Resham Ramkissoon, MD

Phenomenal narrative review of SBP prophylaxis by @vinayjaha.bsky.social in @liverfellownetwork.bsky.social.

www.aasld.org/liver-fellow...

Discusses the literature, new and old, and the emerging antibiotic resistance. Certainly something to share with my trainees! @cwruim.bsky.social

Outstanding review of AAT deficiency. Bookmarked this one as a reminder of:

✅️Genetics & Pathophysiology
✅️AAT phenotypes
✅️SZ phenotype and ⬆️ cancer risk
✅️Controversies with plasma-purified AAT

#LiverSky #MedSky

This trend is *very* concerning given that alcohol damages the liver of females at 2x the rate of males. We are seeing so many young females (20s and 30s) who get very sick and often die from🍸🍷🍻-associated liver disease!

We need to work on strategies to 📉 alcohol use in this population! #liversky

A practical review of new AGA guidance on PVT management by @drjessicadavis.bsky.social
#liversky
📍don’t delay AC
📍can hold AC for EGD for 48 hours
📍AC does NOT increase risk of bleeding from varices while you wait for EGD

Congrats to Thailand for nearly eliminating vertical transmission of hepatitis B

The vaccine works

doi.org/10.12932/ap-...

The famous "Table 7" from the Gupta et al. paper on surveillance of colon polyps. A paper I refer to regularly in my practice and when teaching fellows. A must-read for all GI trainees. Note the second surveillance intervals.

#GISKY #MedSky @cwruim.bsky.social

pubmed.ncbi.nlm.nih.gov/32044092/

De Novo Malignancy After Liver Transplantation: Risk... : Transplantation - to 3-fold higher in transplant recipients than in age- and sex-matched healthy controls. Long-term immunosuppressive therapy, which is the key in maintaining host tolerance and achieving good long-t...

Great consensus statement about de novo malignancy screening after liver transplant. It also reviews management of immunosuppression with de novo malignancies, including mTOR inhibitors.
#Liversky

journals.lww.com/transplantjo...

It was a privilege to share and moderate a great case presentation by Dr. Satoi at #LiverRounds with @ohioliver.bsky.social There was a great turnout of hepatologists, fellows, and residents.

This is an interesting letter to the editor that highlights the pitfalls of poorly validated ICD-10 codes and confirms my growing concerns with the increasingly popular but alarmingly weak TriNetX database and platform

@zachsmithgi.bsky.social

#gisky #liversky

Primary Biliary Cholangitis and Primary Sclerosing Cholangitis Therapy Landscape - PubMed Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are rare, and chronic cholestatic diseases that can progress to liver failure. The goals of treatment are to halt the progres...

A well-written review of new and established therapies for PBC and PSC that covers:

✅️Drug mechanisms
✅️Clinical trial results/efficacy
✅️Side effects

#Liversky #GiSky

pubmed.ncbi.nlm.nih.gov/39480026/#:~....

There are three reasons why platelets are low in advanced liver disease

Low TPO
Portal hypertension (sequestration)
Immune-related destruction
#liversky

Love it! do you often get a liver biopsy before stopping prednisone? you hear about this discordance between biochemical and histologic remission

Our first edition of Tavill Liver rounds is coming up March 5, 2025 at Embassy suites in Independence OH

Look for educational, passionate discussions and great educational content. Come support our trainees from @metrohealthcle.bsky.social @clevelandclinic.bsky.social and university hospitals!

Challenge for #liversky :
Monitoring regression/progression on resmetirom & deciding on alternative treatments
▶️ AASLD provided guidance
▶️ We commented on the role of LSM: doi.org/10.1097/HEP....
‼️ Random variation in LSM >25%
‼️ Consider overall medical benefit (e.g., GLP-1)

'Conjunctival Icterus,' Not 'Scleral Icterus' To the Editor.—  The expression "scleral icterus" generally used by physicians is grossly incorrect. For decades, physical diagnosis primers have cued medical students to look for "scleral icterus...

