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MASLD AI 06:42 AM
July, 2025
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Gabriella McCarty
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Alison Moe
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Christie Morrison
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Jill Olmstead
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Oyin Penny
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Emily Przybyl
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Lisa Richards
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Sharon Rimon
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Jordan Mayberry
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Carla Molliner
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Ann Moore
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April Morris
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Janet Gripshover
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Milly Ng
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Michelle Barnett
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Erin Parkinson
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Christina Hanson
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Summer Collier
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Allysa Saggese
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Patrick Horne
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Valerie Shin
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Lavinia Iordache
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Elizabeth Simkus
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Tessa Janovsky
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Kelly Smeester
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Jeremy Davis
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Chantil Jeffreys
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Robin Soto
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Edith Johannes
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Becky Klemme
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Brian Lam
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Scott Springer
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Whitney Steinmetz
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Sarah Dawkins
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Erin Tanner
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Maly Tiev
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Jonathan Yeh
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Lindsay Yoder
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Anthony Derencius
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Melissa Franco
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Jennifer Geremia
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HoChong Gilles
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Elizabeth Goacher
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Ellie Gonyeau
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Andrea Gossard
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Jessica Crimaldi
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Maribeth Capuno
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Lindsay Pratt
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Amy Rourke
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Elizabeth Alqueza
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Michael Hodo
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Suzanne Robertazzi
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Sherona Bau
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Gena Ettinger
In this comprehensive discussion, HoChong Gilles, a nurse practitioner with 25 years of hepatology experience at the Richmond VA Medical Center, explores the critical importance of accurately distinguishing between F3 (advanced fibrosis) and F4 (cirrhosis) in patients with MASH (metabolic-associated steatohepatitis). While both stages carry increased risks of liver-specific and overall mortality, Gilles explains that F3 may still be reversible with lifestyle changes or pharmacotherapy, whereas F4 signals irreversible liver damage with heightened risk of complications like portal hypertension, hepatic encephalopathy, and liver cancer. Viewers will gain a deeper understanding of how non-invasive tests—like FIB-4, ELF, FibroScan, and MRE—perform in identifying fibrosis stage, including their limitations and overlaps. Gilles also outlines when to consider liver biopsy, especially in cases with discordant test results, atypical features, or clinical uncertainty. This video emphasizes how staging accuracy informs eligibility for therapies, surveillance strategies like HCC screening, and overall prognosis. Learn how to approach this nuanced distinction in clinical practice and why F3 vs. F4 isn't just semantics—it's a turning point in patient care.
Related Podcast
Podcast: Pharmacotherapy for MASH/MASLD: An Overview
June, 2025
In this informative episode, Lindsay Yoder, PA, a hepatology expert at Indiana University, provides a comprehensive overview of current pharmacotherapy options for MASH (Metabolic Dysfunction–Associated Steatohepatitis), focusing on the first FDA-approved medication, resmetirom (brand name: Rezdiffra). Speaking directly to the MASLD/MASH Community Network, Lindsay breaks down the key histologic endpoints that led to resmetirom’s conditional approval—namely, fibrosis improvement without worsening of steatohepatitis, and MASH resolution without worsening fibrosis. She shares real-world data from clinical trials showing that resmetirom nearly doubles the rate of fibrosis improvement and triples MASH resolution compared to placebo. Lindsay also explains how the drug works: as a thyroid hormone receptor beta agonist, resmetirom improves hepatic lipid metabolism, reduces liver fat, and dampens inflammation—all key drivers of MASH progression. She outlines ideal patient criteria (stage F2–F3 fibrosis without cirrhosis), safety considerations, tolerability, potential side effects, and statin interactions. With an emphasis on combining pharmacotherapy with lifestyle changes, this episode serves as a practical guide for clinicians treating patients with MASH who qualify for advanced intervention.
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LFTs Demystified: A Practical Guide for APPs
July, 2025
In this informative session, Anthony Derencius, PA-C and sub-investigator at Pinnacle Clinical Research, provides a practical and accessible breakdown of liver function tests (LFTs) and liver-associated enzymes, with a focus on their role in diagnosing and monitoring fatty liver disease—including MASLD (metabolic dysfunction-associated steatotic liver disease) and MASH (metabolic-associated steatohepatitis). Drawing from years of experience in both general and transplant hepatology, Anthony explains how to interpret key markers like ALT, AST, alkaline phosphatase, bilirubin, albumin, and GGT. He emphasizes why elevated or even normal LFTs don’t always tell the whole story, and how a full workup—including viral hepatitis panels, autoimmune markers, alcohol-related labs, imaging, and non-invasive fibrosis assessments—can help uncover the root cause of liver injury. This video also walks viewers through when to consider additional tools like FIB-4, ELF score, FibroScan, or even liver biopsy. Whether you're a primary care provider or hepatology specialist, this session will sharpen your ability to distinguish between benign lab variations and signs of serious liver disease, ultimately supporting earlier diagnosis and better outcomes for your patients.
