔🔼 with ascites, HCC, ETOH,
👍Need to avoid/modify precpt causes: diuretics, GI losses ie with lactulose, nephrotoxins
Review of AKi emcrit.org/ibcc/aki/#top
#gisky #medsky #imsky
🤔Defined AKI with labs up to 1 yr apart
🤔12% developed AKI in 3 year
🤔🔼 with ascites, HCC, ETOH,
👍Need to avoid/modify precpt causes: diuretics, GI losses ie with lactulose, nephrotoxins
Review of AKi emcrit.org/ibcc/aki/#top
#gisky #medsky #imsky
Hepatic Encephalopathy with healthy liver?
🤔Pt with cognitive impairment, - neuro workup. Discharged with diagnosis of dementia, focal seizures.
👍CT lge intrahepatic portovenous shunt; Ammonia 🔼
😀Improved with PSE Rx, ultimately treated in IR
Sort of a congenital TIPS
#IMsky #GIsky #Medsky
🤔Pt with cognitive impairment, - neuro workup. Discharged with diagnosis of dementia, focal seizures.
👍CT lge intrahepatic portovenous shunt; Ammonia 🔼
😀Improved with PSE Rx, ultimately treated in IR
Sort of a congenital TIPS
#IMsky #GIsky #Medsky
November 20, 2025 at 10:38 PM
AUD Rx: Much room for improvement
🤔We Rx AUD in only <5% eligible patients!
👍Study (not ideal) showing meds tolerated in severe ALD (no adverse liver issues)
👍(Naltrexone, acamprosate) were major ones
Message: We should all be more aggressive in trying to treat AUD.
🤔We Rx AUD in only <5% eligible patients!
👍Study (not ideal) showing meds tolerated in severe ALD (no adverse liver issues)
👍(Naltrexone, acamprosate) were major ones
Message: We should all be more aggressive in trying to treat AUD.
November 17, 2025 at 1:11 PM
AUD Rx: Much room for improvement
🤔We Rx AUD in only <5% eligible patients!
👍Study (not ideal) showing meds tolerated in severe ALD (no adverse liver issues)
👍(Naltrexone, acamprosate) were major ones
Message: We should all be more aggressive in trying to treat AUD.
🤔We Rx AUD in only <5% eligible patients!
👍Study (not ideal) showing meds tolerated in severe ALD (no adverse liver issues)
👍(Naltrexone, acamprosate) were major ones
Message: We should all be more aggressive in trying to treat AUD.
Priming the Pump: Colon Prep
🤔Maeda et al AmJGastro: Linaclotide before low vol prep ➡️ better prep in "High-Risk" pts than senna
🤔Ed: suggests better tol than stimulant laxative
👍Personally found works great with large and small vol preps: especially with 🔼risk poor prep
#IMsky #GIsky #medsky
🤔Maeda et al AmJGastro: Linaclotide before low vol prep ➡️ better prep in "High-Risk" pts than senna
🤔Ed: suggests better tol than stimulant laxative
👍Personally found works great with large and small vol preps: especially with 🔼risk poor prep
#IMsky #GIsky #medsky
November 16, 2025 at 12:05 PM
Review of MASLD (Adults) in JAMA
👍Re-emphasizing value/use of the FIB-4 and follow up with elastography
👍Useful summary of therapeutic options: diet, exercise, no ETOH, considerations of Bariatric Surgery, semaglutide (GLP-1), and Resmetirom for moderate-advanced fibrosis
#IMSky #Medsky #GIsky
👍Re-emphasizing value/use of the FIB-4 and follow up with elastography
👍Useful summary of therapeutic options: diet, exercise, no ETOH, considerations of Bariatric Surgery, semaglutide (GLP-1), and Resmetirom for moderate-advanced fibrosis
#IMSky #Medsky #GIsky
November 15, 2025 at 5:58 PM
Arguments with Neph. Rectal NSAIDS and AKI
🤔Rectal NSAIDS decrease ERCP Pancreatitis
🤔Study with stage 1-3b CKD >7,000 pts each group
👍NO difference in aki and group with NSAIDS less post-ERCP pancreatitis. (Abstract at ACG)
Once got trashed for doing this.😟
#GIsky #IMsky #MEDsky
🤔Rectal NSAIDS decrease ERCP Pancreatitis
🤔Study with stage 1-3b CKD >7,000 pts each group
👍NO difference in aki and group with NSAIDS less post-ERCP pancreatitis. (Abstract at ACG)
Once got trashed for doing this.😟
#GIsky #IMsky #MEDsky
November 8, 2025 at 11:33 PM
Fear is the path to the Dark Side.... Embrace the FIB-4
👍We need to be aggressive in r/o advanced fibrosis especially in fatty liver. FIB available from common labs, MD Calc etc to quick calculation.
👍If high risk (see below) or FIB 🔼 elastography.
Crucial with Rx available
#IMsky #MEDsky
👍We need to be aggressive in r/o advanced fibrosis especially in fatty liver. FIB available from common labs, MD Calc etc to quick calculation.
👍If high risk (see below) or FIB 🔼 elastography.
Crucial with Rx available
#IMsky #MEDsky
November 5, 2025 at 7:54 PM
Alpha-Gal Syndrome...nothing to do with Wonder Woman or T Swift😟
🤔Probably missing most of this, often IBS symptoms
🤔Allergy to alpha 1,3 galactose, brought on by lone star tic bite
🤔Symptoms 2-8 hr after ingesting animal products incl milk
🤔No treatment; IgE testing available
#IMsky #Medsky
🤔Probably missing most of this, often IBS symptoms
🤔Allergy to alpha 1,3 galactose, brought on by lone star tic bite
🤔Symptoms 2-8 hr after ingesting animal products incl milk
🤔No treatment; IgE testing available
#IMsky #Medsky
November 2, 2025 at 1:34 PM
Ascites...always a controversial issue
🤔AGA Clinical Practice update on Ascites, volume overload and hyponatremia
🤔Not to restrict water till Na <125
😟Still uncertain re-role of Vaptans???
