Hepatology

Gastroenterology

Questions discussed in this category

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?

1 Answer available

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...

1 Answer available

How do you decide when to use acid-suppressive medications for GI prophylaxis when patients are on prolonged corticosteroid therapy?

Do you prescribe it universally or based on specific risk factors?

2 Answers available

What are your top takeaways from AASLD 2025?

1 Answer available

Should an individual who received the purified protein Hepatitis B vaccine in 1985 receive a booster or have antibody titers checked?

1 Answer available

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?

1 Answer available

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

Is this a sequential process? Simultaneous?

1 Answer available

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?

2 Answers available

Given that cardiovascular disease is the top cause of morbidity/mortality in patients with MASLD, do you perform any additional screening and/or testing for these patients to minimize this impact?

1 Answer available

In a patient with Zieve's Syndrome and alcohol related cirrhosis which antibiotic regimen is safe to treat H. pylori?

Most antibiotics used to treat the H. pylori are contraindicated in cirrhosis.

2 Answers available

In patients with Met-ALD, would you still offer the same therapeutic/pharmacologic treatments (ex: GIP/GLP-1 agonists, Resmetirom, ex) for management of their disease as in a "pure" MASLD patient?

1 Answer available

What clinical features would raise your suspicion for IgG-4 related disease?

Is a liver mass a presentation of IgG4 related disease?

1 Answer available

For remote liver transplant recipients back under the care of a community gastroenterologist (or PCP), what should be the approach to new liver enzyme elevations?

What should be ordered? Any medications given?

1 Answer available

Do you have any concerns about lower extremity compression (e.g., compression stockings, intermittent pneumatic compression, etc.) worsening ascites in a patient with portal hypertension?

1 Answer available

How do you decide when to initiate or restart diuretics in a cirrhotic patient with ascites if they are receiving a therapeutic paracentesis?

2 Answers available

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...

1 Answer available

In what clinical scenario would you consider the use of budesonide over prednisone as part of the pharmacologic management of autoimmune hepatitis?

1 Answer available

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?

3 Answers available

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

1 Answer available

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?

1 Answer available

In what scenario do you obtain ammonia levels in a patient with cirrhosis?

How would this value impact your subsequent management?

1 Answer available

How do you manage anticoagulation/antiplatelet therapies with strong indications for uninterrupted therapy in setting of urgent procedures?

For example, anticoagulation for recent, significant PE or dual antiplatelet therapy for recent MI, but requiring urgent procedures such as biopsy of ...

4 Answers available

Do you avoid peritoneal dialysis in cirrhotic patients with ascites?

3 Answers available

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

3 Answers available

What is your approach to the management of post-TIPS hepatic encephalopathy?

1 Answer available

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

2 Answers available

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

1 Answer available

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

3 Answers available

How do you incorporate other pharmacologic bariatric/appetite suppressants in the context of their clinical care plan for MASLD?

1 Answer available

What clinical scenario do you consider screening for hepatitis delta?

1 Answer available

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?

1 Answer available

What is your strategy in the management of patients with autoimmune hepatitis who failed azathioprine therapy and what parameters do you monitor with what frequency?

1 Answer available

What is your approach to perioperative risk stratification and optimization in patients with cirrhosis?

Do you find risk scores such as VOCAL-Penn to be helpful?

1 Answer available

What kind of monitoring do you choose in patients at risk for reactivation of hepatitis B who are on immunosuppression?

1 Answer available

When do you pursue liver biopsy for assessment of DILI?

1 Answer available

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

1 Answer available

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

2 Answers available

Do you avoid terlipressin for patients with hepatorenal syndrome who have an elevated bilirubin level?

2 Answers available

Is there benefit to aggressively treating hemochromatosis in a patient who has already progressed to cirrhosis at the time of diagnosis?

2 Answers available

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

2 Answers available

Can fatty liver disease present with elevations in alkaline phosphatase without other liver enzyme elevations (AST and ALT)?

1 Answer available

How does presence of clinically significant portal hypertension change patient prognosis in MASLD?

1 Answer available

Would you consider long term avatrombopag use in patients with cirrhosis requiring higher platelet counts for medical therapy?

For example, someone needing a higher platelet count for dual antiplatelet agent use after coronary stent placement.

1 Answer available

How do you rule out spontaneous bacterial peritonitis in a patient with minimal ascites that is not amenable to paracentesis?

1 Answer available

How do you manage fatty liver disease in patients on olanzapine who are reluctant to change meds?

I have several forensic patients who have elevated LFTs and fatty liver on ultrasound, at least in part due to long-term olanzapine use. They are all ...

2 Answers available

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

2 Answers available

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

1 Answer available

Papers discussed in this category

Lancet (London, England), 2015-03-14

Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial.

The New England journal of medicine, 2020 Nov 13

A Placebo-Controlled Trial of Subcutaneous Semaglutide in Nonalcoholic Steatohepatitis.

Gastroenterology, 2015 Apr 10

Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis.

The New England journal of medicine, 2010 Apr 28

Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis.

Hepatology (Baltimore, Md.), 2022 Jan 24

Placebo effect on progression and regression in NASH: Evidence from a meta-analysis.

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2021 Jun 04

The Placebo Response in Randomized Trials in Nonalcoholic Steatohepatitis Simply Explained.

The New England journal of medicine, 2024 Feb 08

A Phase 3, Randomized, Controlled Trial of Resmetirom in NASH with Liver Fibrosis.

Hepatology (Baltimore, Md.), 2024 Oct 18

Resmetirom therapy for metabolic dysfunction-associated steatotic liver disease: October 2024 updates to AASLD Practice Guidance.

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2020 Oct 23

Pretransplant solid organ malignancy and organ transplant candidacy: A consensus expert opinion statement.

Clinical journal of the American Society of Nephrology : CJASN, 2023 Oct 17

How We Treat Hyperammonemia in Acute Liver Failure.

International journal of molecular sciences, 2022 Mar 13

SGLT-2 Inhibitors in NAFLD: Expanding Their Role beyond Diabetes and Cardioprotection.

Hepatology (Baltimore, Md.), 2012 Apr

Albumin infusion in patients undergoing large-volume paracentesis: a meta-analysis of randomized trials.

The New England journal of medicine, 2021 Mar 04

Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome.

Archives of internal medicine, 2006 Feb 13

Screening for hemochromatosis in asymptomatic subjects with or without a family history.

Gastroenterology, 2018 May 17