Taseen Syed MD, FACP

Transplant Hepatologist/Gastroenterologist @integrishealth_ | GI/Transplant Liver fellowship @VCU | IM @OUmedicine | @AASLDFoundation Emerging Liver Scholar

[Taseen Syed MD, FACP @tsyedMD]

"Performance of VCTE and Clinical Prediction
Models In LT recipients" - CGH

👉VCTE can potentially be used to risk stratify at-risk LTR non-invasively.

https://t.co/VPWF5j4dNx

@mikethtseng @HassounehRamzi @VCU @AGA_CGH @liverprof @RichSterlingMD @ChathurAcharya #LiverTwitter

[Taseen Syed MD, FACP @tsyedMD]

@haseeb170 @IUGastro @MetabolicEndo @PittGILiverNutr @ASGEendoscopy @alhaddad_mo @AzizullahBeran @zubairkhan254 @SighPichamol @AmerGastroAssn @IrbazRiaz @AmCollegeGastro Congratulations

[Taseen Syed MD, FACP @tsyedMD]

@haseeb170 @PittGILiverNutr @ASGEendoscopy @MetabolicEndo @SighPichamol @zubairkhan254 @maham_waqar170 @AmCollegeGastro @AmerGastroAssn @DDWMeeting @SultanMahmoodMD Great news. Congratulations 🎊

[Taseen Syed MD, FACP @tsyedMD]

@SultanMahmoodMD Congratulations. Strong work.

[Taseen Syed MD, FACP @tsyedMD]

@zubairkhan254 @DrHasan_Orlando @DennisYangMD @KKadkhodayan @MahamHayatMD @NCosgroveMD @MN_GIMD @SChandanMD @abdullahaabbasi @helpatologist @ASGEendoscopy Congratulations 🎊

[Elliot Tapper @ebtapper]

Hepatitis E can become chronic in the setting of immunosuppressives, including after transplant

Here in @HepCommJournal is a report of a pig model for chronic hep E on anti-rejection 💊. Shows why HEV is chronic & that it lives in the gut

https://t.co/dlgC1KRLNG #livertwitter

[Juan Turnes @jturnesv]

Well, it's official now, we have a new drug for patients with primary biliary cholangitis who don't respond to UDCA: #elafibranor, a PPAR agonist

It simply works, it's safe, and not only does it not cause itching, but it also seems to improve it!

#TLM23 #LiverTwitter #PBC

[Elliot Tapper @ebtapper]

Pssst. Ultrasound and CT scan are not sensitive for #cirrhosis

Pass it on

https://t.co/qhyWrIt3TP

Open access in @HepCommJournal from Hetland, Gluud and co on the combined results from 4 prospective cohorts #livertwitter #MedEd

[Tony Breu @tony_breu]

1/15
🤔Why does portal hypertension lead to splenomegaly.

I also assumed the spleen became "congested" from backflow of blood.

Turns out, it isn't that simple. And there are interesting therapeutic implications.

Let's have a look.

[Ramon Bataller @rabataller]

This study including 27 million people shows increased risk of developing liver disease in people undergoing CHOLECYSTECTOMY.

Strict indications should be imlemented to reduce unnecessary cholecystectomy.

#livertwitter #medtwitter https://t.co/5Y8OVxVpHp

[Liver Transplantation Journal (LTxJournal) @LTxJournal]

“But I Didn’t Drink!”: What to Do with Discordant Phosphatidylethanol Results
by Winder et al of @MichiganLiver

https://t.co/3Az3qzm8zP

#livertwitter @ponnivp

[Ramon Bataller @rabataller]

What is the BEST DIET for patients with fatty liver ? What is the scientific evidence supporting their health benefits ?

This critical and didactic review explains it all.

#livertwitter #MedTwitter @EASLedu https://t.co/wtTvpoIcLD

[Elliot Tapper @ebtapper]

Supermassive transfusions - >50 units of blood - happen in liver transplant

Incidence: 5.6% of transplants

Risk factors:
1️⃣MELD>35
2️⃣portal thrombosis
3️⃣prior surgery/transplant

https://t.co/IduiKFeLdl #livertwitter

[Jessica Davis @DrJessicaDavis]

🚨🚨#PROCBLEED is out!
https://t.co/X5ihPYb6pM

➡️>1,000 pts w/#cirrhosis undergoing non-surgical procedures

➡️Risk of bleeding is low (3%)

➡️Plt/INR not predictive of risk

➡️Transfusion not protective

➡️Bleeding associated w/BMI, MELD, & mortality

#livertwitter #gitwitter

[Lizzie Aby, MD @LizzieAbyMD]

Just spent the morning w/our amazing liver pathology team & was told about this great resource from @UPMCPath - Transplant Pathology Internet!

The 'consult corner' section has over >100 hepatobiliary cases to learn from!

https://t.co/h0XXxIL1bb

#livertwitter #pathologytwitter

[Liver Fellow Network @LiverFellow]

Ever wonder why GLP-1 agonists being used to treat patients with nonalcoholic fatty liver disease (#NAFLD)?

