Atoosa Rabiee
@AtoosaRabiee
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Transplant hepatologist/GI doc|Chief of Transplant Director of Hepatology @DCVAMC @HopkinsMedicine @UMiamiHealt alum #livertwitter | #livercancer | #portalHT | #MEDed
Washington, DC
Joined November 2019
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Updates of portal HTN guidance statement by
@ggarciatsao
🔺CSPH can be defined by
📍Collaterals on imaging
📍EV on endoscopy
📍LS>25, LS 20-25/Plt<150
🔺Carvedilol is the NSBB of choice 6.25-12.5 daily
🔺Goal is prevention of decompensation in the new…
7
119
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My
#livertwitter
in review
Highlights of new guidance statements & interesting publications in 2023
🧵1/11
From
@AASLDtweets
new guidance statements
Portal HTN
ACLF
@JuanAbraldes
@ggarciatsao
@AsraniSumeet
8
142
344
🚀new practice guidance on management of portal HTN from
@AASLDtweets
is here
📍concept of cACLD
📍noninvasive assessments of CSPH
📍change in paradigm & early use of NSBB to prevent decompensation
📍preemptive TIPS
Keep calm on beta block your patients ❤️
#livertwitter
…
0
93
229
Updated guideline alert 🚨
#livertwitter
Diagnosis, evaluation and management of
#ascites
and
#HRS
@AASLDtweets
@ggarciatsa
@WRayKimMD
@HEP_Journal
3
70
178
17
10
175
I usually don’t share anything personal, but this meant a lot to me.
My colleagues and friends at work celebrated my BD in the midst of a pandemic. There is still so much good in this 🌎❤️
#WeAreAllInThisTogether
43
0
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🧵
In acute variceal 🩸
New statements 👇
- use vasoactive drugs at least 2 and up to 5 days
- oral nutrition should be started ASAP
- 🛑 PPI immediately after EGD if no strict indication
- Hemostatic powder NOT recommended as first line for AVB
#livertwitter
@BavenoVII
4
33
157
25
3
155
📢 New GI fellows:
You want to book mark this 👇🏼
Iron deficiency anemia is a very common consult and could be annoying at times, but needs critical thinking and a step wise approach
#GItwitter
@AmerGastroAssn
6
30
152
Updates on interventional treatment of portal HTN by
@JuanAbraldes
🔺First review pic 👇🏼
🔺start TIPS at 8 mmHg with goal below 12 (between PV and IVC)
🔺if pressure not below 12 with dilation to 10 mm, add NSBB
🔺see table 👇🏼for contraindications
#TLM23
#livertwitter
…
4
44
150
If you want to change behavior, show the data. So proud of
@RabieeAnahita
adding to evidence behind safety of naltrexone in cirrhosis.
Among 2940 patients with cirrhosis started on naltrexone for AUD, zero cases of DILI was identified!
#livertwitter
1
46
148
📢Albumin is on the news again!
In this open-label study led by
#ShivSarin
, critically-ill cirrhosis pts were randomized to 20% albumin or plasmalyte with primary end-point of MAP> 65 at 3 hrs
⚠️Results 👇🏼👇🏼👇🏼
#livertwitter
@JHepatology
1
47
129
Great talk by Dr. Dieterich
📌HBV carrier is a misnomer
📌 most patients with CHB fall into grey zone based on current guidelines
📌 ⬆️DNA levels is a/w ⬆️ risk of cirrhosis & HCC
📌 a proposed treatment algorithm : treat the 🦠 NOT ALT
#liverMTg21
#livertwitter
@AASLDtweets
9
45
117
📢 Very much anticipated guidelines on PVT, procedural bleeding and vascular dis in pts with liver disease is here
#livertwitter
@AASLDtweets
@HEP_Journal
2
44
118
Long 🧵
#livertwitter
#gitwitter
1/6
I feel detached from my body in the morning, when I go to the hospital, round with the team, see new consults, attend meetings.
Then I check my social media which takes me back to my life before.
