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MASLD AI 01:46 AM
January 2025
Thank you to Madrigal for sponsoring this FAQ Video Module.
In this GHAPP FAQ Video Module, Jonathan Yeh, a physician assistant at the Center for Liver Disease and Transplantation at Columbia University Irving Medical Center, discusses advancements in diagnosing and staging metabolic dysfunction-associated steatohepatitis (MASH). He explains the transition from traditional liver biopsy to non-invasive testing methods such as FibroScan and the Enhanced Liver Fibrosis (ELF) test for assessing fibrosis stages. Jonathan highlights the use of these methods, in combination with blood tests, to provide reliable staging of fibrosis in patients with MASH. For more information, visit the GHAPP website or ACE app.
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In this informative video, Michelle Barnett, PA-C, a hepatology expert based in Colorado Springs, answers frequently asked questions about elevated liver enzymes in the context of MASH (Metabolic Dysfunction–Associated Steatohepatitis) and MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease). She breaks down how to interpret common liver enzyme patterns—such as ALT greater than AST versus AST greater than ALT—and what these patterns may indicate, from MASH to alcohol-related liver disease and other potential causes like autoimmune hepatitis or drug-induced liver injury. Michelle outlines how to perform a thorough workup, including patient history, medication review, and physical exam findings, and emphasizes the importance of using tools like FIB-4 and abdominal ultrasound to assess for fibrosis and portal hypertension. The discussion also covers the clinical value of GGT, alkaline phosphatase, bilirubin, albumin, and platelets in evaluating liver function. Michelle shares practical guidance on when to refer patients to hepatology and how to monitor liver enzymes over time, particularly in those undergoing lifestyle changes or pharmacologic treatment. This comprehensive Q&A is an essential resource for providers managing patients with suspected or confirmed metabolic liver disease.
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In this informative video, Janet Gripshover, DNP, FNP-BC, and nurse manager for the liver transplant program at Cedars-Sinai, answers key questions about managing MASH (Metabolic Dysfunction–Associated Steatohepatitis) and navigating non-invasive testing. She addresses a common clinical challenge—what to do when FIB-4 and FibroScan results are discordant. Janet explains that while non-invasive tests are useful, they're not foolproof, and when results are unclear—especially in patients with significant metabolic risk factors—liver biopsy remains the gold standard for accurate diagnosis. She also shares expert recommendations on dietary changes for patients with fatty liver disease, emphasizing alcohol avoidance, high-protein, low-fat, and lower-carb diets, as well as achievable weight loss goals (around 5% of body weight). Janet highlights when to escalate care beyond lifestyle interventions—typically after 3 to 6 months if there’s no improvement—and discusses options such as pharmacologic therapy or bariatric surgery. This video provides practical, evidence-based guidance for healthcare providers managing the complexities of MASLD and MASH.
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