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Resham Ramkissoon, MD @rayrammd.bsky.social · Jun 22

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

https://aasld.org/liver-fellow-n…

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Resham Ramkissoon, MD @rayrammd.bsky.social · Apr 22

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

Reposted by Resham Ramkissoon, MD

Hanna Blaney, MD, MPH @blaneymd.medsky.social · Apr 17

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

JAMA @jama.com · Apr 17

Past-month binge drinking among young adult females in 2021-2023 was higher than among males, reversing 2017-2019 patterns, whereas males in other age groups continued to binge and heavy drink at higher rates. https://ja.ma/42pf2V6 #MedSky

Sex-Based Differences in Binge and Heavy Drinking

This cross-sectional study compares differences in binge and heavy drinking among male and female adults in recent years.

ja.ma

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Reposted by Resham Ramkissoon, MD

Atoosa Rabiee @atoosarabiee.bsky.social · Apr 5

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

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Reposted by Resham Ramkissoon, MD

Elliot Tapper @ebtapper.bsky.social · Mar 31

Congrats to Thailand for nearly eliminating vertical transmission of hepatitis B

The vaccine works

doi.org/10.12932/ap-...

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Resham Ramkissoon, MD @rayrammd.bsky.social · Mar 31

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/

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Resham Ramkissoon, MD @rayrammd.bsky.social · Mar 23

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...

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...

journals.lww.com

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Resham Ramkissoon, MD @rayrammd.bsky.social · Mar 23

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.

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Reposted by Resham Ramkissoon, MD

Elliot Tapper @ebtapper.bsky.social · Mar 9

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

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Resham Ramkissoon, MD @rayrammd.bsky.social · Mar 3

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/#:~....

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...

pubmed.ncbi.nlm.nih.gov

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Reposted by Resham Ramkissoon, MD

Elliot Tapper @ebtapper.bsky.social · Mar 1

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

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

NEJM.org @nejm.org · Mar 1

Case Record of the MGH: A 65-year-old woman was evaluated for back pain and pancytopenia. A peripheral-blood smear was notable for nucleated red cells, large platelets, and immature granulocytes. A diagnosis was made. Full case details: nej.md/4bfXXBf

#MedSky #Oncology

Case Records of the Massachusetts General Hospital
A 65-Year-Old Woman with Weakness, Back Pain, and Pancytopenia

A Venn diagram of the causes of acquired cytopenias.

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Resham Ramkissoon, MD @rayrammd.bsky.social · Mar 2

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

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Reposted by Resham Ramkissoon, MD

Northeast Ohio Liver Alliance @ohioliver.bsky.social · Feb 23

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!

Anthony S. Tavill, MD Liver Rounds Registration

app.etapestry.com

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Reposted by Resham Ramkissoon, MD

mattiasmandorfer.bsky.social @mattiasmandorfer.bsky.social · Feb 15

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)

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Resham Ramkissoon, MD @rayrammd.bsky.social · Feb 13

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

'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...

jamanetwork.com

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Resham Ramkissoon, MD @rayrammd.bsky.social · Feb 11

Yes here you go

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

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...

journals.lww.com

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Resham Ramkissoon, MD @rayrammd.bsky.social · Feb 11

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.socia#Liverskyk#GITwitterer

https://journals.lww.com/hepcomm/fullte…

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Resham Ramkissoon, MD @rayrammd.bsky.social · Feb 9

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

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Resham Ramkissoon, MD @rayrammd.bsky.social · Feb 2

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...

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

An abstract is unavailable.

journals.lww.com

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Resham Ramkissoon, MD @rayrammd.bsky.social · Feb 2

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

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Resham Ramkissoon, MD @rayrammd.bsky.social · Feb 2

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…#LiverSkyk#GiSkyk#MedSkyky

https://journals.lww.com/hep/abstract/9…

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Resham Ramkissoon, MD @rayrammd.bsky.social · Feb 1

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

NEOLA in the 2025!

mailchi.mp

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Resham Ramkissoon, MD @rayrammd.bsky.social · Jan 29

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

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Reposted by Resham Ramkissoon, MD

American College of Gastroenterology @amcollegegastro.bsky.social · Jan 24

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

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Resham Ramkissoon, MD @rayrammd.bsky.social · Jan 28

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

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