Fundamentals of Liver Disease- Abnormal Liver Tests

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There is currently an anticipated shortage of trained providers capable of diagnosing and treating different liver diseases. As a result of this increased demand and limited specialists in the field, more and more front line providers are faced with these patients and do not have the experience or resources that will allow them to manage them appropriately.

The overall goal is to improve patient care by increasing learner competence and confidence in both proper patient identification and assessment and increasing learner performance in therapeutic options and on-treatment management strategies for patients. Patient outcomes will be improved as a result of the improvements in more providers understanding these key components in the management and care of patients with liver diseases.

Key topic areas:

Anatomy and Physiology of the Liver

Liver Tests

Acute Hepatocellular Injury

Acute Cholestatic Liver Injury

Chronic Hepatocellular Injury

Chronic Cholestatic Injury

Interpretation of Viral Serologies in Acute and Chronic Hepatitis

Outcomes of Patients with Abnormal Liver Tests

 

COMPONENTS

Online presentations comprised of PowerPoint slides and accompanying audio and online pre- and post-tests and evaluations:

-8 online interactive, narrated modules 15 to 20 minutes in length

-Pre- and post-test questions for each module


Original release date: November 4, 2016

Expiration date: November 3, 2018

Time to complete each module: 15-20 minutes

 

Copyright:

All faculty in this activity have given their permission for publication OR

©2016 AASLD

 

Contact Information

For questions on CE credit for this activity, email Certificate@AmedcoEmail.com

For questions on MOC/CME/CE content or the activity web site, contact education@aasld.org

The Abnormal Liver Tests unit of the Fundamentals of Liver Disease currently does not offer CME, CE, or MOC. This unit is available for viewing purposes only. A newly updated version will be available soon for credits or points. Check back for updates!

Tamar H. Taddei

Tamar Taddei, MD, FAASLD is an Associate Professor of Medicine in the Section of Digestive Diseases at Yale University and staff hepatologist at the VA Connecticut Healthcare System in West Haven, CT. She directs the liver cancer program at VA Connecticut.  She is Associate Director of the MD/PhD Program at Yale School of Medicine.  She is a board certified gastroenterologist with a certificate of added qualification in transplant hepatology.  Her clinical interests include end stage liver disease, liver transplantation, and liver cancer.  She leads the VA Connecticut’s Cancer Care Tracking System Team, a group that has facilitated early detection of cancer and timely access to comprehensive cancer care through innovation in systems of care and technology.  She is co-PI of the Veterans Outcomes and Costs Associated with Liver disease (VOCAL) Study Group.

Hugo E. Vargas

Hugo E. Vargas, MD, FAASLD is a Mayo Clinic Consultant in the Department of Gastroenterology and Hepatology and the Mayo Clinic Transplantation Center. He is the Medical Director for the Office of Clinical Research – Arizona, and a Professor of Medicine in the Mayo Clinic Alix School of Medicine. Dr. Vargas is the Chair of the Clinical Research Subcommittee, and the Vice Chair of the Arizona Research Operations Management Team.  

Dr. Vargas has authored or coauthored more than 125 peer-reviewed articles. He is a Fellow of the AASLD, AGA, ACG, ASGE and ACP. He has been active in AASLD and has chaired the Annual Meeting Education Committee, Ethics Commiteee and co-chaired the AASLD/IDSA HCV group from 2016 to 2018. 

Oren K. Fix

Oren K. Fix, MD, MSc, FAASLD is Medical Director of the Liver Transplant Program at Swedish Medical Center in Seattle. He earned his medical degree at SUNY Buffalo School of Medicine and a masters degree in Epidemiology from Boston University School of Public Health. He completed his Internal Medicine residency and Gastroenterology fellowship at Boston University and Transplant Hepatology fellowship at University of California San Francisco (UCSF). Dr. Fix was a site principal investigator in the NIH-funded Acute Liver Failure Study Group for 8 years at University of Washington and UCSF. He has published over 45 peer-reviewed manuscripts and book chapters, many on the topic of acute liver failure.

