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MASLD AI 06:42 AM
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: Liver Model Overview
July, 2025
Join Alison Moe, PA-C with United Digestive, as she walks through a hands-on demonstration using a life-sized liver model to help patients better understand fibrosis and liver disease progression. In this engaging and practical overview, Allison explains how different stages of liver fibrosis—from normal liver to cirrhosis and hepatocellular carcinoma—can be felt and visualized using a segmented anatomical model. She shares how this tool enhances patient education during discussions about non-invasive liver testing, such as FibroScan, CAP scores, FIB-4, ELF testing, and more. Designed to support visual learners and improve comprehension of disease state, this video is a valuable resource for clinicians and patients navigating the complexities of metabolic-associated fatty liver disease (MASLD) and its progression to MASH. Learn how tactile and visual teaching aids can bridge the gap between diagnostics and patient understanding in hepatology care.
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Alcohol and MASLD/MASH: Navigating the Complex Relationship
July, 2025
In this insightful video, Jordan Mayberry, a seasoned physician assistant at UT Southwestern in Dallas, explores the complex intersection of alcohol use and metabolic-associated steatotic liver disease (MASLD), including its progressive form, MASH. With over 12 years of hepatology experience, Jordan breaks down why accurate assessment of alcohol intake is essential—not just for diagnosis but for guiding patient management. Learn how to use motivational interviewing techniques to respectfully screen for alcohol use, quantify intake effectively, and differentiate between MASLD, MASH, and the emerging diagnosis of MetALD (metabolic dysfunction-associated alcoholic liver disease). Jordan also shares practical tips on managing patients with MASH who drink above recommended thresholds, including behavioral interventions, medications like acamprosate, and referral pathways such as SMART Recovery or addiction psychiatry. The video also highlights how ongoing alcohol use can skew liver function tests (LFTs), distort non-invasive testing (NIT) results like FibroScan or MRE, and potentially affect eligibility for future MASH pharmacotherapies. This session is a must-watch for clinicians aiming to provide holistic, evidence-based care to patients navigating the dual challenges of liver disease and alcohol use.
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Podcast: Viral Hepatitis and MASH/MASLD: Understanding the Connection
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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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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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Differentiating Between F3 and F4
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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.
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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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Podcast: Role of Exercise in Liver Health
June, 2025
In this engaging episode of the GHAPP MASLD/MASH Community Network podcast, Jonathan Yeh, PA at Columbia University Medical Center, discusses the essential role of exercise in liver health—especially in managing MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) and MASH (Metabolic Dysfunction–Associated Steatohepatitis). With over 14 years of hepatology experience, Jonathan breaks down the most effective types of physical activity, highlighting the benefits of combining aerobic and resistance training over high-intensity interval training (HIIT) alone. He provides practical, personalized exercise recommendations tailored to patients’ physical abilities, access to resources, and comorbidities—including suggestions for those with mobility limitations or time constraints. Jonathan also offers motivational strategies to help patients overcome common barriers such as lack of time, motivation, or access to fitness facilities. From parking farther from a destination to lunchtime walks and home-based workouts using resistance bands, he emphasizes creative and realistic ways to build physical activity into daily routines. Beyond weight loss, he explains how exercise directly improves liver function by reducing liver fat, enhancing insulin sensitivity, and preventing fat and sugar buildup in the liver. This episode is a must-watch for clinicians and patients alike seeking to understand and implement exercise as a cornerstone in the management of fatty liver disease.
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Discordant NITs, the Gray Zone
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Join Lindsay Pratt, PA-C, from the University of Colorado School of Medicine’s Hepatology and Liver Transplant Department, as she unpacks the challenges of interpreting discordant results between non-invasive liver testing tools such as FIB-4 and FibroScan in patients with MASLD and MASH. With over 15 years of clinical experience, Lindsay walks viewers through how age, transaminase levels, platelet count, and patient factors like BMI and fasting status can impact test accuracy and reliability. She emphasizes when to consider advanced diagnostics like MRI elastography (MRE) or liver biopsy, and how to tailor decisions to the individual patient, especially when results don't align. This practical session is ideal for hepatology and GI providers navigating complex liver disease management, and includes tips for communicating test limitations and next steps with patients. Learn how to make informed decisions using non-invasive tests while maintaining patient-centered care in the management of fatty liver disease.
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In this podcast episode, Michelle Barnett, PA-C, a liver disease specialist based in Colorado Springs, provides a clear and practical overview on demystifying liver enzyme abnormalities—particularly in the context of MASH (Metabolic Dysfunction–Associated Steatohepatitis) and MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease). With MASLD affecting nearly 1 in 4 American adults, understanding liver enzyme patterns is critical for early detection and effective management. Michelle breaks down commonly reported values from hepatic function panels—ALT, ALP (alkaline phosphatase), and total bilirubin—explaining what constitutes normal, acute, subacute, and chronic elevations. She walks through hepatocellular, cholestatic, mixed, and isolated hyperbilirubinemia patterns and what they reveal about underlying liver conditions such as MASH, alcohol-associated liver disease, viral hepatitis, biliary obstruction, and drug-induced liver injury. Whether you're a provider or a patient looking to better understand lab results, this episode delivers expert guidance on interpreting liver enzyme elevations to support more informed clinical decisions.
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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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