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Digital Seminar

The Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease, Nonalcoholic Steato Hepatitis, Cirrhosis, & Hepatoma

Peter Buch, MD, AGAF, FACP
2 Hours 07 Minutes
Audio and Video
Dec 08, 2023
Product Code:
Media Type:
Digital Seminar


Nonalcoholic Fatty Liver Disease (NAFLD) affects 24% of the US population and only 5% are aware of their disease.  That’s staggering when you consider how NAFLD can progress to Nonalcoholic Steato Hepatitis, Cirrhosis, and Hepatoma. 

How can we diagnose and follow these patients in a primary care setting? What treatments are available? What is the data on these treatments? 

Please join Peter Buch, MD as he discusses the important role that you will play in treating a tsunami of future liver disease due to NAFLD.  This will be done in a practical, case based, very interactive and fun format. You’ll conclude with practical, useful clinical tools necessary to help you NAFLD patients. 


Planning Committee Disclosure - No relevant relationships

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners.  For speaker disclosures, please see the faculty biography.

* Credit Note - **

NOTE: Tuition includes one free CE Certificate (participant will be able to print the certificate of completion after passing the online post-test (80% passing score) and completing the evaluation). Instructional methods will include PowerPoint, didactic lecture, and others.

Continuing Education Information:  Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Program content is reviewed periodically per accrediting board rules for currency and appropriateness for credit. Credit approvals are subject to change. Please note, your state licensing board dictates whether self-study is an acceptable form of continuing education, as well as which credit types are acceptable for continuing education hours. Please refer to your state rules and regulations. If your profession is not listed, please contact your licensing board to determine your continuing education requirements and check for reciprocal approval. 
For other credit inquiries not specified below, please contact or 800-844-8260 before purchase.

Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of your profession.  As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your profession's standards.  

For Planning Committee disclosures, please see the statement above.  For speaker disclosures, please see the faculty biography.

* Credit Note - ---

Earn up to 2.0 CE hours. Please see below, for more details, as credit amounts vary by state and profession. 

Nurses - Pharmacology Nurse Practitioners

This self-study program offers 127 instructional minutes of pharmacology content which is designed to qualify for 2.0 contact hours toward your pharmacology requirement. 

Nurses - Nurses, Nurse Practitioners, and Clinical Nurse Specialists - ANCC

PESI, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. Nurses completing these self-study materials will earn 2.0 contact hours. Expires: 12/08/2026.

Nurses - California Nurses

PESI, Inc. is a provider approved by the California Board of  Registered Nursing, Provider #: 17118 for 2.0 self-study contact hours. 

** You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Nurses - Florida Nurses

PESI, Inc. is an approved provider by the Florida Board of  Nursing. Provider #: FBN2858. These materials qualify for 2.0 self-study contact hours.

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Nurses - Iowa Nurses

PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 2.0 self-study contact hours. Please email with your license number, include the title, speaker name and date. PESI must have this number on file in order for your hours to be valid.

Physicians - Physicians

PESI, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. PESI, Inc. designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credit(s)™. This activity was originally recorded on 12/08/2023. It was last reviewed on 03/15/2024 and is valid until 03/14/2027.


Physicians should only claim credit commensurate with the extent of their participation in the activity. You are required to successfully complete and submit a post-test prior to receiving a certificate of completion.

Other Professions

This self-study activity qualifies for 2.0 continuing education clock hours as required by many national, state and local licensing boards and professional organizations. Save your activity advertisement and certificate of completion, and contact your own board or organization for specific requirements.



Peter Buch, MD, AGAF, FACP's Profile

Peter Buch, MD, AGAF, FACP Related seminars and products

Peter Buch, MD, AGAF, FACP, is a double board-certified clinical gastroenterologist,  leading a team that treats all GI conditions. Dr. Buch sits on editorial boards for numerous professional journals and is a highly sought-after international presenter.

Dr. Buch has a passion for teaching. His style is case-based, practical, very interactive and evidence supported. Dr. Buch’s expertise has been shared with experienced clinicians and advanced-level students. He teaches at the University of Connecticut School of Medicine, the University of New England College of Osteopathic Medicine, the Frank H Netter School of Medicine/Quinnipiac University and the University of Connecticut APRN School.