Victor J. Navarro

Victor J. Navarro, MD, MHCM, FAASLD earned his Doctor of Medicine degree from the Pennsylvania State College of Medicine and completed medical residency followed by chief residency in Internal Medicine at Temple University.  Thereafter, he obtained fellowship training in Gastroenterology, Hepatology, and Hepatobiliary Endoscopy at Yale University.  In 1994, Dr. Navarro joined the faculty of the Yale University School of Medicine as an Assistant Professor of Medicine and Epidemiology and the Director of its Liver Failure and Transplantation service. He was also the Director of the State of Connecticut Emerging Infections Program Liver Study Unit.  His scholarly work while at Yale focused on the population-based epidemiology of chronic liver disease. In 2019, Dr. Navarro earned his Masters in Healthcare Management from Harvard University.

As a mentor, Dr. Navarro has been directly responsible for the scholarly and clinical training of many young and mid-career health professionals and academicians.  Dr. Navarro’s chief sources of research funding are the National Institutes of Health as an investigator for the U.S. Drug Induced Liver Injury Network (DILIN), and the Patient Centered Outcomes Research Institute for his study of Palliative Care in Patients with End Stage Liver Disease.

Manal F. Abdelmalek

Manal F. Abdelmalek, MD, MPH is tenured Professor of Medicine in the Division of Gastroenterology and Hepatology and Director of the NAFLD Clinical Research Program at Duke University. She received training in Internal Medicine, Gastroenterology and Hepatology at the Mayo Clinic, Scottsdale AZ and Rochester, MN and obtained a MPH degree with emphasis in epidemiology, public health and clinical investigation at the University of Florida, Gainesville, Florida.  Since first reporting on nonalcoholic fatty liver disease (NAFLD) as a cause of cryptogenic cirrhosis over 20 years ago, her clinical and research area of interest have been in the field of NAFLD, its associated risk factors for disease acquisition and progression and novel approaches to treatment. She has expertise in the design and conduct of clinical trials in NAFLD/ NASH including investigator-initiated, industry sponsored and NIH-funded clinical studies evaluating new therapies and biomarkers for NAFLD.  She collaborates extensively to translate new compounds to first-in-man clinical studies and the translation of clinic-to-bench and bench-to-clinic research to define pathogenic mechanisms underlying NAFLD acquisition and progression.  Dr. Abdelmalek is a Fellow of American College of Physicians, American College of Gastroenterology and American Association for the Study of Liver Disease.  She is a standing member of NASH Clinical Research Network (NASH CRN).  She has over 150 publications authored publications in the field of liver disease, the majority of which are in the area of NAFLD. 

Cynthia Levy

Cynthia Levy, MD, FAASLD is currently a Professor of Medicine in the Division of Hepatology at the University of Miami Miller School of Medicine. Dr. Levy received her MD from Universidade Federal do Rio de Janeiro, Brazil. She completed an Internal Medicine residency at University of Miami, a Gastroenterology Fellowship at Mayo Clinic, Rochester, and a Transplant Hepatology Fellowship at University of Florida, Gainesville, having received an AASLD Fellowship Award. Dr. Levy is a member of the AASLD Practice Guidelines Committee and of the ABIM Test and Policy Committee on Transplant Hepatology.  At the University of Miami, Dr. Levy is the program director for the Transplant Hepatology Fellowship program and Associate Director for the Schiff Center for Liver Diseases, where she conducts several industry-sponsored and investigator-initiated studies for cholestatic and autoimmune liver diseases.

Mindie H. Nguyen

Mindie H. Nguyen, MD, MAS, AGAF, FAASLD is an Associate Professor of Medicine in the Division of Gastroenterology and Hepatology, School of Medicine, Stanford University in Palo Alto, California, USA. Her main fields of scientific and clinical interest are the epidemiology and management of chronic viral hepatitis, non-alcoholic fatty liver disease and liver cancer, with over 100 peer- reviewed scientific journal articles. She has served as a member of the Steering Committee for the Hepatobiliary Neoplasia Special Interest Group, HBV Special Interest Group, Education Committee and the Hepatology Associate Committee for the AASLD and as research mentor for over 100 trainees and faculty.

