General Hepatology&nbsp;&nbsp;&nbsp;

How do you decide which GLP-1s to prescribe for obesity?

Are there any potency or effectiveness preferences that lead to that decision?

What is your approach in deciding when to start (or briefly defer) anticoagulation in newly diagnosed Budd–Chiari syndrome with large esophageal varices and very recent banding?

What specific bedside thresholds (ex: ongoing bleeding, platelet count, etc.) push you toward immediate anticoagulation versus early portal decompress...

How do you evaluate and manage acute alcohol withdrawal when symptom-driven protocols are confounded/unreliable?

For instance, what do you do when patients have chronic tremors, cognitive impairment, hypertension, etc.?

For pediatric patients with iron overload (high ferritin and transferrin saturation), do you perform HFE screening first, or proceed to non-HFE gene sequencing upfront to evaluate for HJV mutation as well?

Especially considering that family history is not fully available.

If a patient has persistent ascites requiring diuretics after TIPS, at what point do you consider re-evaluation of TIPS?

In what cases do you use baclofen for alcohol use disorder?

How do you use IVC caliber and collapsibility to guide decisions about diuresis?

4 Answers available

Do you use lactulose in acute liver failure, particularly in patients on continuous renal replacement therapy (CRRT) for ammonia or toxin clearance?

How do you consider sending fungal studies in a patient with pneumonia?

Considering the recent article in CHEST that describes the increasing incidence of fungal pneumonia Azar. Chest 2024

How do you approach the optimization and risk stratification of a cirrhotic patient who is undergoing extra-hepatic abdominal (or other) surgery?

Would you consider adding a loop diuretic for patients with HRS type 1 who are on a stable dose of vasoconstrictors to enhance diuresis?

Velez et al., PMID 39990915

How do you pragmatically approach a conversation about "liver detox"/"liver cleansers" when patients bring up this topic?

What risk factors in a cirrhotic patient would predispose them to the development of sarcopenia and how do you address these risk factors?

Would you consider making a diagnosis of hepatorenal syndrome-associated acute kidney injury with a one-day diagnostic fluid challenge instead of a two-day challenge to expedite vasoconstrictor therapy if needed?

Do you recommend restarting GLP-1RA after bariatric surgery if they tolerated it before the surgery?

How long do you typically treat patients with phentermine for weight loss and what clinical markers do you follow?

In patients with MASLD, would you consider management with off-label metformin, pioglitazone (despite weight gain risk), GLP-1 RA, or simply intensify lifestyle and monitor?

If you prefer monitoring strategy, how frequently do you repeat labs and what is your referral thresholds to hepatology if you're practicing in primar...

What factors do you consider when deciding to treat IgA nephropathy with immunosuppression in a patient with cirrhosis, given the possibility that IgA nephropathy could be secondary to cirrhosis?

4 Answers available

How do you counsel patients on the risks vs benefits of naltrexone for alcohol use disorder with persistently elevated liver enzymes?

Is there an absolute cutoff for AST/ALT that you use where the risks outweigh the potential harm reduction benefits of using the medication? &nbs...

What is your approach to liver transplantation candidacy in those with decompensated cirrhosis who have been treated for a solid-organ malignancy, such as oral SCC?

Is there a minimum time of waiting that is necessary between the completion of cancer treatment and liver transplantation?

What are your top takeaways from AASLD 2025?

How would you approach the management of asymptomatic ALT and GGT elevation in an older adult patient with depression with psychosis and without history of hepatitis who recently had dose of quetiapine increased and new initiation of SNRI?

How do you decide between anticoagulation or portal vein recanalization in a patient with portal vein thrombosis?

Is this a sequential process? Simultaneous?

If you do not have easy access to shear wave elastography (aka Fibroscan), what do you recommend for non-invasive tests to determine if a MASLD patient has clinically significant portal hypertension and risk-stratify them?

How do you utilize Cystatin-C as a marker of renal dysfunction in patients with chronic liver disease?

How do you balance the need for diuretics from a volume perspective (Ex: ascites, edema) in decompensated cirrhotic patients and progressive renal dysfunction?

Do you opt for "accepting" a higher creatinine and worsening renal dysfunction for more euvolemia? How would this change your practice if a patient wa...

In patients with MASLD and F2–F3 fibrosis, would you initiate Resmetirom even if they are not making active lifestyle changes?

And for how long?

How do you choose between resmetirom and semaglutide in the treatment of MASH?

When giving albumin challenge, for acute kidney injury with suspected hepatorenal syndrome, do you administer a single dose daily or split the dose of albumin?

Is the Enhanced Liver Fibrosis (ELF) test superior to the FIB-4 test in the diagnosis of MASLD?

How would you manage a patient who presents with hair loss that began after they started a GLP-1 inhibitor?

What is your approach to the use of GLP-1 agonists in older adults with diabetes with or at risk of sarcopenia?

Do you avoid peritoneal dialysis in cirrhotic patients with ascites?

How do you determine whether to limit volume removal during therapeutic paracentesis in a patient without acute or chronic kidney disease?

What is your strategy to manage peri-procedural bleeding risk in patients with cirrhosis?

Do you use TEG or ROTEM? How do you counsel proceduralists on the unique hemostatic profile of patients with cirrhosis?

How do you approach the workup for a patient with imaging showing features suggestive of cirrhosis?

How do you approach dosing beta blockers for variceal prophylaxis when the standard dose doesn’t achieve the target heart rate?"

Is there a serum ammonium level for which you recommend initiation of dialysis in a patient with hepatic encephalopathy?

How do you decide whether ordering a 5' nucleotidase or a GGT is the most appropriate option in the evaluation of an elevated alkaline phosphatase?

What is your approach to a patient with an elevated alkaline phosphatase level, but negative PBC serologies and normal biliary imaging?

At what BMI or waist-circumference threshold do you opt to move from Fibroscan to other NILDA for fibrosis assessment?

And what would be your choice?

How do you approach HCC screening in patients with advanced fibrosis e.g., F3 on FibroScan?

Do you recommend starting naltrexone at discharge for alcohol use disorder in patients with decompensated cirrhosis secondary to alcohol use?

What is your clinical approach to the evaluation of cytopenias in patients with end-stage liver disease?

How do you approach the use of viscoelastic assays (ex: TEG, ROTEM) in patients with identified coagulopathy in the peri-procedural period?

What parameters would you use to monitor and interpret iron levels in a hemochromatosis patient where ferritin is unreliable due to underlying chronic inflammation?

How would your recommendation change if the patient has H63 homozygous mutation?

When would you consider use of EUS guided liver biopsy over percutaneous and/or transjugular?

How do you approach a patient who has incidentally found liver and renal cysts?

Do you obtain liver biopsy to confirm the diagnosis of cirrhosis if cirrhotic liver morphology is noted on imaging?

Do you recommend the use of SGLT2 inhibitors to reduce the risk of liver cirrhosis in patients with Type 2 diabetes mellitus?