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October 2025
In this educational video, Anna Marie Hefner, CPNP, a hepatology nurse practitioner at the Southern California Liver and GI Centers, shares valuable insights for primary care providers managing patients with fatty liver disease. Anna Marie explains how her community-based practice collaborates with local clinicians to streamline care for patients with MASLD (Metabolic Associated Steatotic Liver Disease) and MASH (Metabolic Associated Steatohepatitis). She outlines a clear approach for evaluating patients with elevated liver enzymes and fatty liver, including when to use non-invasive testing (NITs) such as FibroScan and how to interpret fibrosis stages (F0–F4) to guide next steps in management. Anna Marie emphasizes that patients with early-stage fibrosis (F0–F1) can often be managed in primary care with regular weight monitoring, labs, and annual imaging, while those with advanced fibrosis (F3–F4) require hepatology referral for specialized care and cirrhosis management. She also discusses how her team supports community physicians—offering FibroScan services, consultative guidance, and direct communication to ensure patients receive coordinated, evidence-based care. This session is a practical resource for APPs, hepatology teams, and primary care providers navigating fatty liver disease screening, risk stratification, and referral pathways.
Related Webcast
Podcast: NIT's: A Practical Overview: Navigating the Basics
October 2025
In this educational session, Tuesday Werner, DNP, from Mayo Clinic Arizona, provides an in-depth overview of non-invasive testing (NITs) and their critical role in the diagnosis and management of MASLD (Metabolic Associated Steatotic Liver Disease) and MASH (Metabolic Associated Steatohepatitis). With over 20 years of experience in hepatology, she breaks down the fundamental differences between simple steatosis (MASLD) and inflammatory steatohepatitis (MASH), explaining why identifying fibrosis risk through non-invasive methods—such as FIB-4, NFS, ELF, FibroScan (VCTE), and MRE—is essential for guiding patient management, referrals, and surveillance. Tuesday discusses the strengths and limitations of serum-based vs. imaging-based NITs, emphasizing their complementary roles in evaluating fibrosis and preventing unnecessary biopsies. She also outlines how to integrate NIT results with patient history, comorbidities, and liver function tests to determine monitoring intervals and hepatology referrals. Viewers will learn key thresholds and cutoff values for interpreting FIB-4 and liver stiffness measurements, helping to stratify patients into low-, moderate-, and high-risk categories for advanced fibrosis or cirrhosis. This session underscores how NITs are transforming liver care—allowing for early detection, better patient stratification, and proactive management of MASLD and MASH through evidence-based, non-invasive approaches.
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Podcast: Alcohol and MASLD/MASH: Navigating the Complex Relationship
October 2025
In this insightful presentation, Marcella Pomeranz, DNP, lead nurse practitioner at Digestive Associates in Las Vegas, shares practical strategies for managing patients with alcohol use and MASLD. Drawing on her experience leading a team of 12 APPs, Marcella explains how to effectively screen for alcohol consumption, build trust and openness with patients, and use tools like the AUDIT-C and phosphatidylethanol (PEth) testing to accurately assess alcohol intake and monitor progress. She highlights the synergistic relationship between alcohol and metabolic dysfunction, emphasizing how even low to moderate alcohol use can accelerate liver injury, fibrosis, and the progression to cirrhosis or hepatocellular carcinoma. Marcella breaks down the biological mechanisms behind this interaction—oxidative stress, inflammation, mitochondrial dysfunction, and increased gut permeability—and provides evidence-based advice on lifestyle modification, structured support programs such as AA and addiction medicine referrals, and potential roles for GLP-1 therapies in managing both metabolic and behavioral aspects. She also discusses the importance of interpreting non-invasive tests (NITs) like FibroScan and serum markers in the context of recent alcohol use, using them as motivational tools to show patients measurable improvement. This session offers real-world clinical guidance for APPs, GI providers, and hepatology teams working to reduce risk and optimize care for patients with alcohol-associated MASLD and MASH.
