Hepatology
Expert perspectives on liver disease, viral hepatitis, cirrhosis management, and liver transplantation.
Recent Discussions
How would you differentiate neurologic manifestations of a patient with Wilson's disease versus manifestations of hepatic encephalopathy due to end-stage liver disease?
The neurological manifestations of Wilson's include movement disorders (tremor, dystonia, parkinsonian rigidity, dysarthria, gait abnormalities, pseudobulbar signs) and neuropsychiatric symptoms (impaired executive function, cognitive disorders, depression), ophthalmologic Kayser Fleischer rings. He...
How do you balance infection risk in patients with immune-mediated liver disease on chronic immunosuppression (ex: prednisone, AZA, MMF, etc)?
The risk of infection depends on patient-related factors (some related to liver disease, others due to other conditions) as well as the degree of immunosuppression. Patient-related risk factors include the presence of cirrhosis, age, diabetes, CKD, and others, which can increase the risk of infectio...
How do you approach the surveillance and serologic evaluation of a patient in whom you suspect has a hepatitis B pre-core mutant?
HBeAg- HBeAb+/- with HBV DNA > 2 log likely precore mutant. Surveillance similar to wild-type with ALT and HBV DNA q6mos to assess for reactivation (abnormal ALT, DNA > 2000IU) that you would consider treating. If considering treatment, qHBsAg might be useful to identify patients who might be able t...
What role is there for the assessment of hepatitis B virus genotype as it pertains to pharmacologic therapy and HCC screening?
We always get genotype before treatment of HBV. It supplies a lot of valuable information.A-G not so much but resistance testing is important in case they took Chinese herbs with lamivudine in them unknowingly. What is really important though for risk of HCC is the presence of the Basal Core Promote...
When would you consider quantification of hepatitis B surface antigen as part of the treatment decision making process?
It is not absolutely necessary. Treatment initiation decisions primarily hinge on expected benefit for reduction of inflammation, injury and fibrosis. qHBsAg is primarily a predictor of treatment duration, the likelihood of HBsAg loss during treatment.
What clinical evidence do you find most favorable of a positive response post-liver transplant for patients with portopulmonary hypertension?
In our Mayo Clinic experience, POPH patients who normalize the PVR with therapy (measured by right heart catheterization pre-transplant) are most likely to resolve POPH post-transplant and come off of all pulmonary artery hypertension medications. Normalization of right ventricular function by echoc...
What clinical scenario would you favor NOT using terlipressin for the management of HRS if there were no notable contraindications for its initiation?
None if all the contraindications are excluded.
What are your clinical considerations to pursue an automated-low-flow ascites (ALFA) pump for a patient with refractory ascites?
A patient whose ascites is difficult to control and has contra-indications for TIPS.
What patient clinical factors do you find most impact a patient's "beta-blocker window" and their ability to maintain and tolerate beta-blocker therapy?
Hypotension (SPB<90), bradycardia (HR <50) and refractory (grade 3) ascites are typically considered triggers to at least hold but likely stop NSBB. On the other end of the window, evidence of clinically significant portal hypertension (CSPH) is the typical trigger to consider starting NSBB treatmen...
How do you foresee the integration of artificial intelligence in the management and evaluation of patients with liver lesions/tumors?
I believe it will have a major impact on the diagnosis, prognosis and response to therapy in the future for liver lesions.