#Mahsa_Amini
15
32
113
What more could I ask for? Amazing transplant team
@DCVAMC
bringing joy to every day work. They even had a gift for my sister
@RabieeAnahita
who is soon going to be a transplant hepatologist with
@DeptVetAffairs
#livertwitter
#Transplanttwitter
7
4
111
🔥 off the press
Long anticipated
#NAFLD
practice guidance
🎯use FIB-4 in high risk patients: T2DM, MetSyn, alcohol use
🎯ELF or TE as second step
🎯Multidisciplinary care is 🔑
#livertwitter
@AASLDtweets
@DrLoomba
1
36
104
We did it!
Lee brothers and Rabiee sisters!
📢There is 4 of us!
Please check our names before hitting the send button 😂
@RabieeAnahita
@HowardTLeeMD
@howiethedoc
@AASLDtweets
#TLM23
#LiverTwitter
6
6
105
Norouz Mobarak ❤️
Happy Spring Equinox
#GItwitter
#Livertwitter
@BMoshiree
@RezaEmaminia
@MSharifpourMD
@arghavan_salles
8
5
104
⚠️AC for portal vein thrombosis in cirrhosis?
This recent meta-analysis showed ⬇️⬇️⬇️ all cause mortality
There was ⬆️⬆️⬆️ in non-portal HTN 🩸
‼️Benefit independent of severity or recanalization
#livertwitter
@JHepatology
@ReibergerThomas
1
40
104
When liver is a bystander….
1/3
At least once a month, this ❓comes up on consult; why are liver enzymes
abnormal in ICU patients?
🔹Hypoxic/ischemic hepatitis
🔸Cholestatic liver dysfunction
How to diagnose these conditions? 👇🏼👇🏼👇🏼
#livertwitter
2
35
103
@MondayNightIBD
#CopingWithCovid
#nottodaycovid
#covidGI
NEVER posted a video of myself
@DCharabaty
reassured me that you all will get the message through the accent ❤️ cause more than ever
#WeAreAllInThisTogether
Still got cut off last sec, share your tips with me
#wegotthis
20
23
102
1/2To all trainees
@AASLDtweets
trying to figure out their future 🛣️:
I was in your 👠 5 yrs ago. Not all advice is good advice. I received not so good advice right👇🏼in 2017.
U can do what you want, have as many passions as you wish, take on as many roles as you desire
#TLM22
2
10
102
Want to know more about management of portal vein thrombosis
#livertwitter
?
🚨Look no further!
Here is a review by
@jcgarciapagan
and
@ggarciatsao
on
#PVT
@JHepatology
7
31
101
Happy new year to those who celebrate the first day of spring!
Norouz Mobarak 😊
(spring equinox)
#livertwitter
#GItwitter
7
8
99
Very surreal experience.
I asked if I could take a photo
Nurse: “Honey, we are making history. Take as many as you want.”
Thankful to all who worked hard to get us here.
#stickittoCOVID
#MyCOVIDvax
#thisisourshot
#sciencematters
@ABIMcert
@AmCollegeGastro
@AASLDtweets
4
3
98
Great MTE with
@ggarciatsao
and Florence Wong
📌 management of AKI/HRS in decompensated cirrhosis
#livertwitter
#LiverMtg21
0
34
96
If you are still on the fence about carvedilol and it’s role in compensated patients
Or if you still debate EVL vs NSBB
Review these slides For the answer
👇🏼👇🏼👇🏼
#livertwitter
@BavenoVII
0
36
96
💥Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases💥
@AASLDtweets
@HEP_Journal
#livertwitter
3
34
91
treating alcohol use by
@rabataller
📌 biomarkers of alcohol use
📌 personalized medicine goes beyond genes in alcohol use
📌 motivational interviewing saves lives
📌 role of pharmacologic therapy
WE AS HEPATOLOGISTS NEED TO BE BETTER TRAINED 💯
#livertwitter
#LiverMtg21
4
23
91
Excellent talk by
@ggarciatsao
on portal vein thrombosis
🔑 points:
👉 main impact in
#cirrhosis
-> post
#LT
survival
👉 Treatment indications
- >50%/progressive PVT
- PVT of both branches
- extension into SMV
👉 Don't wait too long for TIPS
#livertwitter
6
39
91
excellent statements on PVT in non-cirrhotic patients
📌consider liver bx /HVPG in those w/abnormal liver test/imaging
📌DOACs can be 1st line except triple+APL
📌long term AC >6 months indications 👇
and the big finale
YES, YOU CAN BAND WHILE ON AC!