Meena B. Bansal

Meena B. Bansal, MD, FAASLD is currently Professor of Medicine in the Division of Liver Diseases at the Icahn School of Medicine at Mount Sinai, Deputy Chief Medical Officer for Mount Sinai Health Partners, and Vice President, Population Health for Quality and Efficiency. Dr. Bansal attended Harvard University and then Cornell Medical School. She did her internship and residency at Cornell Medical School and then completed Gastroenterology Fellowship at the University of Pennsylvania in 2001.

Her current research interests focus on the impact of HIV on hepatic inflammation and fibrosis. She became the Director of Translational Research in the Division of Liver Diseases in 2013 and has been principal investigator for numerous clinical trials ranging from HCV to NASH. In 2013, she became the Medical Director of all Hospital-based Clinics at Mount Sinai. In this latter role she developed an interest in population health and the challenges of the evolving health care landscape. Over the past 5 years, her focus has also been on building a population health infrastructure that will allow a large academic health system to be successful in value-based care.

Key:

Complete
Failed
Available
Locked
Acknowledgement of view only
Acknowledgement of View Only
Agree to terms to continue.
Agree to terms to continue.
Module 1: Anatomy and Physiology of the Liver
Module 1 Pre-Test
5 Questions  |  1 attempt  |  3/5 points to pass
5 Questions  |  1 attempt  |  3/5 points to pass
Module 1: Anatomy and Physiology of the Liver
Open to view video.
Open to view video.
Module 1 Post-Test
5 Questions  |  Unlimited attempts  |  3/5 points to pass
5 Questions  |  Unlimited attempts  |  3/5 points to pass
Module 1 Evaluation
4 Questions
4 Questions Please complete the following evaluation form to share your feedback on this activity.
Module 2: Liver Tests
Module 2 Pre-Test
5 Questions  |  1 attempt  |  3/5 points to pass
5 Questions  |  1 attempt  |  3/5 points to pass
Module 2: Liver Tests
Open to view video.
Open to view video.
Module 2 Post-Test
5 Questions  |  Unlimited attempts  |  3/5 points to pass
5 Questions  |  Unlimited attempts  |  3/5 points to pass
Module 2 Evaluation
4 Questions
4 Questions Please complete the following evaluation form to share your feedback on this activity.
Module 3: Acute Hepatocellular Injury
Module 3 Pre-Test
5 Questions  |  1 attempt  |  3/5 points to pass
5 Questions  |  1 attempt  |  3/5 points to pass
Module 3: Acute Hepatocellular Injury
Open to view video.
Open to view video.
Module 3 Post-Test
5 Questions  |  Unlimited attempts  |  3/5 points to pass
5 Questions  |  Unlimited attempts  |  3/5 points to pass
Module 3 Evaluation
4 Questions
4 Questions Please complete the following evaluation form to share your feedback on this activity.
Module 4: Acute Cholestatic Liver Injury
Module 4 Pre-Test
5 Questions  |  1 attempt  |  3/5 points to pass
5 Questions  |  1 attempt  |  3/5 points to pass
Module 4: Acute Cholestatic Liver Injury
Open to view video.
Open to view video.
Module 4 Post-Test
5 Questions  |  Unlimited attempts  |  3/5 points to pass
5 Questions  |  Unlimited attempts  |  3/5 points to pass
Module 4 Evaluation
4 Questions
4 Questions Please complete the following evaluation form to share your feedback on this activity.
Module 5: Chronic Hepatocellular Injury
Module 5 Pre-Test
5 Questions  |  1 attempt  |  3/5 points to pass
5 Questions  |  1 attempt  |  3/5 points to pass
Module 5: Chronic Hepatocellular Injury
Open to view video.
Open to view video.
Module 5 Post-Test
5 Questions  |  Unlimited attempts  |  3/5 points to pass
5 Questions  |  Unlimited attempts  |  3/5 points to pass
Module 5 Evaluation
4 Questions
4 Questions Please complete the following evaluation form to share your feedback on this activity.
Module 6: Chronic Cholestatic Injury
Module 6 Pre-Test
6 Questions  |  1 attempt  |  4/6 points to pass
6 Questions  |  1 attempt  |  4/6 points to pass
Module 6: Chronic Cholestatic Injury
Open to view video.
Open to view video.
Module 6 Post-Test
6 Questions  |  Unlimited attempts  |  4/6 points to pass
6 Questions  |  Unlimited attempts  |  4/6 points to pass
Module 6 Evaluation
4 Questions
4 Questions Please complete the following evaluation form to share your feedback on this activity.
Module 7: Interpretation of Viral Serologies in Acute and Chronic Hepatitis
Module 7 Pre-Test
5 Questions  |  1 attempt  |  3/5 points to pass
5 Questions  |  1 attempt  |  3/5 points to pass
Module 7: Interpretation of Viral Serologies in Acute and Chronic Hepatitis
Open to view video.
Open to view video.
Module 7 Post-Test
5 Questions  |  Unlimited attempts  |  3/5 points to pass
5 Questions  |  Unlimited attempts  |  3/5 points to pass
Module 7 Evaluation
4 Questions
4 Questions Please complete the following evaluation form to share your feedback on this activity.
Module 8: Outcomes of Patients with Abnormal Liver Tests
Module 8 Pre-Test
5 Questions  |  1 attempt  |  3/5 points to pass
5 Questions  |  1 attempt  |  3/5 points to pass
Module 8: Outcomes of Patients with Abnormal Liver Tests
Open to view video.
Open to view video.
Module 8 Post-Test
5 Questions  |  Unlimited attempts  |  3/5 points to pass
5 Questions  |  Unlimited attempts  |  3/5 points to pass
Module 8 Evaluation
4 Questions
4 Questions Please complete the following evaluation form to share your feedback on this activity.
Final Evaluation
Final Evaluation
4 Questions
4 Questions Please complete the following evaluation form to share your feedback on this activity.

