VA Report Pearls 1.19 – ESLD Pearls

3 great pearls that came out of our discussion today were:

 

1. Association between Primary Sclerosing Cholangitis and UC: ~90 % of patients with PSC will have co-morbid Ulcerative Colitis, but only ~5% of patients with UC will also have PSC. Therefore, even though it is relatively rare, if you encounter a UC patient with abnormal LFTs you have to consider PSC (most of the time it will be med effect) since you wouldn’t want to miss this! If you encounter a patient with PSC, they almost certainly have IBD, most likely UC, so those patients will need colon cancer screening!

2. New kid on the transplant block: The MELD-Na Model – We heard that just recently the transplant world started preferentially using the MELD-Na model for prognostication but especially for organ allocation purposes. Because it takes into account the patient’s sodium it performs better in terms of predicting mortality. According to HRSA.gov, based on simulation modeling results it is estimated that moving from MELD to MELD-Na could “reduce waiting list mortality by 50-60 deaths per year without adversely affecting post-transplant survival or negatively impacting any group of candidates (e.g., age, gender, ethnicity, diagnosis).”

http://www.mayoclinic.org/medical-professionals/model-end-stage-liver-disease/meld-na-model

3. Remember that there are certain infections that love iron-overload states!

Unless you think of these you might miss them:

A partial list includes:

-Mucormycosis (Rhizopus oryazae)

-Listeria monocytogenes

-Yersenia enterocolitica

-Aeromonus hydrophilia

-Eschericia coli

-Cunninghamella bertholletiae

-Vibrio vulnificus

Learn more here: http://sickle.bwh.harvard.edu/Feinfection.html

thanks again folks see you tomorrow!!

D/M

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