#livertwitter
2
43
91
Excellent work 🌎 liver community for removing stigmatization from most common chronic liver dis by creating new nomenclature
#MASLD
Let's continue to ⬆️ awareness, ⬇️ stigma & expedite advancement in 💊 for our patients
#LiverTwitter
@AASLDtweets
2
46
91
Such fun project to do with my sister!
Thanks
@CLD_Learning
for the invitation!
Keep beta blocking and carry on!
@jturnesv
@JuanAbraldes
@BrettEFortuneMD
@AASLDtweets
#livertwitter
1
25
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2
4
87
👋
#livertwitter
please welcome my sister
@RabieeAnahita
to twitter, finally convinced her to join
She is a 2nd year GI fellow at Yale & also loves liver!
@MTPapaD
@DCharabaty
@stevenbollipo
@renumathyd
@drkeithsiau
@jturnesv
@RashidLui
@KapuriaMd
@gilbenyakov
@sconglymd
20
3
86
Happy Norouz (Spring equinox) to all my
#GItwitter
#livertwitter
friends 😊
May this be a year of health and happiness (the two things we need the most)!
8
1
85
🚨Diagnosis and management of drug induced liver injury
#DILI
🚨
@AmCollegeGastro
@AmJGastro
#livertwitter
1
20
87
📣Management of 🩸 in patients with cirrhosis undergoing endoscopy or paracentesis
Gaps and consensus 👇🏼👇🏼👇🏼
#livertwitter
@ebtapper
0
40
86
From no twitter account to social media correspondent for
#LTMdx
😊excited and looking forward to this experience
@AASLDtweets
#livertwitter
12
1
82
📌Indications for using AC in PVT in cirrhosis
📌Length of AC
📌Use of DOACs in cirrhosis
@BavenoVII
#livertwitter
1
31
77
Q: So can I still tap the patient with elevated INR?
A: YES
📌⬆️ PT/INR & aPTT ⬇️decreasing factor V activity should NOT be used to assess bleeding risk in
#cirrhosis
#livertwitter
@LiverFellow
@JHEP_Reports
A new study reported that liver dysfunction biomarkers (prolonged PT/INR and aPTT, decreasing factor V activity) should not be used to assess bleeding risk in patients with
#cirrhosis
. Alternative biomarkers need to be developed.
#thrombosis
@CHUVLausanne
0
16
27
6
25
78
And we meet again to improve transplantation care for Veterans
So good to see you
@ruben_hernaez
#livertwitter
@DCVAMC
4
4
78
Make sure to stop by
@AASLDtweets
booth in exhibit hall and pick from all the goodies available 😊❤️
#TLM23
#livertwitter
@dclaurin
0
3
79
🚨TIPS for refractory ascites & prevention of variceal rebleeding ⬇️ further decompensation
⬆️ survival in highly selected pts
As
@BrettEFortuneMD
said
TIPS SAVES LIVES!
NNT with TIPS to save one life was 13
@JHepatology
@jcgarciapagan
#livertwitter
2
22
76
8
29
78
If I may provide a piece of advice as a hepatolgist who also scopes to new GI fellows:
Use your procedure note to offer an actual assessment and plan.
Follow up in GI clinic or resume diet is NOT a plan.
Make it a habit from day 1!
#GItwitter
#livertwitter
#tipsfornewdocs
7
5
76
From Charleston to Chicago ✈️
Tired but ready to connect with
#livertwitter
friends
With my travel buddy
@MTPapaD
@AASLDtweets
@DDWMeeting
#DDW2023
1
2
76
📣 Are you interested in portal hypertension
#livertwitter
?
