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August 2025
Join Kelly Smeester, MMS, RD, PA-C, from South Denver Gastroenterology, for an in-depth discussion on the latest tools and strategies in non-invasive liver disease assessment, presented through the GHAPP MASLD Community Network. This evidence-based session walks viewers through a case study of a patient with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and explores the full range of non-invasive testing modalities used to evaluate liver fat, stiffness, and fibrosis risk. Kelly breaks down the utility of key tests including FIB-4, ELF Score, FibroScan (VCTE), and MR Elastography, and compares their accuracy, accessibility, limitations, and clinical value. Learn how to interpret biomarkers such as CAP (Controlled Attenuation Parameter) and kPa (Kilopascals), how to navigate indeterminate FIB-4 results, and when to escalate to more advanced imaging like MRE. The session also provides insights into combined scoring models (FAST, MAST, MEFIB), real-world use cases, and how comorbidities and patient-specific factors (BMI, ALT, bilirubin, ascites) can impact test reliability. Whether you're managing early-stage fatty liver disease or advanced fibrosis, this session provides essential knowledge to guide accurate diagnosis, risk stratification, and long-term monitoring without a liver biopsy.
Related Podcast
APP Insight: Misconceptions About Liver Health
June 2025
In this video, Kelly Smeester, PA-C from South Denver Gastroenterology, addresses some of the most common and harmful misconceptions about liver health. One major myth she tackles is the belief that liver disease only affects those who drink excessive amounts of alcohol. Kelly explains that liver disease has many causes—including autoimmune conditions, viral infections, and metabolic dysfunction—meaning even individuals who don’t drink at all may still be at risk. She emphasizes the dangers of relying on unregulated “liver detox” supplements, clarifying that the liver is a natural detox organ and doesn’t require external cleanses, which may actually do more harm than good. Kelly also highlights how liver disease can be entirely asymptomatic, particularly in patients with conditions like type 2 diabetes, obesity, hypertension, and high cholesterol. Finally, she reinforces that cirrhosis is not solely alcohol-related and can result from steatotic liver disease, making regular liver evaluations and screenings crucial for early detection and management. This video is an essential resource for patients and providers aiming to better understand liver health beyond outdated myths.
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Non-Invasive Testing With Maly Tiev
September 2025
Maly Tiev, NP, NYU Langone Health, shares a practical, case-based walkthrough of non-invasive testing (NITs) for MASLD/MASH—showing how to move from initial risk identification to confident staging and follow-up without a biopsy in most patients. Using Albert’s case, a 65-year-old with steatosis and mild ALT elevation, she explains how to apply FIB-4 first, then layer in FibroScan/VCTE with Liver Stiffness (kPa) and CAP for fat quantification, plus when to order ELF or MRI elastography. You’ll learn reliability checks for FibroScan, common confounders, insurance/operational tips for MRE, and an easy algorithm for primary care/endocrine clinics: start with FIB-4 → triage by cutoffs → use VCTE/ELF → refer when intermediate or high risk. She closes with clear next steps for low-risk patients—lifestyle modification, cardiometabolic optimization, and repeating NITs in 2–3 years—and when to escalate to hepatology for advanced disease.
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Common Questions From Primary Care Providers About MASH
August 2025
In this MASLD and MASH Community Network, Tessa Janovsky, PA-C at Arizona Liver Health, answers common questions from primary care providers about Metabolic Dysfunction–Associated Steatohepatitis (MASH) and its updated terminology. She explains why MASH has replaced the term NASH, highlighting the shift to reflect underlying metabolic drivers such as obesity and type 2 diabetes while removing stigmatizing language. Tessa discusses how normal or mildly elevated liver enzymes do not rule out MASH, the importance of screening high-risk groups—including patients with diabetes, obesity, metabolic syndrome, or incidental fatty liver on imaging—and why the FIB-4 score is the preferred first-line test for fibrosis risk assessment. She also reviews the first FDA-approved medication for MASH, resmetirom, as well as the role of GLP-1 therapies and upcoming treatment options. Whether you’re a clinician seeking updated screening guidelines or a patient wanting clarity on diagnosis and management, this session provides clear, evidence-based guidance on identifying and treating MASH.
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Comparing F3 and F4 Fibrosis With Lindsay Yoder
September 2025
In this in-depth educational session, Lindsay Yoder, PA from Indiana University in Indianapolis, walks through two detailed case studies to highlight the differences between advanced F3 fibrosis and F4 cirrhosis. Using real-world clinical data—including labs, FibroScan, ELF testing, and imaging—she explains how to stage patients with MASLD/MASH, interpret non-invasive fibrosis assessments, and tailor treatment strategies. Viewers will learn how subtle differences in labs and imaging findings, such as thrombocytopenia and liver stiffness measurement, can shift a patient’s diagnosis from advanced fibrosis to cirrhosis. Lindsay also discusses the role of lifestyle interventions, multidisciplinary management, and therapeutic options like resmetirom and GLP-1s, as well as key monitoring strategies for hepatocellular carcinoma (HCC) surveillance and variceal screening. Whether you’re a hepatology provider, an APP, or a clinician looking to sharpen your skills in managing MASLD/MASH, this case-based discussion provides practical insights you can apply in everyday practice.
