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How Would You Assess These Patients for Liver Fibrosis?

  • Authors: Rohit Loomba, MD, MHSc
  • CME Released: 2/28/2023
  • Valid for credit through: 2/28/2024, 11:59 PM EST
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    You Are Eligible For

    • Letter of Completion

Target Audience and Goal Statement

This activity is intended for gastroenterologists, diabetologists, and endocrinologists.

The goal of this activity is for learners to be better able to use appropriate NITs to assess patients for liver fibrosis.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Appropriate NITs to use in assessing a patient for liver fibrosis
    • Guideline recommendations for NAFLD screening in patients with diabetes
  • Have greater competence related to
    • Implementing NITs for disease stratification in clinical practice


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  • Rohit Loomba, MD, MHSc

    Professor of Medicine
    Director of Hepatology
    University of California at San Diego
    Director, NAFLD Research Center
    San Diego, California, United States


    Rohit Loomba, MD, MHSc, has the following relevant financial relationships:
    Consultant or advisor for: 89 Bio Inc; Aardvark Therapeutics; Altimmune; Amgen Inc.; Anylam/Regeneron; Arrowhead Pharmaceuticals, Inc.; AstraZeneca; Bristol Myers Squibb Company; CohBar; Eli Lilly and Company; Galmed Pharmaceuticals Ltd.; Gilead Sciences, Inc.; Glympse Bio; HighTide; INIPharma; Intercept Pharmaceuticals, Inc.; Inventiva; Ionis Pharmaceuticals; Janssen; Madrigal Pharmaceuticals, Inc.; Merck; Metacrine; NGM Biopharmaceuticals; Novartis; Novo Nordisk; Pfizer Inc.; Sagimet Biosciences; Terns Pharmaceuticals; Theratechnologies Inc.; Viking Therapeutics
    Research funding from: Arrowhead Pharmaceuticals, Inc.; AstraZeneca; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol Myers Squibb Company; Eli Lilly and Company; Galectin Therapeutics; Galmed Pharmaceuticals Ltd.; Gilead Sciences, Inc.; Hanmi Pharm. Co., Ltd.; Intercept Pharmaceuticals, Inc.; Inventiva; Ionis Pharmaceuticals; Janssen; Madrigal Pharmaceuticals, Inc.; Merck; NGM Biopharmaceuticals; Novo Nordisk; Pfizer Inc.; Sonic Incytes; Terns Pharmaceuticals
    Other: Co-founder of LipoNexus Inc.


  • Anne G. Le, PharmD

    Senior Medical Education Director, Medscape, LLC


    Anne G. Le, PharmD, has no relevant financial relationships.

  • Gina Montanero, PharmD, RPh

    Associate Medical Writer, Medscape, LLC


    Gina Montanero, PharmD, RPh, has no relevant financial relationships.

Compliance Reviewer

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Yaisanet Oyola, MD, has no relevant financial relationships.

Peer Reviewer

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

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How Would You Assess These Patients for Liver Fibrosis?

Authors: Rohit Loomba, MD, MHScFaculty and Disclosures

CME Released: 2/28/2023

Valid for credit through: 2/28/2024, 11:59 PM EST


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: A Woman With Type 2 Diabetes

Carol is a 50-year-old woman who was diagnosed with type 2 diabetes (T2D) 7 years ago. She comes into your endocrinology office for her first visit after recently moving to the area. Her glycated hemoglobin (HbA1c) is 8% on metformin. You note that she has other indicators of metabolic syndrome such as class 2 obesity, low-density lipoprotein (LDL) cholesterol of 130 g/dL, and her blood pressure (BP) is 130/90 mm Hg on ramipril 5 mg. Her alanine transaminase (ALT) is 65 U/L, aspartate aminotransferase (AST) is 45 U/L, and platelet count is 200,000. Carol explains that things have been hard in her personal life. She got divorced 3 years ago, moved twice, and had 3 jobs changes which interrupted her health insurance. She is finally settled into a new home with a good job and wants to get her health back on track.

Carol's medical record and current laboratory results are listed in Table 1.

Table 1. Carol's Medical Record

History Findings
Medical T2D × 7 years, HTN × 15 years, dyslipidemia × 10 years, and
Current medications Metformin 1000 mg twice daily, ramipril 5 mg/d, metoprolol 100
mg twice daily, simvastatin 20 mg/d
Social/Occupational Married; smoker × 30 years, recreational drinker; has 2 adult
sons. Sedentary lifestyle. High-fat diet, poor intake of fruit,
vegetables, and whole grains
Physical Exam Findings
Vital signs BP: 130/90 mm Hg
Heart rate: 78 bpm
Body measurements Weight 90 kg, BMI = 35 kg/m2; class 2 obesity
Extremities No edema
Neck No distended neck veins
Heart LVEF = 60%
Lungs No rales
Abdomen Soft, nontender
CBC Results
  Normal, except platelets 200,000
Metabolic Panel Results
FPG 135 mg/dL
HbA1c 8%
Lipid panel LDL: 130 mg/dL; HDL: 35 mg/dL; TG: 170 mg/dL
AST 45 U/L
ALT 65 U/L
eGFR 91 mL/min/1.73 m2
UACR 9 mg/g
BMI, body mass index; CBC, complete blood count; eGFR, estimated glomerular filtration rate; FPG, fasting plasma glucose; HDL, high-density lipoprotein; HTN, hypertension; LVEF, left ventricular ejection fraction; TG, triglycerides; UACR, urine albumin-to-creatinine ratio.
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