Consider joining
@BavenoCoop
by contacting
@ReibergerThomas
See instructions below on who qualifies 👇🏼👇🏼👇🏼
5
22
72
#livertwitter
Role of Noninvasive Tests in Clinical Gastroenterology Practices to Identify Patients With Nonalcoholic Steatohepatitis at High Risk of Adverse Outcomes: Expert Panel Recommendations
@AmCollegeGastro
2
29
73
📝From past to present to future:
A great review and practical guidance on terlipressin use in HRS-AKI by
@JoeCullaro
et al
@HEP_Journal
#livertwitter
3
16
77
Where all the cool
#womenInhepatology
are hanging out this weekend ❤️
#CLFD
#liverconnect
#livertwitter
@laurakulik1
@AnjanaPillaiMD
3
3
73
#livertwitter
#palliativehepatology
👇🏼👇🏼👇🏼👇🏼👇🏼
🎯🎯🎯 Love that
@JHepatology
is providing a platform for a topic that many of us in the
#palliativehepatology
space hold close to our hearts.
0
1
12
4
22
72
🔥Liver Injury in Liver Transplant Recipients with COVID‐19: US Multicenter Experience
Our
#livertwitter
to paper is out
Read the summary 👇🏼
Thankful to all the authors/collaborators &
special thanks to
@BWSadowskiMD
@renumathyd
7
16
72
what to tell my patient with
#NAFLD
?
👉 Mediterranean diet recommended by EASL
👉 Not enough data on IF/low carb diet, if it works for you go for it
👉 🔽 red meat 🔼 fiber
👉 Watch out for sugar: excellent tips from
@DrMTLong
👉 Quantify alcohol use
#livertwitter
@AASLDtweets
3
23
70
Nice summary of management of alcohol related hepatitis presented by Ashwani Singal
#DDW2021
#livertwitter
#MedEd
3
19
67
8
2
68
1
20
68
updates on autoimmune hepatitis
📌incidence is increasing
📌19-34% ab negative
📌 AIH and NAFLD
📌 increasing incidence of checkpoint hepatitis
#TLMdx
#livertwitter
@AASLDtweets
1
23
67
It was really like we have known each other in real life for many years
#livertwitter
It’s easy conversation when you are among liver lovers!
#DDW2022
@renumathyd
@LizzieAbyMD
@dr_ash_arvind
@allisonkwong
@wong_yujun
@GarrettKangJH
@ArpanPatelMD
2
1
65
Role of IR in treatment of
#HCC
summarized by Dr Ed Kim
#livertwitter
@HCCLIVEConf
My 🔥 take:
- Time to share the space with rad onc
- TACE: old and familiar but are we settling for familiar vs effective?
@freddyeescorcia
6
15
66
🚨Will you use
#FIPS
(Freiburg index of post-TIPS survival) to predict risk of
#TIPS
?
Age, bil, albumin & cr ->most significant predictors of 6-months survival post TIPS
superior to the MELD, MELD-Na, CP
@JHepatology
#livertwitter
3
14
64
It was so good to meet my friends from
#GOAL
#livertwitter
and celebrate
@stevenbollipo
promotion
@renumathyd
@jturnesv
@sconglymd
and talk about new research ideas ❤️
#TLM23
@AASLDtweets
#LiverTwitter
2
2
63
Take away from
@DavidPatch1
presentation
If you love your patients, stop that PPI!
#LiverTwitter
@BavenoVII
0
14
64
Tomorrow is Feb 14th. Also known as
National Donor Day ❤️
Every 10 mins someone finds out they need a life-saving organ transplant.
@DonateLife
#livertwitter
#transplanttwitter
#BetheGift
#TalkDonation
@AASLDtweets
@AST_LICOP
@AST_LDCOP
@AST_info
1
25
63
3
10
63
The results are in!