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APP Insight: Common Questions From Community GI About MASH
October 2025
In this educational video, Tuesday Werner, DNP, from Mayo Clinic Arizona, answers some of the most common questions she receives from Community GI in regards to fibrosis in MASLD and MASH. With over 20 years of hepatology experience, she explains what it means to be diagnosed with fatty liver disease—whether discovered incidentally on imaging or in the presence of metabolic risk factors such as obesity, hypertension, hyperlipidemia, or diabetes. Tuesday emphasizes the importance of lifestyle modification, including 5–10% weight loss, regular exercise, and optimized management of metabolic conditions to slow or reverse disease progression. She also discusses how patients with advanced fibrosis or compensated cirrhosis can stay proactive through ongoing monitoring, ultrasound or MRI surveillance every six months, and close follow-up with their hepatology team. This conversation highlights the value of community support, patient education, and multidisciplinary care in improving long-term liver health and preventing complications from MASH and MASLD.
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Podcast: Monitoring for MASLD in Type 2 Diabetes
October 2025
In this educational session, Punam Punja, MMS, PA-C, from Emory Healthcare in Atlanta, discusses the crucial connection between type 2 diabetes and MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease). With over 15 years of hepatology experience, Punam outlines a practical, evidence-based approach for screening and monitoring patients with type 2 diabetes who are at risk for MASH (Metabolic Associated Steatohepatitis). She explains how the American Diabetes Association (ADA) now recommends routine fibrosis screening using the FIB-4 index, a simple, non-invasive calculation that helps identify patients at risk for advanced fibrosis — the strongest predictor of liver-related outcomes. Punam breaks down risk thresholds, screening intervals, and the role of secondary assessments such as transient elastography or ELF testing. She also emphasizes the importance of patient education, noting that unlike diabetic complications such as retinopathy, MASH is often silent but reversible with lifestyle modification. As October marks National Liver Awareness Month, Punam encourages APPs to make liver screening a standard part of diabetes care.
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Podcast: PCP Screening for MASH/MASLD: Identifying At-Risk Patients
October 2025
In this educational video, Cheryl Walsh, ACNP-C, from GI Alliance in Arkansas, shares practical guidance on screening for MASH (Metabolic Associated Steatohepatitis) and MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) in the primary care setting. Drawing from over 15 years of experience in gastroenterology, Cheryl highlights how nurse practitioners and advanced practice providers can efficiently identify at-risk patients—particularly those with type 2 diabetes, obesity, or cardiometabolic risk factors such as hypertension and elevated triglycerides. She explains how simple, validated tools like the FIB-4 index and ELF score can be incorporated into routine labs to detect early signs of fibrosis and liver disease progression. Cheryl also discusses communicating positive results, setting appropriate follow-up intervals, and empowering patients through lifestyle modifications and diet counseling. By streamlining screening into busy primary care workflows, clinicians can play a vital role in early detection and prevention of advanced liver disease.
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APP Insight: Misconceptions About Liver Health
October 2025
In this educational discussion, Marcella Pomeranz, NP, lead nurse practitioner at Digestive Associates in Las Vegas, addresses one of the most common misconceptions she encounters in clinical practice—patients believing that only heavy alcohol use causes liver disease. Drawing on NHANES data, Marcella explains that nearly 38% of Americans have hepatic steatosis, and the vast majority of cases stem from MASLD (Metabolic Associated Steatotic Liver Disease), not alcohol. She highlights how factors such as metabolic dysfunction, high blood pressure, high cholesterol, diabetes, viral hepatitis, autoimmune liver diseases, genetic disorders like Wilson’s disease and hemochromatosis, and even medications like NSAIDs and methotrexate contribute to liver injury and fibrosis. Marcella also discusses the impact of ethnicity, noting that Hispanic patients face a higher risk of progression to cirrhosis. By helping patients understand that liver disease is often metabolic—not self-inflicted, clinicians can reduce stigma, encourage earlier detection, and promote lifestyle optimization to prevent fibrosis and cirrhosis. This session offers valuable insights for APPs, GI specialists, and hepatology providers dedicated to improving patient education and liver health outcomes.
