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November 2025
In this engaging session from the GHAPP MASLD Community Network, Erin Tanner, DNP, from Gastro Health in Birmingham, Alabama, discusses how motivational interviewing can empower patients with fatty liver disease to make meaningful lifestyle changes. Drawing from over 14 years of experience in hepatology and gastroenterology, Erin explains how a collaborative, patient-centered approach can improve adherence to diet, exercise, and weight management plans. Using the RULE framework—Resist the righting reflex, Understand motivation, Listen with empathy, and Empower the patient—she demonstrates practical ways to foster trust and promote behavior change without judgment. Erin also introduces the SMART goals method (Specific, Measurable, Achievable, Relevant, Time-bound), guiding clinicians on how to set realistic, personalized goals that patients can achieve and sustain. Through reflective listening, affirmation, and consistent follow-up, providers can help patients overcome ambivalence, build confidence, and stay motivated on their journey to better liver and metabolic health.
Related Podcast
PCP Screening for MASH/MASLD: Identifying At-Risk Patients
August 2025
Join Tessa Janovsky, PA-C from Arizona Liver Health, for a practical and guideline-based discussion on screening for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH) in primary care. This session outlines which patient populations Advanced Practice Providers (APPs) should routinely screen—such as individuals with type 2 diabetes, medically complicated obesity, metabolic risk factors with fatty liver on imaging, moderate alcohol use (MetALD), or a family history of MASH cirrhosis. Learn how to apply first-line non-invasive screening tools like FIB-4 and the NAFLD Fibrosis Score, understand their limitations, and incorporate them into busy clinic workflows. Tessa shares strategies for communicating positive results to patients, next steps for further evaluation (ELF test, FibroScan, MRI elastography), and criteria for timely referral to gastroenterology or hepatology. With practical tips for integrating MASLD/MASH screening into electronic medical records, building clinical pathways, and standardizing protocols, this episode equips PCPs and specialists to detect high-risk patients earlier, intervene effectively, and ultimately improve liver health outcomes.
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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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Differentiating Between F3 and F4
July 2025
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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NITs: A Practical Overview: Navigating the Basics
July 2025
In this episode, Christie Morrison breaks down the fundamentals of non-invasive testing (NITs) for evaluating patients with fatty liver disease, including MASLD and MASH. She explains the key differences between steatosis (MASLD) and steatohepatitis (MASH), highlighting how non-invasive tests can replace liver biopsy for staging fibrosis. Christy reviews common tools like FIB-4, NAFLD fibrosis score, Enhanced Liver Fibrosis (ELF) score, transient elastography (FibroScan), and MR elastography, and outlines how to choose the right test based on patient factors such as co-morbidities, geography, access to labs, and imaging availability. The episode also emphasizes the importance of fibrosis risk stratification, interpreting FIB-4 cutoffs, and monitoring liver stiffness or ELF scores after initiating lifestyle or pharmacologic treatment—including newer therapies like resmetirom. This is a must-watch for APPs, GI clinicians, and primary care providers seeking to improve care pathways and outcomes in patients with metabolic liver disease through practical, accessible strategies for fibrosis detection and management.
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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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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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Serological Workup: A Step-by-Step Guide
July 2025
In this comprehensive video, Sherona Bau, NP from UCLA, breaks down the essential hepatology workup for patients with MASLD (formerly NAFLD) and MASH, offering guidance for both primary care providers and GI/hepatology specialists. Drawing from her extensive clinical experience, she outlines a systematic approach to evaluating abnormal liver ultrasound findings—starting with critical labs to rule out chronic liver conditions like hepatitis B, hepatitis C, autoimmune hepatitis, PBC, and hereditary hemochromatosis. Sherona discusses the importance of ordering ANA, AMA, ferritin, serologies, and even specialized labs like the phosphatidylethanol (PEth) test to uncover alcohol-related liver disease that may be overlooked. She emphasizes the need to screen for cardiometabolic risk factors including type 2 diabetes and dyslipidemia and highlights non-invasive tests such as FibroScan and FIB-4 to help identify patients at risk of advanced fibrosis who may benefit from specialist referral. Most importantly, Sherona addresses the fears many patients face around liver disease progression and life expectancy, encouraging early intervention and coordinated care to improve long-term outcomes. This video is a must-watch for any clinician managing steatotic liver disease.
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PCP Screening for MASH/MASLD: Identifying At-Risk Patients
July 2025
In this episode, Jeremy Davis, NP from Gastrointestinal Specialists in Shreveport, Louisiana, discusses the vital role of primary care screening for MASLD (metabolic dysfunction-associated steatotic liver disease) and MASH (metabolic-associated steatohepatitis). With the rising prevalence of metabolic co-morbidities like type 2 diabetes, hypertension, dyslipidemia, and obesity, early identification of at-risk patients is more critical than ever. Jeremy outlines practical and evidence-based strategies for screening in the primary care setting, starting with simple tools like the FIB-4 score—which relies on common lab values—and how to interpret results to guide referrals to hepatology or GI specialists. He also discusses the downstream workup upon referral, including non-invasive tests like FibroScan, ELF score, and liver ultrasound. Treatment fundamentals such as the Mediterranean diet, physical activity, and weight loss remain the cornerstone of care, while emerging therapies like GLP-1 agonists and resmetirom offer new options for high-risk patients. Whether you’re a PCP, APP, or specialist, this episode offers clear guidance on how to incorporate MASLD screening into everyday workflows to catch liver disease early and optimize outcomes.
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Diet and Nutrition: Tailoring Plans for Diverse Populations
October 2025
In this episode, Allison Moser, NP, from Rush University Medical Center, dives into one of the most impactful aspects of MASH (Metabolic Dysfunction–Associated Steatohepatitis) management — diet and nutrition. While weight loss is often the starting point, Allison explains why sustainable liver health depends on personalized, culturally sensitive, and practical nutrition strategies. Learn how evidence-based eating patterns like the Mediterranean diet and plant-based diets can reduce hepatic steatosis, improve insulin sensitivity, and lower inflammation, even without weight loss. Allison shares actionable food swaps for diverse cultures, affordable ways to eat healthy when access is limited, and tailored recommendations for patients with comorbidities like diabetes, CKD, and cardiovascular disease. She also discusses the major role of added sugars, processed foods, and sugary or diet beverages in driving liver damage — and how to help patients make realistic, stepwise changes that last. Whether you’re an APP, NP, PA, or clinician treating patients with MASH or MASLD, this episode offers practical, evidence-based tools to improve nutrition counseling, build patient trust, and support long-term liver health.
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Alcohol and MASLD/MASH: Navigating the Complex Relationship
July 2025
In this insightful episode, Oyin Penny, NP with Premier Gastroenterology of Kansas City, addresses the complex clinical challenge of managing patients with MASLD (metabolic dysfunction-associated steatotic liver disease) who also consume alcohol. Oyin shares practical, evidence-based strategies for screening alcohol use in MASLD and MASH, emphasizing the importance of creating a nonjudgmental, patient-centered environment. She outlines how to use tools like PEth (phosphatidylethanol) testing to objectively quantify alcohol intake and explains the synergistic hepatotoxicity that occurs when alcohol use coexists with metabolic liver disease. Oyin also explores when to initiate non-invasive tests (NITs), why alcohol can distort fibrosis staging, and how to time assessments and treatment appropriately. From setting SMART goals to recommending behavioral support, medications like naltrexone, and exploring mental health and social work interventions, this episode offers a full-spectrum approach to managing high-risk patients. Whether you're a GI, hepatology provider, or in primary care, this episode provides tools for personalized care, alcohol harm reduction, and effective long-term MASLD management.
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