It was a great session, lots of questions and all seats taken 😊
Thank you to our moderators and speakers
#portalHTNSIG
#livertwitter
#TLM23
@AASLDtweets
@DougSimonetto
@serperm
3
1
64
Important study in
#HCC
detection
🟢Biannual US -> suboptimal performance for early-stage
🔵Annual NC-AMRI ⬆️ diagnostic yield without⬆️ false referral
🔴Alternating biannual US & NC-AMRI⬆️ sensitivity>> biannual US
#livertwitter
@JHepatology
4
11
62
After watching social dilemma on
@netflix
was trying to reassess my relationship with social media!
Then I got👇🏼 as a reminder of all the wonderful people I have met, collaborated with & learned from on twitter
I am more than ever grateful to my
#livertwitter
community 😊
7
2
62
1/2
Updates on management of HRS-AKI with
#FlorenceWong
#livertwitter
#TLM22
@AASLDtweets
⭐️ How does albumin help
⭐️ How to use terlipressin
⭐️ Watch out for respiratory failure
⭐️ Who would not respond well to terlipressin
2
16
61
🔔Excellent review of
#HCC
down staging for transplant using locoregional therapy, novel systemic therapy and clinical trial design by
@bruixj
#livertwitter
#livercancerSIG
@HEP_Journal
0
21
59
Great things happen when a team of ambitious, caring, dedicated people come together.
I look at this picture and pinch myself seeing how lucky I am to work with this all star team increasing access to Veterans needing liver and kidney transplant
@bthomas215
@DrJessicaDavis
…
3
4
60
In decompensated patients
- low risk varices->NSBB
- high risk varices-> NSBB preferred over EVL
🚨 attention to those with refractory ascites and low MAP
#LiverTwitter
#portalHTNSig
@BavenoVII
2
11
60
Women promoting women
#ScrubsNHeels22
And
✅ enjoying the 🌊
✅ connecting with mentors/sponsors
✅learning from the leaders
✅having fun
#GItwitter
#LiverTwitter
3
6
58
Here are the
@BavenoVII
statements on prevention of decompensation in compensated cirrhosis with CSPH
#livertwitter
#portalHTNSig
@jaumebosch9
what a wonderful session as evident by all questions streaming 👏👏👏
0
14
58
ascites and kidney injury
📌Pathophysiology, diagnosis and treatment
@WRayKimMD
#livertwitter
#TLMdx
@AASLDtweets
4
14
56
A thread 🧵 to bookmark
Spring 💐 is when new practice guidances come out👇🏼👇🏼👇🏼👇🏼
📣1/3
Non-invasive testing for assessment of portal hypertension
#livertwitter
@AASLDtweets
@HEP_Journal
1
17
57
🔥Fibrates for itch: FITCH🔥
📍PSC, PBC or SSC pts
📍double-blind
📍bezafibrate (400mg/d) or placebo 21 days
📍primary endpoint >50% ⬇️ of pruritus
📍bezafibrate-> endpoint in 45%
📍also ⬇️ serum ALP
📍Mild ⬆️ creatinine
#livertwitter
@AGA_Gastro
2
21
57
nicely summarized take home points by
@JuanAbraldes
on statin use in patients with cirrhosis
#livertwitter
#liverMtg21
@AASLDtweets
#portalHTNSig
1
14
56
Is it cost-effective to treat all HBsAg+ in 🇺🇸
by
#DevinRazavi
-Shearer
🔑 points
- eliminates decompensation
- ⬇️ HCC & HBV related 💀
- can be cost-effective
💭 provoking study
#livertwitter
#LiverMtg21
@AASLDtweets
Is it 🕰 to retire the fancy, complicated hep B algorithms?
3
19
55
As a transplant hepatologist married to a periodontist who grills me on flossing, I am super fascinated by this study presented by
@AndrewMMoon
showing periodontitis is associated with chronic liver disease
#TLMdx
#livertwitter
@AASLDtweets
@PerioNews
4
5
55
One of the best talks I have heard on the role of biopsy in diagnosis, staging and disease monitoring of liver disease by
@ebtapper
Best quote: "We make decisions not tests"
Session: post graduate course
#TLMdx
#livertwitter
3
13
56
🚨This is a must read
#livertwitter
Not just because my sister
@RabieeAnahita
wrote it 😊
why we use NSBB in
#cirrhosis
❓❓❓
@DrJessicaDavis
@drkeithsiau
@stevenbollipo
@jaumebosch9
@JuanAbraldes
Ever wonder why we use non-selective beta-blockers (NSBB) in patients w/
#cirrhosis
?
