Welcome to the Emergency Medicine Cases Podcast.

I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.

This is part two of our two-part EM cases podcast on liver disease for the ED doc with Walter Himmel and Brian Steinhart.

In this part two, we're going to talk about thrombosis and bleeding in liver patients.

Very confusing, but we're going to clear it up for you nicely, about spontaneous bacterial peritonitis and some pearls on tapping bellies and a few more little goodies to wrap up with.

So we've covered GI bleeds in two big episodes.

That was number 101 and 102 with Swami and Salim Rizai.

So we're not going to get into the details of managing the actual

GI bleed here, but there are some nuances when it comes to liver patients and bleeding that I

think we need to cover. We've all seen patients that have liver disease and come in with horrible

GI bleeds. We also know that liver patients

are at increased risk for thrombotic events, for portal vein thrombosis, PE, dvt, etc.

And we know that the elevated INR we see in liver patients doesn't necessarily mean they're

protected from thrombotic events. This is all very confusing to me.

So Dr. Himmel, I hereby present you a challenge.

Good sir.

In less than five minutes, can you explain to our listeners what's going on in the liver

patient when it comes to coagulopathy and hemorrhage?

Absolutely.

First of all, liberate yourself from all your misbeliefs completely.

And remember the following.

Individuals with cirrhosis who admitted to the hospital get more DVTs than patients who don't have cirrhosis.

...