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Misconceptions About Liver Health
September 2025
Elizabeth Goacher, PA-C at Duke University in Durham, North Carolina, addresses a common misconception about Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)—that it’s a “death sentence.” While early screening and awareness are critical, Elizabeth emphasizes the importance of balanced messaging: most patients with MASLD, especially those without advanced fibrosis, will not experience liver failure or require a transplant. Instead, their greatest health risks are often from cardiovascular disease and all-cause malignancy, making lifestyle changes, metabolic health management, and cardiovascular risk reduction key priorities. This discussion encourages both patients and referring providers to focus on evidence-based care, clear communication, and realistic risk assessment, ensuring that awareness doesn’t translate into unnecessary fear.
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APP Insight: Common Questions from Patients About MASH
June 2025
In this video, Jonathan Yeh, PA, answers three of the most frequently asked questions about MASH—Metabolic Dysfunction–Associated Steatohepatitis—and offers practical advice for understanding and managing this progressive form of fatty liver disease. He begins by explaining what MASH is: an inflammatory, more advanced stage of MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease), driven by abnormal fat accumulation in the liver due to impaired fat transport. Jonathan then breaks down the treatment approach, emphasizing the importance of lifestyle modification—particularly diet and exercise. He highlights the benefits of a green Mediterranean diet, regular physical activity, and sustainable weight loss, which can improve or even reverse MASH in many patients. For individuals with more advanced fibrosis, pharmacologic treatment with resmetirom (Rezdiffra) may be indicated. This concise FAQ offers helpful guidance for patients and providers alike on tackling MASH with evidence-based strategies.
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Pharmacotherapy Review
July 2025
Join Christina Hanson, FNP-C, from South Denver Gastroenterology, as she provides an in-depth overview of the current pharmacologic treatment landscape for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH). This expert-led session explores the three cornerstones of MASH management—lifestyle and weight loss interventions, cardiovascular risk reduction, and liver-directed therapy—while highlighting the evolving role of GLP-1 receptor agonists and the recent FDA approval of resmetirom, the first medication indicated for adults with MASH and moderate to advanced fibrosis. Christina also discusses clinical trial data from MAESTRO-NASH, reviews historical agents like vitamin E and pioglitazone, and offers practical guidance on patient selection, safety considerations, and monitoring strategies. Whether you’re a GI provider, hepatology specialist, or primary care clinician managing fatty liver disease, this video provides valuable insights into how emerging therapies are shaping the future of MASH treatment.
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Comparing F3 and F4 Fibrosis With Jessica Crimaldi
August 2025
In this educational session, Jessica Crimaldi, a nurse practitioner at Cleveland Clinic with nearly a decade of experience in gastroenterology and hepatology, walks through real-world cases comparing patients with F3 fibrosis and F4 fibrosis. She reviews how to assess disease severity using non-invasive tests like FIB-4, FibroScan, CAP scores, and ELF tests, and explains how clinical findings such as platelets, bilirubin, and INR can guide staging. Jessica highlights the differences in management between patients with advanced fibrosis versus cirrhosis, including the role of lifestyle modifications, GLP-1 therapy, statins, blood pressure control, and Resmetirom for eligible F2/F3 patients. She also discusses the importance of HCC surveillance, portal hypertension evaluation, esophageal varices screening, and long-term monitoring in cirrhosis care. This case-based learning approach offers practical insights into fatty liver disease, MASLD/MASH progression, and optimizing patient outcomes through accurate staging and tailored treatment strategies.
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HCC Surveillance: Implementation in Patients with Advanced Fibrosis/Cirrhosis from MASH
July 2025
In this episode of the GHAPP MASLD Community Network podcast, Lisa Richards, a hepatology-focused nurse practitioner in San Diego, shares expert insights on hepatocellular carcinoma (HCC) surveillance for patients with advanced fibrosis and cirrhosis due to MASH (metabolic dysfunction-associated steatohepatitis). Lisa outlines which patients require routine HCC surveillance, emphasizing the importance of staging—particularly stages F3 and F4—and how AASLD guidelines guide surveillance strategies. She discusses recommended surveillance modalities, including ultrasound with AFP every six months, and introduces the LIRADS visualization score to help interpret imaging quality and follow-up needs. Lisa also addresses practical challenges in implementation, from patient education and engagement to overcoming barriers like cost, transportation, and care coordination. For advanced practice providers (APPs), this podcast delivers clear guidance on what to do when new liver lesions are detected and how to proceed with diagnostic imaging and referrals for multidisciplinary review or intervention. Empower your clinical practice with strategies that promote early detection and improve outcomes in patients at risk of HCC.
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MASLD Pharmacotherapy With Chantil Jeffreys
September 2025
In this MASLD Community Network webcast, Chantil Jeffreys, NP, walks through a practical framework for pharmacotherapy in MASLD/MASH—from lifestyle-first approaches to the evolving role of GLP-1 receptor agonists and bariatric/endoscopic options. She clarifies common misconceptions (e.g., statins are safe—and beneficial—for patients with fatty liver), reviews evidence and real-world considerations for vitamin E and pioglitazone, and explains where resmetirom (Rezdiffra) fits today for non-cirrhotic MASH with F2–F3 fibrosis—including monitoring, drug–drug interactions, and documentation tips that support payer approval. The session also covers cardiovascular risk reduction, peri-procedure guidance for GLP-1s, and practical strategies for staging and follow-up so clinicians can confidently personalize therapy and improve outcomes.
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