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.
Reposted by Paul Farkas
my pressor strategy hepatorenal syndrome in the ICU:
#1) start with NE gtt for immediate BP target acquisition
#2) once pt is improving, use PO midodrine to accelerate weaning off NE
midodrine can be helpful to help liberate patients from ICU
but as initial therapy, midodrine is some weak sauce
#1) start with NE gtt for immediate BP target acquisition
#2) once pt is improving, use PO midodrine to accelerate weaning off NE
midodrine can be helpful to help liberate patients from ICU
but as initial therapy, midodrine is some weak sauce
Midodrine and octreotide should not be first line therapy for HRS-AKI #kidneywk
November 6, 2025 at 5:45 PM
my pressor strategy hepatorenal syndrome in the ICU:
#1) start with NE gtt for immediate BP target acquisition
#2) once pt is improving, use PO midodrine to accelerate weaning off NE
midodrine can be helpful to help liberate patients from ICU
but as initial therapy, midodrine is some weak sauce
#1) start with NE gtt for immediate BP target acquisition
#2) once pt is improving, use PO midodrine to accelerate weaning off NE
midodrine can be helpful to help liberate patients from ICU
but as initial therapy, midodrine is some weak sauce
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
If all else fails, re-examine the patient
🤔Tet Toe posted a case on Doximity
🤔Have seen it before as well
Pt with severe abdominal pain, negative workup
Re-examined ... Shingles
Can present with abdominal pain before rash.
One pt I saw was on her way to OR
#GIsky #IMsky #medsky
🤔Tet Toe posted a case on Doximity
🤔Have seen it before as well
Pt with severe abdominal pain, negative workup
Re-examined ... Shingles
Can present with abdominal pain before rash.
One pt I saw was on her way to OR
#GIsky #IMsky #medsky
October 13, 2025 at 11:07 AM
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
Refractory Ascites: The ALFA pump...
👍RA tough to treat. Paracenteses, TIPS, Txp options.
🤔Many not suitable for TIPS, Txp.
ALFA pumps ascites into bladder. Still issues including renal, and its place still uncertain
Recent study encouraging
Anyone with experience?
#Medsky #GIsky #IMSky
👍RA tough to treat. Paracenteses, TIPS, Txp options.
🤔Many not suitable for TIPS, Txp.
ALFA pumps ascites into bladder. Still issues including renal, and its place still uncertain
Recent study encouraging
Anyone with experience?
#Medsky #GIsky #IMSky
October 4, 2025 at 12:56 PM
I always get antibiotics for my colds
Survey: 54% unaware of C. Diff risk with ABs
Continue efforts to limit AB's.
Need to educate on risk of C. Diff, and warn that if they get diarrhea on antibiotics to let us know
Pt's may not call till critically ill
ICU's busy enough
#IMsky #Medsky
Survey: 54% unaware of C. Diff risk with ABs
Continue efforts to limit AB's.
Need to educate on risk of C. Diff, and warn that if they get diarrhea on antibiotics to let us know
Pt's may not call till critically ill
ICU's busy enough
#IMsky #Medsky
October 1, 2025 at 7:55 PM
Large R Pleural Effusion
Cirrhosis but no evid of Portal Hypertension
Hx CHF (stable)
Alb gradient 1.6 🔼
+Tc-99m peritoneal cavity scintigraphy
Hepatic Hydrothorax can occur in absence of ascites, but also in absence of other signs of portal hypertension.
Rx challenging
#GIsky #IMsky #Medsky
Cirrhosis but no evid of Portal Hypertension
Hx CHF (stable)
Alb gradient 1.6 🔼
+Tc-99m peritoneal cavity scintigraphy
Hepatic Hydrothorax can occur in absence of ascites, but also in absence of other signs of portal hypertension.
Rx challenging
#GIsky #IMsky #Medsky
September 30, 2025 at 10:26 PM