Insights Into Cirrhotic Bleeding of the Liver, and How to Stop It

Roger Seheult, MD of MedCram shares new insights into cirrhotic bleeding of the liver, and how to stop it. See all Dr. Seheult's videos at: www.medcram.com/?Y...
(This video was recorded on July 14th, 2023)
Roger Seheult, MD is the co-founder and lead professor at www.medcram.com/?Y...
He is Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine and an Associate Professor at the University of California, Riverside School of Medicine.
LINKS / REFERENCES:
Coagulopathy in cirrhosis (IBCC) | emcrit.org/ibcc/cirrhosis/
The Liver Explained Clearly (MedCram) | www.medcram.com/courses/the-l...
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Video Produced by Kyle Allred
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#liver #cirrhosis #bleeding

[@Medcram]

For more insights and medical education go to medcram.com We have continuing medical education credits.

[@sylviacarol5766]

Bravo to you for being willing to research and review tests, and adjust as needed. You saved your patient that day.

[@CaptainSteve777]

Dr Seheult at his best. Thank you!

[@mariespi96]

What a blessing for this patient to have had you as his Dr!!! A Dr who who doesn’t think he know it all already. Always willing to research and have an open mind. When my husband’s liver started falling after Covid, they just assumed it was cancer. No tests were done and he was sent to rehab. After returning twice and finally doing all the tests and biopsy, there was NO cancer but it was too late to help him by then. He threw up a black coffee ground substance which I suspect was blood. He passed away a few days later. 😭

[@Medcram]

I’m so sorry.

[@makiph585]

I'm interested in this topic. Thank you so much for this great explanation.

[@DJSouthwest162]

Thanks medcram 😎

[@xxNoFreeWillxx]

wow! nailed the pathophysiology and management in such a succint and easy to understand way! Thanks!

[@AbacusincInfo]

Wow! This guy was trying to quit drinking and probably needed to taper off? Not sure. What a mess that he was having internal fluid build up internally. What a mess. Awesome discussion. I learned something new. Thank you.

[@Mommaslew]

Brilliant. Wish I saw this five years ago❤

[@annarn6540]

Seheult for the win!!

[@mrfoodarama]

Fascinating and useful. I hope this becomes more well known, excellent job!

[@jcm4549]

Nice video! Thank you 👍

[@moecreations1]

Love your channel. All videos are great and every video is superb!😍

[@quietStorm247]

This lesson is very clear and helpful. Thank you!

[@DanielChristopher-js4fb]

Thanks You are the best!

[@riceexperiment]

Wonder that happened to that unfortunate young man to cause him to drink to excess. Great info in this video but also I hope this young man gets mental health help, too. I hope someone listens to his story and his liver repairs itself.

[@karthikreddy8567]

Thank you sir.❤

[@00HoODBoy]

hats off to you

[@WildMidwest1]

Great video. I saw many of these patients throughout my career. Sadly, the quick ICU “save” does little to improve the longer term prognosis and a terrible lifestyle. This patient needs a liver transplant, or a TIPS procedure at the very least.

[@Medcram]

You are absolutely correct.

[@MrRobertFarr]

Mmm. Interesting title Mr.

[@wulanmagriet4570]

So if the ascites start to build up again, will you still doing paracentesis but with transexamic acid drip infusion, doctor?

[@Medcram]

Good question. The bleed likely occurred because if hitting a small blood vessel. I’d make sure the fibrinogen was normal and if not give cryo before the procedure. Maybe a dose of tranexemic acid.

[@brownhildasanto8856]

Great presentation. TXA is very helpful as an adjunct to addressing GI related , trauma related and gyn related hemorrhage. Based on the study you presented , should we be preemptively checking fibrinogen levels before procedure in liver cirrhosis patients and if they are low prophylactically giving them cryo? Pulm/cc here. Thank you

[@Medcram]

I thinking so. It’s an entity that I’ll be looking out for.

[@brownhildasanto8856]

@@Medcram I will start paying attention to this too. I have had a few cases where I took care of post surgery cirrhotic patients in the icu who developed bleeding complications and had to be taken back to the OR. Thank you

[@misteratoz]

​@@Medcramthey use it a lot in anesthesiology and perioperative medicine, especially during cases such as spines. They're also using it more in trauma but data is iffy.

[@farhanqadeer82]

Question all the data regarding use of TXA in GI Bleed. Lots of guideline recommend against using it. I have used it as my last resort. What we know that TXA is better to be given sooner than later in trauma patient. Again should we use in all of our Liver Failure patient with GI bleed?

[@Medcram]

It’s why we I recommend checking fibrinogen levels. Not every liver bleed patient has this entity.

[@patriciahoke4722]

I believe the good doc said Vitamin K produces plasma. This is not my understanding, which is that K produces clotting factors found in the plasma. ""plasma helps give you a blood clot. It comes from outside the blood vessel system where you have the liver that is made by vitamin k which causes the vitamiin k dependent factors to produce plasma."

[@47retta]

What blood tests would be appropriate for someone who has a problem with blood not clotting quickly enough? She is not on blood thinners.

[@mariespi96]

Platelets because platelets aid in clotting blood. I’m not a Dr, though so You should Ask your dr.

[@Medcram]

PT/INR/PTT, fibrinogen, platelets for starters.