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CME / ABIM MOC

Can You Diagnose and Treat These Patients With Liver Abnormalities?

  • Authors: Marlyn Mayo, MD
  • CME / ABIM MOC Released: 6/1/2021
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 6/1/2022
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Target Audience and Goal Statement

This activity is intended for gastroenterologists, primary care physicians, diabetologists, and endocrinologists.

The goal of this activity is to improve the ability of clinicians to diagnose and treat patients with primary biliary cholangitis (PBC) liver abnormalities.

Upon completion of this activity, participants will:

  • Have greater competence related to
    • Selecting diagnostic tests to evaluate liver abnormalities
    • Ordering evidence-based treatments for PBC
    • Tailoring treatments according to patient characteristics and disease progression


Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Faculty

  • Marlyn Mayo, MD

    Program Director, Gastroenterology Fellowship Program
    Professor of Internal Medicine
    UT Southwestern Medical Center
    Dallas, Texas

    Disclosures

    Disclosure: Marlyn Mayo, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Cymabay Therapeutics; GlaxoSmithKline; Mallinckrodt; Mirum Pharmaceuticals
    Received grants for clinical research from: Cymabay Therapeutics; Intercept Pharmaceuticals, Inc.; Mallinckrodt; Salix Pharmaceuticals, Inc.; Target PharmaSolutions, Inc.

Editor

  • Christina T. Loguidice

    Medical Education Director, Medscape, LLC

CME Reviewer

  • Esther Nyarko, PharmD

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.


Accreditation Statements



In support of improving patient care, Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

CME / ABIM MOC

Can You Diagnose and Treat These Patients With Liver Abnormalities?

Authors: Marlyn Mayo, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME / ABIM MOC Released: 6/1/2021

Valid for credit through: 6/1/2022

processing....

The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.

CASE 1: PATIENT HISTORY AND PRESENTATION

Jason is a 49-year-old White man who had mildly elevated liver enzymes at his physical exam 1 year earlier. Results from his current physical show they have further increased (Table 1). No other laboratory abnormalities are observed except for a mildly elevated total cholesterol level of 225 mg/dL (normal, < 200 mg/dL), which he plans on managing with diet. He reports some itching, which seems to worsen at night, sometimes making it difficult for him to sleep. As a result, he says he is left feeling a bit fatigued some days.

You refer Jason for ultrasonography and magnetic resonance cholangiopancreatography (MRCP). Neither of these modalities reveals any abnormalities, such as mechanical bile duct obstruction.

Table 1. Jason's Previous and Current Liver Testing Results

  Results 1 Year Earlier Current Results Normal Range
ALP, U/L 130 583 30 to 120
AST, U/L 26 30 10 to 30
ALT, U/L 43 46 10 to 40
Albumin, g/dL 4.3 3.7 3.5 to 5
Bilirubin (total), mg/dL 0.5 0.5 0.3 to 1.2
GGT, U/L 225 650 2 to 30

 

ALP = alkaline phosphatase; ALT = alanine aminotransferase; AST = aspartate aminotransferase; GGT = γ-glutamyltransferase.
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