
#466 Cirrhosis Update with Scott Matherly
The Curbsiders Internal Medicine Podcast
Cirrhosis Insights and Personal Reflections
This chapter provides a comprehensive overview of cirrhosis, covering its evaluation, management, and the importance of timely referrals for liver transplants. It intertwines personal anecdotes from the speakers, including reflections on competitive powerlifting and career setbacks, which emphasize growth through failure. The chapter culminates with a detailed clinical case analysis that focuses on lab results and imaging for cirrhosis complications, advocating for a thorough understanding of patient history.
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Speaker 1
We need this one, which
Speaker 2
was a New York Times article that came out yesterday where they interviewed a bunch of Gen Z people on this like thing that basically no one's ever going to be able to own a house. And apparently the cost of your housing shouldn't exceed more than 30% of your monthly income, which is
Speaker 1
crazy. When I got a Portugal, it's going to be like, it's going to be 50%. Yeah. Yeah.
Speaker 2
I don't know anyone who can find something when you're living in a major city like that. But this I think is the point that they're making. And I think a lot of people our age have been sold a future via the millennial icons of the time which we talked about last week. I'm talking about sex in the city. Like this isn't, this is a tired trope, but we know it's like the messy millennial woman, right? And I think we need something new to cling on to. And I think the messy millennial woman was the trope that worked for the generation above us. And it's given us, you know, flea bags, Sally Rooney, six in the city, all these things. But we are just like, want to be a teenager girl. Oh, yes. And oh my God, I'm so sorry. I'm so sorry. I'm so sorry. I'm so sorry. I'm so sorry. I'm so sorry. I'm so sorry. I'm so sorry. I'm so sorry. I'm so sorry. I'm so sorry. And oh
Speaker 1
my God, Laura, that is actually such a good point as we were sort of, yeah, we were sold like Dan Humphrey from Gossip Girl being poor, but he lived in a huge Brooklyn apartment. Like I, Carly, it was just her and her brother living together, but they had this huge loft. And it was like, we were sort of sold an incorrect view of what we were going to be growing into. Yeah. And it's like, well, can't have that. Let's just like go back to what we've had once before, which is living with our parents or having to spend a whole lot of money on rent. And then the rest of it, because we can't buy houses on like jelly shoes and now polish and like cute things that make you happy. That is so interesting. I think it's a
Speaker 2
really interesting thing to think about. And like when you even look at the like what we're consuming, like you said, it's a lot of the remakes of things that were really popular when we were younger. There's a move away kind of from the messy millennial woman thing and into more of like a, I don't know, I don't know how far it made it over there, but there was a show here called One Woman Show, which was kind of a parody of Fleabag, which was kind of doubling down on this idea. But this kind of, I don't know, basically just saying that we need different role models and role models look different. And I think this could be a move towards that. I also think, and I don't know if you had this, but I definitely got told a lot that these were the best days of my life, probably between like 18 to 22. Like I don't know how often I was taught, enjoy this time, enjoy this time, enjoy this time to the point where it really stressed me out because I was having a very bad time. Yes. For personal reasons and constantly being told this is the best time you're ever going to have this is like, get out, do everything you ever want to do. Almost, I don't know. Now it's like when, like you said, when you're a little bit older, possibly you have more disposable income. It's like, hey, well, now I'm going to do that. Yeah.
Speaker 1
I don't know. What do you think? I think that is so true. Like we were told, you teenage years are the best years of your life. And that was sort of reiterated by Lord's pure heroine. But then when we got to our twinies, it really moved to like, you know, your twinies are going to be the best years of your life. And then that was like melodrama. And it was like, okay, like, yeah. And now, and I love this about the internet and about the trends that I'm seeing and things. Now it's like your thirties are the best years of your life. And then your forties and then your fifties, like honestly, I feel like as hard as things are with the world for young people, the way that we reframe things to make ourselves feel better is like, I am proud to be living through it. It's reframe. One thing we're going to do is we're going to reframe and romanticize. And I'm like, do you know what? It's what we have to do to get through. It really feels like it's what we have to do to get through. Because I feel like if we asked our parents when if we asked our moms when they stopped being teenage girls, they would probably say at like 18, like, well, my mom, she had fucking, she was married at 23. She had kids at 25 or whatever. I'm like, you didn't really get to do this because of the times back then. And like, yeah, you guys could buy a house and you could afford to have a family of six or whatever. And so that probably felt good at the time for you. But now you could be looking at young people being like, oh my God, they get to do all this. Like, why are young people going all these concerts and how can I afford to be doing that? And it's like, it's such different. I don't know. I've been thinking a lot about like, when would our parents have stopped feeling like teenagers?
