Jonathan Ryder, MD

@JonathanRyderMD

PGY-3 IM Resident|Future fellow|Interests: ID, MedEd, history of science/medicine, books, NFL, and podcasts| Tweets are my own.

Indianapolis, IN
Vrijeme pridruživanja: rujan 2019.

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  1. Prikvačeni tweet
    1. velj

    1/ Let's differentiate pyogenic from amebic liver abscess in a today. We will examine DDx, risk factors, microbiology, clinical features, diagnostics, and treatment. This came from my most recent morning report.

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  2. CORRECTION: For tweet #14, this should be the chart for associated clinical symptoms of ALA

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  3. proslijedio/la je Tweet

    1/9 All day I have been lacking inspiration about which topic to choose for my Sunday . Just looked outside & noticed that a rabbit had hopped out a perfect flask-shaped ulcer in my backyard! So get ready for a tweetorial on 🙏!

    , , i još njih 7
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  4. 2. velj
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  5. 2. velj

    Amazing seeing the artist at work, I learned a ton from this thread and hope to incorporate these ideas more into future posts! Have you always wanted to make a Tweetorial and haven't? Read these posts first & jump into the pool!

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  6. proslijedio/la je Tweet
    2. velj
    Odgovor korisniku/ci

    Rare,but also think about heterosexuals (in non endemic region / no travel history) I did see one case (oro-anal transmission). Drainage was done before Dx and was described as ‘’chocolate’’ (similar to anchovy paste I guess 😉) Similar cases in Toronto;

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  7. 2. velj

    Have found a good source for DDx as well as a radiography-based schema!

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  8. 2. velj

    A related post from in November 2019 regarding E. histolytica

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  9. 1. velj
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  10. 1. velj

    22/ That's it for this . It was a long one! Appreciate feedback as always and hope you learned as much as I did on this one! Appreciate the help on my AM report presentation from

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  11. 1. velj

    21/ Some cool history on this topic! will appreciate the article about Fyodor Lesh! Science was different in the 19th century

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  12. 1. velj

    20/ Antibiotics for ALA: - Metronidazole x 7-10 days for abscess - Then need intraluminal treatment (for cysts!) with paramomycin or iodoquinol

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  13. 1. velj

    19/ Treatment for ALA differs from PLA: - Drainage is not necessary, unless uncertainty of diagnosis, lack of clinical improvement, or high risk for rupture (>10cm) - If drained, cultures will not help for ALA, but the color might! Remember anchovy paste!

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  14. 1. velj

    18/ Stool antigen testing is very useful - 87% sensitive, >90% specific - Detects Gal/GalNAc lectin, specific to E. histolytica PCR tests being developed Summary: serum Ab & stool Ag tests are the best methods for diagnosis. Don't order stool microscopy!

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  15. 1. velj

    17/ Serum antibody serology is great for rule out - Detectable after 7 days of infection in 85-95% of patients (sensitive), but negative early in infection - Persists for years, so 10-35% of uninfected have +Ab in endemic areas, cannot distinguish old from new infection

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  16. 1. velj

    16/ Diagnostics for ALA are tricky! Stool/aspirate microscopy - Insensitive (only 24% in one series) - Non-specific: cannot distinguish between pathogenic E. histolytica & non-pathogenic E. dispar (morphologically the same!) - Need specialized lab personnel & >3 stool samples

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  17. 1. velj

    15/ Lab/Imaging findings of ALA: - 75% leukocytosis (WITHOUT eosinophilia) - 2/3rds elevated AST/ALT, 80% elevated ALP - Anemia, hyperbilirubinemia, and hypoalbuminemia seen - R hemidiaphragm elevation on CXR in 1/3rd - CT & US useful

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  18. 1. velj

    14/ Clinical presentation of ALA: - Incubation period of weeks to years - Fever, RUQ pain for ~2 weeks - Referred pain to R shoulder/chest, epigastric, pleuritic - Diarrhea in ~1/3rd - Can rupture into peritoneum, pleura, or pericardium uncommonly

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  19. 1. velj

    13/ Risk factors for ALA: - Male (10:1, likely due to EtOH-induced liver damage, as colonic amebiasis 1:1) - MSM, Institutionalization, Immunosuppression - Endemic regions: Mexica, Central/South America, India, Africa - 35% in short term travelers (<6w)

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  20. 1. velj

    12/ E. histolytica lifecycle: - Excreted into feces via cysts which transmit disease via fecal-oral route - Trophozooites multiply and make cysts in the colon Images:

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  21. 1. velj

    11/ E. histolytica exists as 2 forms: Cysts (figure 1): survive for weeks in environment due to thick walls, transmit the disease via feces Trophozooites (figure 2): die in environment & stomach acid, invade colonic walls (amebic dysentery) into blood stream (liver, brain, etc)

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