Advanced Liver Disease Case Studies

Treatment

• 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