Genetic Diseases of the Liver – Karen Krok, M.D., FAASLD
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Questions asked for this faculty member during the 2025 Live Course
What does a “bland” embolization mean?
Bland embolization is a Transarterial embolization that uses only inert particles (no chemotherapy or radioactive agents) to block the arteries feeding the tumor.
As we know that 2nd trimester is the best timing for surgery. Do you consider cholecystectomy for cholecystitis found during trimester 1 and 3?
Yes, cholecystectomy can be performed safely during pregnancy, and the 2nd trimester (14–28 weeks) is generally the preferred time. However, in urgent cases, surgery may be necessary in the 1st or 3rd trimester.
What is the max dose for acetaminophen during pregnancy without chronic liver disease?
The dose in pregnancy is not altered unless there is chronic liver disease. And so in the absence of chronic liver disease the dose is 4000 mg a day in a pregnant patient.
How you determine if the patient will need resmetirom for MASH if there is a history of chronic viral hepatitis for example HCV that was treated years ago, but now has F2-F3 on fibroscan. How will you determine if that is MASH or fibrosis from previous treated hepatitis.
If you have cured their HCV and they have MASH but still have F2/F3 fibrosis, then I would utilize resmetirom in those patients. I would not use a history of HCV or HBV as a reason not to use this.
Normal HFE testing for hemochromatosis only check for HFE genes, not the non-HFE. How do you determine if patient needs non-HFE testing if HFE testing is negative?
This is a great question and a difficult one to answer as the other variants are so rare. If there is evidence of iron overload (MR elastography with iron, biopsy with iron, high ferritin and iron sat) and you have no good diagnosis for this (i.e. no fatty liver, transfusions, that is when you can consider this.
Why do the enzymes not go higher than 300-400 in ETOH hepatitis?
The relatively modest rise in liver enzymes is a reflection of the following:
- the type of cellular injury. In alcohol induced hepatitis, this is damage to the mitochondria. AST is found in both the cytosol and the mitochondria, whereas ALT is just in the cytosol so this is one reason from AST is greater than ALT.
- the extent of hepatocyte death/necrosis is not as extensive as in viral of ischemic hepatitis and so the liver enzymes aren’t as elevated. In Alcohol induced hepatitis this is usually a more chronic, smoldering inflammation and ballooning degeneration and not massive hepatocyte death.
- Usually in patients with alcohol induced hepatitis, there is already some chronic liver disease which will lead to the liver’s diminished capacity to produce and release enzymes.
Patients are usually deficient in vitamin B6, which is a cofactor for ALT. This will prevent a significant elevation in ALT and contributes to the 2 to 1 one ratio of AST to ALT.