Elliot Tapper
@ebtapper.bsky.social
Hepatologist. #LiverSky / LiverLand. #MedSky. #cirrhosis
Academic Chief of Hepatology at University of Michigan. Editor, Hepatology Communications. Kid Chauffeur
Academic Chief of Hepatology at University of Michigan. Editor, Hepatology Communications. Kid Chauffeur
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
August 30, 2025 at 12:52 AM
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
When did I start rounding?
August 6, 2025 at 9:22 PM
When did I start rounding?
doi:10.1001/jamanetworkopen.2025.19426
July 14, 2025 at 12:19 AM
doi:10.1001/jamanetworkopen.2025.19426
Wake up new cause of liver enzyme elevation just dropped
July 9, 2025 at 10:41 AM
Wake up new cause of liver enzyme elevation just dropped
They are establishing upper limits of normal for ammonia in pets
Thank you for your attention to this matter!
Thank you for your attention to this matter!
June 28, 2025 at 2:26 PM
They are establishing upper limits of normal for ammonia in pets
Thank you for your attention to this matter!
Thank you for your attention to this matter!
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)
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)
June 14, 2025 at 4:19 PM
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)
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)
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.
June 14, 2025 at 4:19 PM
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.
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.
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.
June 14, 2025 at 4:19 PM
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.
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.
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!
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!
June 14, 2025 at 4:19 PM
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!
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!
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????
Cognitive performance is impacted by so many things!
Cutoffs on one validated test from Wisconsin would classify CONTROLS as sick in Virginia!
WHY????
June 14, 2025 at 4:19 PM
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????
Cognitive performance is impacted by so many things!
Cutoffs on one validated test from Wisconsin would classify CONTROLS as sick in Virginia!
WHY????
But there are problems
First, many people withOUT covert HE can get overt HE
First, many people withOUT covert HE can get overt HE
June 14, 2025 at 4:19 PM
But there are problems
First, many people withOUT covert HE can get overt HE
First, many people withOUT covert HE can get overt HE
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
They predict overt hepatic encephalopathy (the delirium, the coma), and identify patients with unmet needs
June 14, 2025 at 4:19 PM
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
They predict overt hepatic encephalopathy (the delirium, the coma), and identify patients with unmet needs
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
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
June 14, 2025 at 4:19 PM
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
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
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?
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?
June 14, 2025 at 4:19 PM
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?
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?
June 5, 2025 at 6:08 PM
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
It is not supported by an evidence.
Alcohol is 'contraindicated for cirrhosis'. That is supported by evidence
May 29, 2025 at 12:21 PM
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
It is not supported by an evidence.
Alcohol is 'contraindicated for cirrhosis'. That is supported by evidence
See you at the liver meeting
May 18, 2025 at 8:27 PM
See you at the liver meeting
May 7, 2025 at 3:58 PM
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
#liversky
April 12, 2025 at 1:59 PM
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
#liversky
April 4, 2025 at 12:13 AM
An early look at how resmetirom is being used and impacts patients with MASH
journals.lww.com/hepcomm/full...
#liversky
journals.lww.com/hepcomm/full...
#liversky
April 4, 2025 at 12:10 AM
An early look at how resmetirom is being used and impacts patients with MASH
journals.lww.com/hepcomm/full...
#liversky
journals.lww.com/hepcomm/full...
#liversky
Congrats to Thailand for nearly eliminating vertical transmission of hepatitis B
The vaccine works
doi.org/10.12932/ap-...
The vaccine works
doi.org/10.12932/ap-...
March 31, 2025 at 12:13 AM
Congrats to Thailand for nearly eliminating vertical transmission of hepatitis B
The vaccine works
doi.org/10.12932/ap-...
The vaccine works
doi.org/10.12932/ap-...