The newest Why Series post by
@RabieeAnahita
(of
@YaleDigestive
) is now out on NSBB in cirrhosis (part 1):
#livertwitter
#MedEd
#FOAMed
#GITwitter
1
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4
3
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6/6
What part of children and teenagers being killed as they are fighting for their freedom does not merit support?
I feel guilty, ashamed and angry. I feel like I am on a different planet.
#Mahsa_Amini
Thank you for reading
Please
#beourvoice
#livertwitter
#gitwitter
9
2
56
To all the undergrads, med students & residents I met over the past few days
@AmCollegeGastro
#ACG2023
📍You are amazing
📍You should be proud of your accomplishments
📍Future of GI is bright
Fortunate to moderate/review your fantastic research
#livertwitter
0
4
54
2/2
✴️Be genuine
✴️Be present
✴️only say yes if you have time and passion about the task
✴️know your strengths
✴️know and avoid imposter syn
#TLM22
#livertwitter
3
4
55
One of the best illustrations for types of portal HTN 👇🏼
#livertwitter
#medEd
Portal hypertension: An increase in pressure gradient in any segment of the portal venous system. It is classified on the basis of the site of increased vascular resistance: extrahepatic or intrahepatic.
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986
0
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so much hard work has been put into gathering high quality data, summarize them and come up with practical statements👏
I would not do justice by trying to summarize them, so read them below Down pointing backhand index
#LiverTwitter
@BavenoVII
@ggarciatsao
2
14
54
📣Do you want to know more about Terlipressin use in AKI-HRS?
Register for this
@AASLDtweets
#portalHTNSIG
webinar
Thursday, July 20, 12:00 pm - 1:00 pm (EDT)
Moderator: Florence Wong
Presenter: Pratima Sharma
#livertwitter
0
18
54
Blessed to be working with these amazing, strong, motivated women.
Every day that I get out of bed to come work with this team
@DCVAMC
is a good day 🙏
@DrJessicaDavis
#liverlovers
#LiverTwitter
9
0
54
New practice guidance alert 🚨
Palliative care and symptom-based management in decompensated cirrhosis
Congrats Shari Rogal,
@ArpanPatelMD
@NnekaUfereMD
@KanwalFasiha
#livertwitter
@AASLDtweets
0
15
53
Congratulations to a true leader, an exceptional example of women supporting women and my good friend
@AnjanaPillaiMD
as newly elected vice chair of liver cancer SIG.
well deserved :)
#livertwitter
@AASLDtweets
4
8
52
Another twitter to paper moment!
I collaborated with these two super ✨ 🌟 on this paper having never met them in real life 😊 and the results are 👇🏼👇🏼👇🏼
#livertwitter
@CLD_Learning
@LizzieAbyMD
@HassaanZiaMD
3
11
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Risk of
#HCC
post
#SVR
in F3
🧵
#livertwitter
🔹large cohort, multi center, observational study
🔹stage 3 definition
TE 9.5-14.5 kPa
excluded those with nodular liver surface, splenomegaly, ascites or collaterals on imaging, low plt or varices.
1
14
53
🔔GI fellow and medicine residents
Print this & put in your pocket 😊
#livertwitter
#gitwitter
Want to learn more about spontaneous bacterial peritonitis?
Check out the next installment of Liver Fellow Network Quick Tips on SBP by
@HershShroff
!
#meded
#FOAMed
#livertwitter
#gitwitter
#GIFellowship
2
58
147
3
9
52
Nice summary of all treatments available for systemic therapy of advanced HCC.
#TLMdx
#livertwitter
0
21
51