Speaker 2
And it's way earlier than us. That is really interesting. And I think also what you'd happen into is it's like a luxury to be able to feel like a teenager as well in a lot of ways. Yes.
Speaker 1
There's
Speaker 2
one. This really, I found quite fascinating. And it was talking about the rise of nostalgia, which I think in essence is what we're talking about here. And like, I feel like I've written about this a thousand times about how I love nostalgia. I've had the season start to turn. I get very emotional. But the New York Times last year reported that old technology is selling at an absolutely rapid rate. Things like Polaroids, Tamagotchies, nostalgia-driven movies, which we know, right? We've seen this in the rise. So why all the nostalgia now? They've done some research where they ask people to describe under what circumstances they become nostalgic. And the most frequent reported triggers were negative emotions, mood states, and in the particular feeling, lonely, cue, lockdown, and isolation. The results were surprisingly straightforward. Those who read negative stories were subsequently more likely to engage in nostalgia than those who read neutral or more positive ones. In other words, nostalgia is a way of coping with distress by temporarily escaping the pain of the
Speaker 1
present. Preach.
Speaker 2
That's what everyone's doing. It's exactly what is going on right now. And as a result of engaging in kind of these recollections, though, people do actually experience a mood boost. It's shown that people feel more socially connected. They've got a greater sense that their lives are more meaningful. And I'll link this article because there's a lot more study in there. But I think it actually showed that in some ways it can improve well-being.
Speaker 1
I don't know to what extent you delve into living completely in the past, but I thought that was fascinating. I was literally about to say, obviously we're not out here saying quit your jobs, get in bed and rewatch Zoey 101. You'll feel good temporarily. But then you won't be able to keep paying for your Netflix subscription and shit like that. But I will say, if you can balance, there is nothing wrong with working your fucking corporate job and going home and having dinner and then wanting to put on confessions of a teenage drama queen or for you, confessions of a schopperholic. We both have our confessions, right? Yeah, we get it. But I'm like, do you know what? Whatever it takes to get you through the day in this type of world, we're not going to shit on you for it. But yeah, I love that you've pointed out, I don't know how much we should be only living in the past.
Speaker 2
Well, I think there's definitely, you know, there's a whole, and we're thinking about this as well. It's like the end of the day, a lot of capitalism's just throwing a lot of things at us. They probably want us to stay in bed, rewatching, you know, episodes of whatever and not engaging with the real world. But I think, and we've talked about this a little bit before, like this idea of comfort things, be it comfort food, comfort people, comfort books, whatever it is, like, is very real. And I think for like, is a genuine mood boost, especially when you're feeling lonely and the sense of connection that it brings you not just with the thing you're engaging with, but the community around the thing you're engaging with, like exactly what you're talking about with kind of teenage girlhood is really interesting and a genuine connect over a lot of people.
Speaker 1
And sort of while we're talking about a little bit about capitalism and they probably want us to go and watch all of these things, they, as who the fuck we were even talking about when we say they probably want us to go and sit in bed and watch this, it is like genuinely they do and they've tapped into this because I'm just going to read you a few of the reboots. And yes, we're still going to do an episode on does everything need a reboot because it's just such a good topic. But anyway, we've seen reboots in the past few years, especially during the pandemic, when everyone was lonely and sort of needed something comforting was like we have had ICarly, Zoe101, Gossip Girl, Friends, Reboots or Reunions, I should say, Six in the City, Gilmore Girls, now we're getting all the Taylor Swift albums, like we're getting in these aren't reboots, but it's like, obviously Olivia Rodrigo is coming back hard with pure teenage and nostalgia, like Lorde.