The correct term is conjunctival icterus.

The expression "scleral icterus" was previously and incorrectly perpetuated. See this scathing remark in @jama.com by an ophthalmologist.

jamanetwork.com/journals/jam...

#Liversky #GiSky #Medsky @cwruim.bsky.social

Practical approach to diagnose and manage benign liver... : Hepatology Communications r cystic lesions. Recent advancements in MRI technology, particularly with hepatocyte-specific contrast agents, have enhanced the characterization of these lesions, reducing the reliance on invasive t...

Yes here you go

journals.lww.com/hepcomm/full...

Great review of hemangiomas, FNH, & more by @renumathyd.bsky.social! I encourage all learners to read the classic imaging features.

✅️Review the imaging yourself
✅️Follow up if >5cm
✅️Biopsy for atypical appearance

journals.lww.com/hepcomm/fullte…

@jhepatology.bsky.social #Liversky #GITwitter

Great case-based review of acute pancreatitis in @AmJGastro.

Remember:
✅️Classic pain + Lipase >3x ULN = Dx
✅️CT isn't always needed
✅️Early, goal-directed fluids! ⬇️BUN ⬇️HGB ⬆️UOP
✅️Early nutrition

pubmed.ncbi.nlm.nih.gov/38857482/

#GISky #MedSky
@cwruim.bsky.social

Autoimmune Hepatitis and the Pathways and Targets for... : Official journal of the American College of Gastroenterology | ACG An abstract is unavailable.

Must-read concise and case-based review of #AIH and therapies published in AJG

✅️Identify the AIH phenotype
✅️Pred+MMF could be >Pred+AZA
✅️Beware! MMF teratogenicity
✅️Tacro troughs: 6-8, then 3-5

#LiverSky #GiSky #MedSky
@cwruim.bsky.social

journals.lww.com/ajg/citation...

Is there a part 3? just joined and would be grateful to be added

Prednisolone for alcohol associated hepatitis? Literature suggests waiting ~1 week before starting. Here's reasons I avoid it:

⛔️Infection
⛔️GI Bleeding
⛔️Renal failure
⛔️Critical illness
⛔️Noncompliance

journals.lww.com/hep/abstract/9…

#LiverSky #GiSky #MedSky

A citywide collaboration with @clevelandclinic.bsky.social, @UniversityHospitals, and @metrohealthcle.bsky.social to promote knowledge and liver health.

Check out the link for the 2025 program calendar!

mailchi.mp/170574b9a487...

#Liversky #GiSky #Medsky
@livermd.bsky.social

Beautiful sunset after a productive afternoon in transplant clinic. @UHhospitals @SeidmanCancerCenter

ACG is proud to be hosting a summit on AI in GI, covering responsible, practical, and sustainable applications to improve clinical practice and patient outcomes.

Thanks to our many experts and innovators for helping shape the future of AI in our field! #AIinGI #GastroSky

journals.lww.com/hepcomm/full...

Great review covering risk factors for #HCC:

✅️ HBV is the #1 cause of HCC
✅️ Aflatoxin and its expanding contamination with #GlobalWarming
✅️ Vinyl chloride is associated with HCC and angiosarcomas
✅️ Others like pollution, arsenic, T2DM

#LiverSky #GISky #MedSky

Hello #LiverSky and #GISky! Happy to join this growing community.

I am a junior attending who's new to Cleveland and passionate about hepatology and education.

Head‐to‐Head Comparison Between Phosphatidylethanol Versus Indirect Alcohol Biomarkers for Diagnosis of MetALD Versus MASLD: A Prospective Study Using a well-phenotyped prospective cohort with systematic assessment through MRI-PDFF, MRE, and PEth testing, this study demonstrates that PEth is an accurate, quantitative, objective alcohol biomar...

💡PEth gets another win!

Compared to previously used non-invasive tests in differentiating MetALD from MASLD

#liversky

onlinelibrary.wiley.com/doi/abs/10.1...