Check out this great 'Why Series' post by Melissa Kaltenbach of @penngihep!

https://t.co/FnqL2tQAMv

#livertwitter #GITwitter #MedEd #FOAMed #MedTwitter #NASH

[TheLiverDoc™ @theliverdoc]

CIRRHOSIS

I urge every #MedTwitter student, graduate and young fellows of Gastroenterology and Hepatology to read this brilliant review on "Diagnosis & Management of Cirrhosis" in @JAMA_current by @ebtapper & @NDP1001

Here are some important & some additional points on cirhosis for non-medical people from the manuscript:

1️⃣ The major cause for cirrhosis is changing - alcohol use and non-alcoholic fatty liver [NAFLD] alone or in combination has surpassed hepatits C in the USA because hepatitis C infection is now curable. In India it is still alcohol, but NAFLD is catching up.

2️⃣ One does not NEED to be an "ALCOHOLIC" to develop cirrhosis. In the presence of other risk factors, such as diabetes, obesity and high blood pressure or even the presence of a specific gene mutation called PNPLA3, even mild to modest amount of alcohol use can promote cirrhosis. The amount of alcohol safest for your liver is zero ml.

3️⃣ The gold standard for cirrhosis diagnosis is a liver biopsy which is invasive, but confirmatory. But this is no more required as newer techniques such as Shearwave scan that measure liver stiffness (value >15) can do the same.

4️⃣ Cirrhosis is no more considered an irreversible disease. Early stages of cirrhosis and stable stages of advanced cirrhosis can undergo regression/reversal with correct treatment of its cause(s).

5️⃣ The major complications of cirrhosis include rupture of large veins (called varices) in the digestive tract that present as blood vomiting or black tarry stools; development of fluid in abdomen (ascites), brain dysfunction (from sleep disorders to confusion and coma, called encephalopathy), life threatening infections, kidney injury and liver cancer.

6️⃣ A large part of management of cirrhosis is still MEDICAL while major life threatening complications and those that are unmanageable with medicines & recurr require transplantation for cure.

7️⃣ Apart from major complications there are minor complications that are STILL major for the patient, resulting in poor quality of life. These need to be asked for, identified and addressed.

These include: [treatments based on small, but good quality trials]👇
➡️Severe recurrent itching
✅️Treatment: Moisturizers, hydroxizine
➡️Severe muscle cramps
✅️Treatment: Sipping pickle brine/juice at onset of cramps, vitamin E+carnitine, prevented using taurine 1000mg per day.
➡️Reversal of sleep, daytime sleepiness
✅️Treatment: Lactulose syrup.
➡️Sexual dysfunction in men, mostly among those who consume alcohol
✅️Treatment: Tadalafil.

8️⃣ Not all patients are diagnosed with cirrhosis at a stable stage. Approximately 40% are diagnosed during the time they present with a major complication. Some are even diagnosed with advanced liver disease and liver cancer on routine testing without any symptoms at all.

9️⃣ Remember alcohol use is an avoidable cause for cirrhosis. Alcohol in mild or modest amounts is also an avoidable cause for cirrhosis in those with additional risk factors and in those diagnosed with cirrhosis, no amount of alcohol is advisable. There should be lifetime abstinence.

🔟 Common concerns/myths⬇️

➡️Low platelet counts in cirrhosis does not need any treatment and low platelet counts does not lead to any symptoms. A count above 50,000 is adequate in cirrhosis patients.

➡️There is no liver detox. Liver detoxes are wellness frauds that can in all likelihood, harm the liver.

��️Swelling of the legs in cirrhosis is not a complication of cirrhosis, it is a feature of the disease due to multiple reasons such as low protein/albumin, varicose veins, slow lymphatic drainage from legs etc.

➡️There is no specific diet for liver health. Overall general health also includes good liver health. Any person who prescribes, advertises or sells specific liver health solution only wants your money.

➡️Whey protein does not damage the liver. It is safe for use.

➡️Fruits and veggies combinations as juices or blended infusions or as a predominant dietary component compromising protein in diet does not improve "liver health." There are no specific fruits or vegetables that specifically improve liver health.

➡️Processed and ultraprocessed foods, sugary diets, fructose-based foods (including an overconsumption of fruit in diet) are ours and our children's greatest enemies when it comes to fatty liver disease.

FULL PAPER LINK HERE
https://t.co/tD45rvQQFY

[Daryl Ramai @DarylRamai]

Patient with severe GAVE. Performed band ligation and did well ✅

Anyone doing band ligation for GAVE? Literature ✍️ BL > APC?
@DouglasAdlerMD @DrSalihTokmak @Stentingwoman @BenClement_MD @NEndoscopy #GITwitter #MedTwitter

👉🏽https://t.co/QWp1GwsnI8

[AASLD @AASLDtweets]

Now Online❗️ AASLD Practice Guidance on the Clinical Assessment and Management of Nonalcoholic Fatty Liver Disease 👉https://t.co/8v9eDqcJ5W #NAFLD #LiverTwitter

[Henry E. Chang @HenryEChang]

Prof. @marurinella provides a summary of key and selected highlights of the updated @AASLDtweets practice guidelines on the clinical assessment and management of #NAFLD (accepted & to be published in @HEP_Journal this month) #2023NASHTAG @NashTagConf #NASH #LiverTwitter 1/3