Speaker 2
That's why I like references destroyed
Speaker 1
me. And yes, our new Hunger Games or like a precursor to the Hunger Games is like no one wants anything new, we just want things, an extension of things that have made us feel good in the past. And honestly, a Willy Wonka with Tim and Charlie, would you say that? Yes, would Tim and Sally. Yeah, I did. And honestly, I'm going to eat that up. How many times have
Speaker 2
they rebooted Willy Wonka? I feel like I've seen the
Speaker 1
original. It's like rolled down no longer has any like references to fucking Charlie or Willy Wonka. It's like me taking seven fucking steps out of his hands, which might not be the worst thing. But like, it's so, it's just, I don't know, it's just kind of nefarious because it is like, did I feel this way on my own or did they, the people that we keep referring to is like capitalism and the people that organize all this shit? Did they want us to feel this way? And so now we're like, we've got all these reboots. So of course, we're like, oh, well, I got to become actually original. And oh, when I was watching the original, I was wearing this. So like, that seems kind of cool again. And I don't know, it's like, did we feel this way on our own? Probably not because nothing happens in a vacuum, but
Speaker 2
I think it's also interesting to know who is going to be in the same way that everything is cyclical, who is going to be engaging with this stuff for the very first time? And will it hit the same way for that like generation of people who this isn't a reboot, but is the genuine first thing? Yes.
Speaker 1
Well, like that tweet we keep talking about, imagine discovering pure hero and for the first time, that would change my fucking life. I'm jealous of the people that got to do that. No, this is actually how I felt about listening to the 1975s music for the first time when I was fucking 25. I was like, how has this all been here? And I've never listened to it. And now it's like a whole new world of music that I'm like, it's like my fucking favorite music. And yeah, I don't know. Will it land? Will all these? Well, actually, the reboots, I don't think will introduce people, will make people want to go back to the original shows because the reboots are like usually really bad.
Speaker 2
Oh, but they draw you in. I remember I hadn't watched Gilmore Girls ever, hadn't been interested in it, didn't understand it. And then when the reboot was getting marketed, I thought I was going through exams at the time and I was having trouble sleeping and basically needed something to watch every night when I was going to bed. And I started watching the series basically, so I would have it finished in time by the time the reboot came out. Aww.
Speaker 1
They got me in. Gilmore Girls is such a good one. Your comfort.
Speaker 2
Okay, that's pure comfort. Okay.
Speaker 1
And it's a good point. My mind has been changed on that because actually, even though I didn't like it, I also watched the six in the city or a little bit of the six in the city. Totally.
Speaker 2
I'm currently watching that and we will review that very soon. So? Oh, honestly, if anyone listening, go listen also to sentimental garbage, their recap of the six in the city reboot because oh my goodness, it's brilliant. It's the best thing ever. I also just have, which I think is quite a nice way to tie this up, I went and found an old article from something that I'd written several years ago where I interviewed three people on advice that gives the 20 something self. And there's some bits in here which I just thought in light of doing this as well, it's just interesting because A, the thing that everyone always says is wear sunscreen, which I just don't know how many times I've been told that in my life, but anyone.
Speaker 1
Same. And I can't lie. I like don't most days. I do it in the sun. I do it if I'm going in the sun, everyone. And I know that I need to, but I just for some reason, can't.
Speaker 2
Every, every person under the
Speaker 1
sun would tell you, tell me.
Speaker 2
But here's some bits of little cutie advice, which I just thought was very sweet. Travel, Lucy, this one's for you. Wherever you go, be where you are, travel doesn't change you, but it does enrich you. You'll never regret any money spent on travel, even the hardest, most awful experiences, something to remember in your visa applications. On health, everything is connected. Your mental, physical, spiritual health, do things that ground you, be with nature as much as you can, it will connect you to your fucker, pupper, beautiful.