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MASLD Pharmacotherapy With Lisa Richards
August 2025
Join Lisa Richards, NP, from UC San Diego Health, for a comprehensive overview of MASLD Pharmacotherapy as part of the GHAPP MASLD Community Network, proudly sponsored by Madrigal Pharmaceuticals. This educational session explores the evolving treatment landscape for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and MASH (Metabolic Dysfunction-Associated Steatohepatitis), including the shift from exclusive reliance on lifestyle interventions and comorbidity optimization to the introduction of targeted pharmacologic therapies. Lisa reviews the role of GLP-1 receptor agonists, such as semaglutide, and the ESSENCE trial results demonstrating significant improvements in MASH and liver fibrosis. She also outlines the clinical considerations and limitations of legacy treatments like vitamin E and pioglitazone, based on data from the PIVENS trial. The highlight of the session is a detailed exploration of resmetirom (Rezdiffra)—the first FDA-approved therapy for non-cirrhotic NASH with moderate to advanced fibrosis (F2–F3). Lisa reviews key findings from the MAESTRO-NASH trial, including improvements in fibrosis and MASH resolution, and discusses real-world implementation strategies, including non-invasive monitoring tools (FibroScan, ELF, MRI-PDFF), statin dose adjustments, and managing drug–drug interactions. This session equips hepatology and GI providers with the tools to personalize MASH care, navigate insurance and safety considerations, and deliver cutting-edge, evidence-based treatment to patients with MASLD.
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Webcast: MASLD Basics With Cheryl Walsh
October 2025
In this MASLD Basics session of the MASLD & MASH Community Network, Cheryl Walsh, ACNP-C explains the new steatotic liver disease (SLD) nomenclature and how to apply it in practice. She clarifies definitions of MASLD, distinguishes MASH, and introduces overlap with MetALD by reviewing practical alcohol-intake thresholds. Cheryl outlines a stepwise primary-care pathway: start with FIB-4 to risk-stratify fibrosis, then use noninvasive tests such as elastography or the ELF blood test, with ultrasound/MRI as needed—and consider liver biopsy only for discordant or indeterminate results. You’ll learn when to reassess (F0–F1 every 2–3 years; F2–F3 annually with consideration of pharmacotherapy), when to refer to hepatology, and why fibrosis—not steatosis alone—drives prognosis. The talk also highlights global epidemiology, the stigma-reducing benefits of the new terminology, and patient counseling on lifestyle change (Mediterranean-style nutrition, activity, weight management) to alter disease trajectory.
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Webcast: MASLD Basics With Anna Marie Hefner & Renee Pozza
October 2025
In this MASLD Community Network session, Anna Hefner, PhD, RN, CPNP, and Renee Pozza, PhD, RN, CNS, FNP-BC, of Southern California GI & Liver Centers break down the new nomenclature for steatotic liver disease (SLD) and what it means for clinical practice. They clarify how to distinguish MASLD from MASH, introduce the overlap category MetALD (metabolic-associated alcohol-related liver disease), and review differential causes of steatosis—from medications and viral hepatitis to genetic and cryptogenic etiologies. The faculty walk through practical primary-care screening with FIB-4, when to escalate with noninvasive tests (FibroScan® CAP/kPa, ELF), and the roles of ultrasound and MRI/MRE—plus when a liver biopsy is still warranted. You’ll learn staging cues (F0–F4), progression risk, who needs closer follow-up, and how to counsel patients on cardiometabolic risk reduction (weight loss, activity, triglyceride/HDL management, blood pressure, glucose). The talk also highlights pediatric considerations, terminology changes to reduce stigma, and tips for consistent waist-circumference measurement and alcohol-intake assessment—equipping PCPs, GI, and hepatology teams to identify fibrosis early and improve outcomes.
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APP Insight: Common Questions From Primary Care Providers About MASH
October 2025
In this educational video, Cheryl Walsh, ACNP-C, from GI Alliance in Northwest Arkansas, shares practical guidance for primary care providers on how to effectively support patients with elevated liver enzymes. With nearly 15 years of experience in gastroenterology and hepatology, Cheryl explains how simple first steps—such as ordering imaging studies and incorporating the FIB-4 index into lab work—can provide valuable insight into whether a patient may have MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) or even early fibrosis. She highlights how these preliminary evaluations streamline care, allowing hepatology specialists to move forward quickly with advanced imaging or elastography when needed. Cheryl underscores the importance of collaboration between primary care and GI teams to ensure early detection and better patient outcomes in metabolic liver disease.
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