Guided by a shared goal to help their patients enjoy a greater quality of life, UTMB’s Hepatology Advanced Practice Providers work collaboratively with faculty in the division to treat a variety of conditions that disrupt liver function.
“It can range from abnormal liver tests, like on your annual lab work, to fatty liver, hepatitis C, and cirrhosis,” says Samantha Boggs, MSN, APRN, AG-ACNP. “We see patients with all acuities – and every situation is different.”
Hepatology, which is a part of the Division of Gastroenterology and Hepatology in the Department of Internal Medicine, is well equipped to manage the full spectrum of liver disease. While the UTMB liver transplant program is taking a pause, the team treats all pathologies up to that stage and has a referral process for transplants.
Boggs says the team has seen a lot of new cases of hepatitis C, particularly in younger patients – a factor that may be related to the growing opioid epidemic among young people. For these patients, the first step is to learn about the liver and look for fibrosis with noninvasive biopsy or lab work.
Treatment for hepatitis C with direct-acting antivirals typically takes eight to 12 weeks and is highly effective, clearing about 95 percent of cases.
If the patient has cirrhosis, or advanced fibrosis of the liver, additional evaluation can help determine what type of therapies the patient may need.
“Cirrhosis looks different for every patient,” she says. “It can be some abnormal findings on imaging, but the patient feels fine, or it can be someone that shows up in the hospital in the emergency room, terribly ill and didn't know they had a liver disease.”
Fortunately, there are various imaging modalities to look at the liver. Imaging allows the provider to see the size, the shape, and the morphology, or what the density and the contour may look like.
One noninvasive tool for measuring fibrosis is FibroScan, a special ultrasound that measures liver stiffness and fatty changes in the liver. Boggs had previous experience with FibroScan when she joined UTMB in 2019 and was excited when UTMB introduced the technology.
“It’s helped to decrease the number of biopsies that we have to do, and that’s beneficial because liver biopsy is invasive and at times can be a risk to the patient. Sometimes there's not enough tissue in the sample and we don't always get the answer that we're looking for,” she says. “As you can imagine, trying to convince a patient to repeat a liver biopsy after they've already done it is hard to do.”
Although there is still a margin of error, it’s much easier to repeat the noninvasive FibroScan if needed, Boggs says. Using FibroScan to show patients their disease progression has been a helpful tool, and it is often encouraging for patients who have made lifestyle changes and experienced improvement.
Boggs and the other APP on the team, Carla Magno, RN, MSN, FNP-C, both see patients independently. They also work in collaboration with the two Hepatology faculty members, Dr. Kashif Khan and Dr. Sheharyar Merwat, and other specialties as needed. For cancers, especially, she says a multidisciplinary decision-making approach is key.
“When you live with cirrhosis, you are at a continued risk for cancer and should be screened every year. And when we diagnose it, sometimes the intervention is interventional radiology, sometimes it’s surgery, sometimes it’s transplant.
“All these decisions are made collaboratively, in a multidisciplinary approach like most of our tumor board discussions when it comes to GI tumors. We approach liver in the same way,” she says.
Boggs sees patients at the UTMB Health Gastroenterology Clinic at the UHC in Galveston. Magno sees patients at the Galveston and League City locations.
Learn more about liver disorders seen and treatment provided in the Division of Gastroenterology and Hepatology.
APP Corner is a monthly feature showcasing UTMB's Advanced Practice Providers.