Speaker 1
Preach that. Love,
Speaker 2
every love is beautiful value, every love and be careful with it. Your first love hurt you, but you'll be better for it. And from it, you'll know how to be a good love. Full and love as often as it happens, don't hold back. And I feel like that is romantic familial friendship, all love. Yes. Yes. And this is the last one on friendship, which I loved. Friendships are what provide the best things in life, the greatest places to live, the most fun holidays, my favorite jobs. They deserve looking after. Make sure you feel comfortable being your unfiltered self in a friendship. And don't forget that your relationship is also a friendship and it's the same kind of care and respect, which I think goes both ways. Again, I think a lot of the stuff I always got stressed out when people would tell me, make the most of this time, do these things, here's the rules to live by. They honestly just fill me with anxiety, but
Speaker 1
I think it is good sometimes to take stock and remember. Yeah. And I think those, honestly, they were great. It sounds like you've like interviewed authors or something on those quotes because I'm like,
Speaker 2
they're all gorgeous people. That's so fucking good. Well,
Speaker 1
everyone, if you're feeling bad or guilty about going back and living in your teenage years, because the future is really scary and it's hard, I hope this has made you feel a little bit better because we're all doing it together. And also, what's on your right, Alora? I actually, beautiful, Ty, and I was,
Speaker 2
I didn't have anything written down, but on my radar is, I have waited my whole life to see my favorite band in the world, Haim Play Live. Haim, if you're listening, I love you. Of course, you would be listening. I basically have somehow missed every single time they've played in the country that I've been in, I have just missed it. And I am seeing them in two weeks and they announce that they're going to be essentially going through their very first album, Days are Gone, which was the soundtrack to me and all of my teenage girls and our friendship. And two of my best friends are in London for it. We're all Haim Gurley's and we're going together
Speaker 1
and I am going to be feral. I cannot wait. That is perfect. That is all that's on my radar for the next 14 days. Oh my god, that is so perfect for this episode and for you to get to relive your teenage self. On this way. And they're playing the fucking, like, your teenage album, that's everything.
Speaker 2
It's everything in one. Haim, if you're listening,
Speaker 1
we want to interview you. Laura, especially. I don't know when, I don't know how.
Speaker 2
I put hers out.
Speaker 1
I'm not, I'm just, they would go viral. So I want that to happen, obviously.
Speaker 2
You're cold. Lucy, what is on your radar?
Speaker 1
On my radar is, and this is very British and it's very reliving or healing your teenage self. But have you ever watched my mad fat diary?
Speaker 2
No, but it is definitely something in my brain is going off.
Speaker 1
Oh my god, it's like, it's based on a British woman's actual diaries. And it's a TV show and it's got, I think, three seasons. I'm on to season two. And it's just about this girl. She's in high school and she had some mental health troubles. And she's just like, everything's all fucked up. But she's just like living through high school. And it's like funny and British and sad and heartwarming and very coming of age. But in a way that is not sanitized because it's literally based on real diaries. And it's so good. And the actress that plays lawyer Barbie in Barbie is the main actress from my mad fat diary. And it's fucking good, bro. So everyone, go and watch it. I posted this on the close friend story and everyone there had seen it was viscerally like, this changed my life. I think it's like, oh, I think it was like 2009 or something, but it's so good. So mine's sort of on that same tangent as
Speaker 2
well. It's giving her Bridget Jones diary a reboot.
Speaker 1
Yes, yes, it is. But it's like, again, you know, she's the messy millennial woman that we were told you don't want to be. She had a great job, a great flat. She had a great body, but she was told she was fucking fat, untalented, like poor. Anyway, anyway, a lot to unpack. I guess we should wrap it up there before we talk for four hours. But everyone, you can find Laura in the Geneva chat. She has a shirt you should cook about place. It's really cute on there.
Update your approach to cirrhosis evaluation and management with Dr. Scott Matherly Associate Professor of Hepatology and Gastroenterology at Virginia Commonwealth University
Claim CME for this episode at curbsiders.vcuhealth.org!
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Show Segments
Claim CME for this episode at curbsiders.vcuhealth.org!
Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME
Show Segments
- Intro, disclaimer, guest bio
- Case from Kashlak; Definitions
- Cirrhosis Diagnosis and Initial Evaluation
- Cirrhosis Physical Examination
- Decompensated Cirrhosis Management
- Ascites and TIPS
- MELD and transplant consideration
- Outro
Credits
- Written and Produced by: Elena Gibson MD
- Infographic and Cover Art: Edison Jyang MD
- Hosts: Paul Williams MD, FACP; Elena Gibson MD
- Reviewer: Emi Okamoto MD
- Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
- Technical Production: PodPaste
- Guest: Scott Matherly MD
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