Viral Hepatitis

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Advanced Liver Disease Case Studies

for Health Care Providers

Advanced Liver Disease Case Studies


  • Case Study 1:
    He has prior psychiatric issues but a very low viral load: A case for shorter duration of treatment? (June 2006)
  • Case Study 2:
    A patient with cirrhosis: Is it too late to treat? (June 2006)
  • Case Study 3:
    He has hepatitis C compensated cirrhosis with nonmetastatic lung cancer: Would you treat? (June 2006)
  • Case Study 4:
    A patient with compensated cirrhosis, diabetes, bipolar disorder, and alcohol relapses: Would you retreat? Would you use beta-blockers for prophylaxis of variceal bleeding? (June 2007)

Cirrhosis Management

  • Case Study 1:
    A decompensated cirrhotic with HIV/HCV coinfection: What can we do and what can't we do? (June 2006)
  • Case Study 2:
    The role of alcohol: What are the acute and chronic effects in alcoholic hepatitis vs hepatitis C? (June 2006)
  • Case Study 3:
    Complications of cirrhosis: What are the main issues involving antibiotics, diuretics, and lactulose? (June 2006)
  • Case Study 4:
    Hepatitis C and MELD 12: How often should lab values be monitored, and does comorbid hemosiderosis exclude this patient from transplant? (June 2007)

Hepatocellular Carcinoma

  • Case Study 1:
    When is it necessary to perform a biopsy on a liver lesion to confirm hepatocellular carcinoma? (June 2006)
  • Case Study 2:
    A case of HCC at late presentation: What are the controversies over screening HCV patients for HCC in order to detect early and treat? (June 2006)
  • Case Study 3:
    Aggressive HCC: Is surveillance ever enough? (June 2007)
  • Case Study 4:
    The Problems with AFP Testing: A Case of AFP Level Rising to 800 µg/L, with No Detectable Mass

About the VA Advanced Liver Disease Resource Training Programs

The Advanced Liver Disease Resource Training Programs focused on hands-on use of current advanced liver disease resources and direct interaction with advanced liver disease experts. They emphasized: 1) early detection and intervention in patients with cirrhosis and the optimization of its management, especially in centers with limited resources to address cirrhosis; 2) support in the screening and management of hepatocellular carcinoma (HCC); and 3) treatment for persons who may undertake the liver transplant process.

The programs were sponsored by the VA Hepatitis C Resource Centers (HCRC) Program, in collaboration with the VA National Clinical Public Health Programs and the VA Transplant Program.

2007 Facilitators/Speakers

  • Sue Currie, MA, Epidemiologist, Associate Director, San Francisco, HCRC
  • Alexander Monto, MD, Hepatologist, Director, San Francisco, HCRC
  • Guadalupe Garcia-Tsao , MD, Hepatologist, Director, Connecticut, HCRC
  • Joseph Awad, MD, Liver Transplant Program Director, Nashville VAMC
  • Anna Sasaki, MD, Hepatologist, Portland, VAMC
  • Thomas Cacciarelli, MD, Liver Transplant Program Director, Pittsburgh VAMC
  • Brenda Salvas, Senior Program Manager, VA National Transplant Program
  • Douglas Heuman MD, Liver Transplant Program Director, Richmond, VAMC
  • Bashar Aqel, MD, Hepatologist, Minneapolis, VA, HCRC
  • HoChong Gilles, RN, MS, FNP, Clinical Coordinator, Richmond, VAMC
  • Kristine Stick, NP, Liver Transplant Coordinator, San Francisco VAMC

2006 Facilitators/Speakers

  • Ann Busch, Liver Transplant Clinical Nurse Specialist, Portland VAMC
  • Sue Currie, Associate Director, HCRC, San Francisco VAMC
  • Guadalupe Garcia-Tsao, Director, HCRC, Connecticut VAMC
  • Douglas Heuman, Liver Transplant Program Director, Richmond VAMC
  • Alexander Monto, Director, HCRC, San Francisco VAMC
  • Roberta Ruimy, Manager, Liver/Kidney Transplant Programs, Portland VAMC
  • Brenda Salvas, Health System Specialist, Manager, Liver and Kidney Transplant Program, VA Transplant Program, VA Central Office, Washington, DC
  • Anna Sasaki, Staff Physician, Portland VAMC
  • Kristine Stick, Nurse Practitioner for Hepatology, San Francisco VAMC
  • Suchat Wongcharatrawee, Associate Director HCRC, Connecticut VAMC

Web Resources

  • Hepatitis Web StudyLink will take you outside the VA website. VA is not responsible for the content of the linked site.
    Interactive, case-based modules related to the clinical care of persons with viral hepatitis, from the University of Washington.