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Podcast: Alcohol and MASLD/MASH: Navigating the Complex Relationship
June, 2025
In this powerful and highly educational episode, Scott Springer, PA-C at Erie County Medical Center in Buffalo, NY, explores the complex and often overlooked relationship between alcohol use and metabolic dysfunction–associated steatotic liver disease (MASLD/MASH). Drawing from his dual expertise in hepatology and addiction medicine, Scott outlines the importance of accurately assessing alcohol use when diagnosing MASLD, MASH, MetALD, or ALD—emphasizing that MASLD and MASH are diagnoses of exclusion and heavily influenced by alcohol consumption thresholds. He discusses best practices for screening, including patient-centered, nonjudgmental interviewing, the use of biomarkers like PEth and urine ethyl glucuronide, and how these tools enhance accuracy and accountability in care. Scott reviews national guidelines that recommend alcohol abstinence for patients with chronic liver disease and presents data showing how even small reductions in alcohol use can significantly lower the risk of cirrhosis. He also unpacks the challenges of interpreting liver tests in patients with ongoing alcohol use, the limitations of non-invasive testing like FibroScan and FIB-4, and how alcohol may disqualify patients from emerging pharmacotherapy such as resmetirom. Finally, he highlights the promising potential of GLP-1 medications in managing both liver fibrosis and alcohol use. This episode is essential listening for hepatology providers, addiction specialists, and any clinician involved in the care of patients with coexisting liver disease and substance use disorders.
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Podcast: Pharmacotherapy for MASH/MASLD: An Overview
June, 2025
In this comprehensive episode, Christina Hanson, FNP-C at South Denver GI, provides an in-depth overview of pharmacotherapy for MASLD and MASH, with a focus on the FDA-approved therapy resmetirom (brand name Rezdiffra). Drawing on over 18 years of experience in hepatology and GI care, Christina explains the histologic endpoints used in clinical trials—MASH resolution and fibrosis improvement without worsening disease—and how they guided the approval of resmetirom. She breaks down the drug’s mechanism of action as a selective thyroid hormone receptor beta (THR-β) agonist, which promotes lipid metabolism and reduces liver inflammation without systemic toxicity. Christina reviews key Phase 3 data from the MAESTRO-NASH trial, showing resmetirom’s significant impact on both MASH resolution and fibrosis regression across diverse patient populations. She also outlines criteria for appropriate patient selection (those with stage F2-F3 fibrosis), clinical monitoring strategies, and management of side effects like transient GI discomfort. Christina emphasizes the importance of baseline screening for liver disease, autoimmune conditions, thyroid function, and lipid levels before initiating therapy. She highlights best practices from the 2024 AASLD guidelines for ongoing monitoring and treatment response assessment, including ALT and liver stiffness thresholds that help determine whether to continue or discontinue therapy. This episode is a must-watch for hepatology clinicians looking to implement evidence-based, patient-centered strategies in the management of MASH.
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Podcast: Discordant NITs, the Gray Zone
June, 2025
In this episode, Gabriella McCarty, NP at Northshore Gastroenterology in Cleveland, Ohio, shares her deep clinical insights on the evolving landscape of MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) and MASH (Metabolic Dysfunction–Associated Steatohepatitis). With over 26 years of experience in private practice, Gabriella explains that the majority of fatty liver cases she encounters are found incidentally—often during evaluations for unrelated GI issues like GERD or routine colon screenings. She discusses the updated nomenclature from NAFLD to MASLD and outlines the cardiometabolic risk factors that inform diagnosis, such as obesity, diabetes, hypertension, and dyslipidemia. Gabriella emphasizes the importance of non-invasive assessments like FibroScan, FIB-4, ELF testing, and, in select cases, liver biopsy or MR elastography for accurate fibrosis staging. She also highlights the challenges of discordant test results and shares practical strategies for follow-up and monitoring. With a strong focus on lifestyle modification—promoting a Mediterranean diet, targeted weight loss, regular exercise, and alcohol avoidance—this episode provides essential education for providers managing patients with fatty liver disease, even when it's not the primary reason for the visit.
