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MASLD AI 07:28 AM
October 2025
Punam Punja, MMS, PA-C, explores how to distinguish F3 fibrosis from F4 cirrhosis in patients with MASLD/MASH using real-world case comparisons. Learn how to interpret non-invasive testing, including FibroScan, ELF score, and FIB-4, and understand how results guide treatment decisions, from lifestyle interventions and GLP-1 therapy to the role of resmetirom in advanced fibrosis. Punja also reviews key monitoring steps, including HCC surveillance, multidisciplinary care, and when to consider MRI elastography or liver biopsy for accurate staging.
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In this session, Sarah Dawkins, NP, breaks down the overlap between MASLD and MetALD using a real case (FIB-4 = 2.01, FibroScan 11.4 kPa [F3], CAP 310). Presented via the GHAPP MASLD Community Network and supported by Madrigal Pharmaceuticals, she reviews how to stage disease with non-invasive tests (FIB-4, FibroScan/VCTE), why alcohol biomarkers (PEth) matter, and when to initiate HCC surveillance. Practical takeaways include counseling on a Mediterranean diet, exercise/weight loss targets, alcohol abstinence, and assessing candidacy for resmetirom in metabolic-predominant cases to slow fibrosis and improve outcomes.
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Join Lindsay Pratt, PA-C from the University of Colorado Liver Transplant Program, for an in-depth clinical comparison of F3 and F4 fibrosis in patients with MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) and MASH (Metabolic Dysfunction–Associated Steatohepatitis). Using an identical patient profile with differing non-invasive testing results, Lindsay demonstrates how to accurately stage fibrosis using tools like FIB-4, FibroScan, CAP score, and ELF test—emphasizing when pharmacologic intervention is appropriate and when advanced monitoring becomes critical. This session explores the clinical implications of fibrosis staging, treatment pathways including resmetirom (Rezdiffra), the role of GLP-1 receptor agonists, and practical nutrition and lifestyle strategies. For F4 patients, Lindsay outlines key elements of surveillance for hepatocellular carcinoma (HCC), portal hypertension management, and transplant evaluation. Whether you're in hepatology or primary care, this case-based discussion offers evidence-backed guidance for managing patients across the MASLD/MASH spectrum and preventing liver disease progression.
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Webcast: Non-Invasive Testing With Kelly Smeester
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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.
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