Speaker Disclosures:
Financial: Dr. Peter S. Buch has employment relationships with the University of Connecticut School of Medicine, the University of New England College of Osteopathic Medicine, and the Frank H Netter, MD School of Medicine. He receives a speaking honorarium and recording royalties from PESI, Inc. He has no relevant financial relationships with ineligible organizations.
Non-financial: Dr. Peter S. Buch serves on the FDA and Patient Care Committees at the American College of Gastroenterology. He serves as an editor of peer-reviewed journals. He is a member of the International Association of Medical Science Educators, the AGA Academy of Educators, the American Gastroenterological Association (AGAF), the American College of Physicians (FACP), the Hartford County Medical Association, the American College of Gastroenterology (FACG), and the Connecticut State Medical Society.


Content Disclosure:

Dr. Buch references the use of antidepressants for Irritable Bowel Syndrome, and the controversial use of Fibrotest to evaluate patients with fatty liver disease who may have fibrosis of the liver. Dr. Buch indicates he wishes to present a fair and balanced approach to practitioners regarding such practices.



Additional Info

Access for Self-Study (Non-Interactive)

Access never expires for this product.


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  1. Differentiate clinically between Nonalcoholic Fatty Liver Disease (NAFLD), Nonalcoholic Fatty Liver (NAFL) and Nonalcoholic Steato Hepatitis (NASH). 
  2. Determine at risk individuals for NAFL and NASH. 
  3. Measure progression of disease from NAFL to NASH to cirrhosis. 
  4. Evaluate the appropriate treatment options. 


Changing Terminology 

  • Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) 
  • Metabolic Dysfunction Associated Steatohepatitis (MASH) 

Evaluation of a Patient with Mildly Elevated Liver Function Tests 

  • Alcohol ingestion 
  • Medication use 
  • Herbs 
  • Illicit drug use 

Necessary Testing 

  • CBC 
  • HBsAg, HBcAb, HBsAb 
  • HCV Ab and RNA confirmation 
  • Fe/TIBC and Ferritin 
  • Ultrasound of biliary tree and pancreas     

Risk Factors for Nonalcoholic Fatty Liver Disease (NAFLD) 

  • Obesity 
  • Type 2 diabetes 
  • Dyslipidemia 
  • High blood pressure 
  • Metabolic syndrome 
  • Dramatic increase in obesity and NAFLD expected by 2030 

NAFLD Diagnosis 

  • First - rule out other causes of liver disease 
  • Especially consider alcohol 
  • Medications 
  • Food supplements 
  • Hepatitis B, C 

Techniques to Determine Alcohol Consumption 

  • CAGE questions 
  • AUDIT questions 
  • Nonjudgmental zone 

Usefulness of Labs to Determine Alcohol Consumption 

  • AST:ALT ratio 
  • GGTP 
  • PEth test 

Importance of Nonalcoholic Steatohepatitis (NASH) in Primary Care 

  • Risk of cirrhosis 
  • NASH will become the major cause of hepatocellular cancer by 2025 

Progression of NAFLD 

  • From NAFLD to NASH to cirrhosis to hepatoma 
  • Only a portion of patients progress to the next stage 

Non-Invasive Tests to Check for Progression of Liver Disease 

  • Fibrosis-4 Score (FIB-4) 
  • What it is and how it is utilized? 
  • What is the sensitivity and specificity? 
  • Fibrosure/Fibrotest 
  • ELF Test 

Imaging in Nonalcoholic Fatty Liver Disease  

  • Ultrasound 
  • Fibroscan 
  • Magnetic Resonance Elastography 

When is a Liver Biopsy Still Needed to Make the Diagnosis 

  • If there is more than one liver disease 
  • If diagnosis is in doubt  

Why Patients with NAFLD have a 10% Higher Mortality Rate 

  • Cardiovascular disease 
  • Cirrhosis/hepatoma is not the main cause of early morbidity/mortality 

Standard Ways of Treating NAFLD  

  • Exercise and weight loss 
  • Hepatitis A and B vaccinations 
  • Avoid alcohol 
  • Coffee as a treatment modality? 
  • Which diet is best? 
  • Mediterranean 
  • Ketogenic 

How do we approach NAFLD in lean individuals? 

  • Weight loss? 
  • Exercise? 

Medications used to treat NASH 

  • Vitamin E 
  • Studies to date 
  • Risks/benefits/alternatives 
  • Pioglitazone 
  • Risks/benefits/alternatives 
  • GLP-1 receptor agonists 
  • Effective for weight loss 
  • Not yet proven to reduce fibrosis in NASH 
  • Improvement in cardiovascular mortality 
  • Renal dysfunction 

Bariatric Surgery for NASH 

  • The data 
  • When it is covered by 3rd party payers 

Target Audience

  • Nurses
  • Physicians         


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