Learning Objective:

· Understand normal liver function and anatomy
· Identify routine liver tests, when to order, and how to interpret results
· Describe most common causes of acute hepatocellular injury and acute cholestatic injury and how to make a differential diagnosis
· Describe most common causes of chronic hepatocellular injury and chronic cholestatic injury and how to make a differential diagnosis
· Describe outcomes for patients with abnormal liver tests

This curriculum was developed for Primary Care Providers and any other healthcare provider interested in liver disease.

DISCLOSURE OF CONFLICTS OF INTEREST
AASLD requires all individuals who are in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Disclosures are collected prior to the start of the educational activity. Any potential conflicts of interest that exist are resolved prior to implementation of the activity. All disclosures are made available and communicated to the leaner prior the activity beginning.

The organizers and faculty have reported the following disclosures:

Dr. Tamar Taddei 
Faculty
Grant/research support: Bayer Healthcare Pharmaceuticals 
Consulting: Onyx Pharmaceuticals

Dr. Hugo E. Vargas 
Faculty
Nothing to disclose

Dr. Oren Fix
Faculty
Nothing to disclose

Dr. Navarro 
Faculty
Nothing to disclose

Dr. Manal F. Abdelmalek 
Faculty
Grant/research support: Gilead Sciences, Synageva, TaiwanJ, Immuron, Tobira, NGM, Bristol-Myers Squibb, Galactin, Galmed, Arisaph, Genfit, and Intercept Pharmaceuticals
Consulting:  TaiwanJ and Islet Sciences. Dr. Abdelmalek has no conflict of interest pertaining to the content of this presentation. 

Dr. Nguyen 
Faculty
Honoraria and research support: Roche Laboratories, Janssen Pharmaceuticals, Gilead Sciences, and Bristol-Myers Squibb. 

Dr. Meena Bansal 
Faculty
Nothing to disclose

Stephanie Graham
AASLD Staff
Nothing to disclose

Claudia Ventura
AASLD Staff
Nothing to disclose

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of AASLD. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

DISCLAIMER
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients' conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Acknowledgement of Commercial Support:
No commercial support was received for this enduring material activity.