🤔Pts with refractory ascites/hydrothorax consider liver txp referral
#IMsky #medsky #GIsky
🤔AGA Clinical Practice update on Ascites, volume overload and hyponatremia
🤔Not to restrict water till Na <125
😟Still uncertain re-role of Vaptans???
🤔Pts with refractory ascites/hydrothorax consider liver txp referral
#IMsky #medsky #GIsky
October 31, 2025 at 11:31 PM
Is Shorter better? Esophageal variceal bleed
due to portal hypertension
🤔Always wondered about value of 5 days of Octreotide after successfully banding varices
😀Study: 1 vs 5 days Rx: No difference in 5 day re-bleeding or 6 week re bleeding and all cause mortality
#GIsky #IMsky #medsky
due to portal hypertension
🤔Always wondered about value of 5 days of Octreotide after successfully banding varices
😀Study: 1 vs 5 days Rx: No difference in 5 day re-bleeding or 6 week re bleeding and all cause mortality
#GIsky #IMsky #medsky
October 28, 2025 at 11:08 AM
Gastroporesis thoughts, AmJGastro 10/25 Liu etal
🤔Yearly testing for nut deficiencies: ie D; B12, Folate, Iron
🤔?Daily MVI
🤔Dietary suggestions (below)
🤔Prucalopride ?1mg especially if constipated
🤔They support gastric electrical stimulation
🤔Some differential Dx thoughts
#GIsky #IMSky #MedSky
🤔Yearly testing for nut deficiencies: ie D; B12, Folate, Iron
🤔?Daily MVI
🤔Dietary suggestions (below)
🤔Prucalopride ?1mg especially if constipated
🤔They support gastric electrical stimulation
🤔Some differential Dx thoughts
#GIsky #IMSky #MedSky
October 27, 2025 at 11:08 AM
Beware of Fake foreign bodies...in the gut
🤔Case of ?FB at EGJ Was Lanthanum Carbonate
Radio-opaque meds: CHIPES (Chloral hydrate, heavy metals, iron, phenothiazides, slow release meds) Another take on CHIPES from Gu et al Korean J Spine 9/15 attached
History is 🔑
#IMsky #GIsky #medsky
🤔Case of ?FB at EGJ Was Lanthanum Carbonate
Radio-opaque meds: CHIPES (Chloral hydrate, heavy metals, iron, phenothiazides, slow release meds) Another take on CHIPES from Gu et al Korean J Spine 9/15 attached
History is 🔑
#IMsky #GIsky #medsky
October 24, 2025 at 9:57 PM
Delta Hep: 3 articles/one editorial CinGastro&Hep
🤔Only testing 4.9% meeting AASLD Criteria
🤔HDV associated with markedly 🔼 HCC
🤔Can use PAGE-8 score (or FIB-4) to predict HCC
(On Medscape Reach-B score)
Identifying D important with new meds coming out, and interferon
#IMsky #GISky #Medsky
🤔Only testing 4.9% meeting AASLD Criteria
🤔HDV associated with markedly 🔼 HCC
🤔Can use PAGE-8 score (or FIB-4) to predict HCC
(On Medscape Reach-B score)
Identifying D important with new meds coming out, and interferon
#IMsky #GISky #Medsky
October 18, 2025 at 1:00 PM
Scan shows Fatty Pancreas. What is that anyway?
🤔Often considered incedentaloma
🤔Marin-Serrano et al in Pancreas shows associated with cardiometabolic risk factors.
🤔Associated with hepatic steatosis.
Maybe we should consider this an Early Warning Sign, and delve in.
#GIsky #IMSky #Medsky
🤔Often considered incedentaloma
🤔Marin-Serrano et al in Pancreas shows associated with cardiometabolic risk factors.
🤔Associated with hepatic steatosis.
Maybe we should consider this an Early Warning Sign, and delve in.
#GIsky #IMSky #Medsky
October 16, 2025 at 4:49 PM
Canadian GI Guidelines re non ulcer UGI Bleed (endorsed by ASGE)
🤔Bleed from NPL Rec Hemostatic spray over conventional endo therapy
🤔Mallory Weiss with non bleeding visible vessels or clots rec no hemostatic Rx
🤔GAVE: Preferred band ligation over APC, prefer APC to RFA.
#GIsky #imsky
🤔Bleed from NPL Rec Hemostatic spray over conventional endo therapy
🤔Mallory Weiss with non bleeding visible vessels or clots rec no hemostatic Rx
🤔GAVE: Preferred band ligation over APC, prefer APC to RFA.
#GIsky #imsky
October 11, 2025 at 12:06 AM
Hot Potato...Who treats Obesity?
PCP? GI? Endocrine??
Medscape Commentary: Dr. Muratore Opines that GI should treat
So many GI issues MASLD, MASH, GERD
Training pathways do exist, as well as specific courses
Often this responsibility ignored or passed off
Thoughts?
#GIsky #IMSky #Medsky
PCP? GI? Endocrine??
Medscape Commentary: Dr. Muratore Opines that GI should treat
So many GI issues MASLD, MASH, GERD
Training pathways do exist, as well as specific courses
Often this responsibility ignored or passed off
Thoughts?
#GIsky #IMSky #Medsky
October 8, 2025 at 9:50 PM