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HCC Surveillance: Implementation in Patients With Advanced Fibrosis/Cirrhosis From MASH
July, 2025
Learn when and how to effectively screen for hepatocellular carcinoma (HCC) in patients at risk, especially those with metabolic dysfunction-associated steatotic liver disease (MASLD). In this informative video, Maribeth Capuno, an adult nurse practitioner at the Richmond Veterans Affairs Medical Center, shares her clinical approach to early HCC surveillance. While AASLD guidelines recommend screening only after cirrhosis has been diagnosed, Maribeth highlights the growing evidence that patients with stage 3 fibrosis can still develop liver cancer—and why she begins surveillance earlier. She discusses the recommended tools, including liver ultrasound every six months and alpha-fetoprotein testing, and explores practical workflow tips to ensure patients remain adherent. Learn how imaging modalities like MRI and CT with liver protocol, along with tools like LI-RADS and tumor board consultations, contribute to timely and accurate diagnosis. The video also emphasizes key risk factors—such as obesity, diabetes, viral hepatitis, and lifestyle behaviors—and how managing these can help prevent the progression to HCC.
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Podcast: Viral Hepatitis and MASH/MASLD: Understanding the Connection
June, 2025
In this episode, Patrick Horne, NP from the University of Florida, explores the important connection between viral hepatitis and MASLD/MASH (Metabolic Dysfunction–Associated Steatotic Liver Disease/Steatohepatitis). While patients may present with a presumed diagnosis of MASLD or MASH, Patrick emphasizes the critical need to rule out coexisting liver diseases such as hepatitis B and C. The presence of both metabolic and viral liver diseases can significantly accelerate liver inflammation, fibrosis progression, and ultimately cirrhosis—a concept he explains using the “two-hit” or even “three-hit” theory. Patrick walks through the recommended screening protocols, including one-time HCV testing for all adults over 18 and complete HBV panels to assess for immunity, past exposure, and chronic infection. He stresses that treating viral hepatitis—especially with today's highly effective antivirals—can and should occur alongside lifestyle modification strategies for MASLD/MASH. He also discusses how liver stiffness measurements can be skewed by active inflammation and suggests reassessing fibrosis after treating viral hepatitis. This episode is a must-watch for providers managing patients with liver disease, highlighting the need for a comprehensive, layered diagnostic approach.
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PCP Screening for MASH/MASLD: Identifying At-Risk Patients
July, 2025
In this essential FAQ video, Jennifer Geremia, PA-C, a seasoned gastroenterology provider practicing in Boston, outlines current primary care screening guidelines for identifying patients at risk for metabolic dysfunction-associated steatohepatitis (MASH) and MASLD. With nearly two decades of experience caring for GI and liver patients, Jennifer emphasizes the importance of integrating liver health into routine health maintenance—particularly for individuals with type 2 diabetes, obesity, metabolic syndrome, and related conditions. She reviews practical steps for risk stratification, beginning with FIB-4 scoring using readily available labs, and discusses how to interpret and act on the results, including when to refer for further testing like elastography or ELF testing. Viewers will also gain insight into patient counseling strategies, alcohol intake guidance, and the urgency of acting early—even in asymptomatic patients. This video is a must-watch for primary care clinicians aiming to improve detection and management of MASH and MASLD through evidence-based screening and timely intervention.
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NITs: A Practical Overview: Navigating the Basics
July, 2025
In this practical and engaging overview, Janet Gripshover, nurse practitioner and nurse manager for the Cedars-Sinai Liver Transplant Program, breaks down the essentials of non-invasive testing (NITs) for assessing fibrosis in patients with metabolic-associated steatotic liver disease (MASLD). She explains the critical distinction between MASLD and MASH (metabolic-associated steatohepatitis), highlighting why early identification of aggressive liver disease is essential—even in patients without cirrhosis. Janet reviews key NIT tools, including FibroScan, MR elastography, and serum biomarkers like FIB-4 and ELF score, providing clinical insights on interpreting results, integrating them into risk stratification, and tailoring next steps for patient care. Viewers will learn when to act on elevated liver stiffness, how to interpret CAP scores, and why weight loss and comorbidity control remain foundational treatments. Whether you're new to hepatology or seeking a refresher on navigating fibrosis assessments, this video offers a clear, actionable framework to help prevent disease progression and optimize outcomes for patients with fatty liver disease.
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GHAPPcast: Recognizing the Severity of MASH
January, 2025
Thank you to Madrigal for sponsoring this episode of GHAPPcast. In this episode of GHAPPcast, nurse practitioners Patrick Horne and April Morris from discuss the complexities of identifying and managing patients with metabolic-associated steatohepatitis (MASH). They explore clinical approaches, including the use of bloodwork, family history, and advanced diagnostic tools such as FibroScan, to recognize patients at risk. Patrick and April emphasize the importance of lifestyle interventions like diet and exercise alongside new medical therapies, while also offering practical tips for clinicians on patient monitoring and treatment management. Tune in for valuable insights into managing MASH in clinical practice.
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