liver cirrhosis

5% albumin for resuscitation, 25% for this quote-unquote oncotic support, which may or may not be a thing.

Cirrhosis, hepatorenal syndrome, large volume paracentesis.

all things to think about using albumin for monitor volume status closely and consider cost and evidence base before routine use right this is not a routine use thing other than in some of these more evidence-based scenarios like large volume paracentesis and hepatorenal syndrome that is a really bad arrow it kind of looks like a tree maybe we'll just leave it as a tree So if we were to compare 5% and 25%, 5% albumin, the concentration is 5 grams per 100 milliliters compared to 25%, which is 25 grams per 100 milliliters.

So this is, you know, what people talk about for volume resuscitation, whereas this is what people talk about for increasing albumin.

And the circle keeps going around.

And then the last thing, which is kind of less tied into this nice series of pathophysiologic steps we talked about, is just general systemic inflammation and cardiac dysfunction.

Cirrhosis is not just the vascular plumbing problem we talked about, but you get bacterial translocation, systemic inflammation, adrenal dysfunction, cardiomyopathies, all that stuff.

And all these little things add up over time and can lead to worsening kidney injury.

When scarring becomes advanced and widespread and the liver's normal function is remodeled, that's called cirrhosis.

Scar tissue can't interfere with blood flow through the liver and the work of normally functioning liver cells.

Cirrhosis raises the risk of liver failure and liver cancer, and it requires ongoing specialist care.

And here's something many people don't realize.

Fatty liver isn't only a liver issue.

He said, "Your liver is turning into a piece of leather.

Cirrhosis has already set in.

There's nothing anyone can do for you.

And your mental and emotional condition and your addiction, I don't know if there's a rehabilitation center that can help you." But one day, a young woman named Linda Smith, who saw past my faults to my needs, looked over at me and she wasn't one of those creepy Christians, you know, granola, fruits, flake, and nuts.

Well, Joshua and Tracy, thank you much for joining us on the podcast.

I was very excited to read your article and to talk about it because This has been a big change in the management of cirrhosis to use carvedilol as opposed to natilol and propranolol.

And I thought that having a conversation about the study you did is going to be very helpful for us to better understand.

So let's just start out with why you did the study.

Yes, we were very excited to be able to put this study together too.

And thank you for having us on the podcast.

We wanted to do this study because, as you mentioned, Carvedilol is now the preferred non-selective beta blocker for patients with cirrhosis and portal hypertension.

And it's been shown to reduce portal pressure more effectively than alternatives, so more effectively than Natilol or Procranilol in very small clinical trials to date.

Here we go.

First question is from Ethel Eggsinham from Cirrhosis of the Liver, New South Wales, who says, "Dear Troy, do you think it's possible that all NRL coaches across the 17 teams share a group chat? What do you think they would talk about?" Well, wouldn't you love to be privy in those sort of conversations, Ted, if they did have a group chat?

Yeah.

What, what, what are some of the things they would talk about?

Do you know a- about MASH? How many of you have MASH? Oh, Tony, I had no symptoms, but it progressed, then one phone call changed everything.

Cirrhosis due to MASH, liver cancer, and I needed a transplant.

I never knew how serious this disease could become.

Tony, patient advocate, Pittsburgh, PA.

So you know, everybody might respond a little bit differently, but it's very reassuring, it's very encouraging that very serious liver issues can improve.

And I spoke to Dr. Baker, he said he had one patient that uh on at least on his imaging that his cirrhosis his alcoholic liver cirrhosis actually went away and i've certainly seen fatty liver go away i mean quickly in fact we have you know randomized controlled trials showing that that can happen just by eliminating fructose so um So he was saying that that patient was going to go in for a liver biopsy because his doctors were like, that can't happen.

Cirrhosis doesn't reverse.

They put him in for a liver biopsy.

I never heard what the results of that liver biopsy was.

His health deteriorated.

Cirrhosis causes the liver to scar and fail, leading to jaundice, fluid buildup, and eventually death.

When Pierce died in eighteen sixty-nine, there was little mourning.

Newspapers printed brief, cold obituaries.