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Saturday, September 29, 2012

7:30 AM Registration and Breakfast
8:00 Welcome and Introductions
8:05 Acute on Chronic Liver Failure: Defining ACLF as a Unique Clinical Entity, Patrick Kamath, MD

Learning Objectives: The audience will be introduced to the concept of acute on chronic liver failure and, in particular, how this differs from decompensated cirrhosis. The audience will understand the rationale for establishing this entity in the vernacular of the medical community. Finally, the audience will be introduced to the potential clinical implications of this distinct disease entity.

8:50 Understanding Root Cause: Pathogenesis of Hepatic Fibrosis and Portal Hypertension, David Brenner, MD

Learning Objectives: The audience will gain a basic understanding of the pathogenesis of hepatic fibrosis as it relates to various etiologies of chronic liver disease, including hepatitis C and NASH. The audience will able to apply knowledge gained from this presentation in understanding therapeutic options for management of complications of portal hypertension discussed later in the program.

9:10 Epidemiology of Cirrhosis in the US, Rohit Loomba, MD, MHSc

Learning Objectives: The audience will gain an understanding of the current burden of cirrhosis in the United States as well as insight into projected disease burden based on prevalence and natural history of chronic liver disease in the US. The impact of treatment rates and treatment efficacy of chronic HCV on projected incidence of cirrhosis in the US will be discussed given the emergence of new, promising antiviral therapies.

9:30 Panel Discussion
9:45 Break
10:00 Viral Hepatitis, Cirrhosis and Liver Cancer: Strategies for Prevention and Control, Anthony Martinez, MD

Learning Objectives: The audience will review pertinent findings from the 2010 Institute of Medicine report. In particular, the lack of awareness among health care providers, at-risk populations, and the public remain a major problem in the US. The IOM proposes that improved surveillance and better integration of viral hepatitis services are needed. The audience will leave with strategies specific to their role in patient care that may help to address this need.

10:20 Optimizing Diagnostic Yield by Informed Selection of Imaging Techniques in Patients with Liver Disease, Cynthia Santillan, MD

Learning Objectives: The audience will gain an understanding of the inherent strengths and weaknesses of various imaging modalities in patients with cirrhosis. They will be able to use guidelines provided to optimize diagnostic yield from radiographic studies within their practice.

Management of Patients with Compensated Cirrhosis
10:40 Hepatocellular Carcinoma Screening: Who, How and How Often, Yuko Kono, MD, PHD

Learning Objectives: The audience will have an opportunity to review current screening guidelines and understand the context in which these guidelines were created. Relative risk for hepatocellular cancer in different disease states such as viral hepatitis and nonalcoholic fatty liver disease will be reviewed. The audience will learn how to use available data to determine a screening protocol based on the patient characteristics and liver imaging techniques specific to their institution or practice.

11:00 Management of Viral Hepatitis in Cirrhosis, Paul Pockros, MD

Learning Objectives: The audience will understand the rationale for viral eradication in patients with compensated cirrhosis as well as the limitations in reaching this endpoint based on currently available therapies. The audience will also have an opportunity to hear about emergent treatments for chronic hepatitis C and how these may expand the pool of patients eligible for therapy.

11:45 Surgery in the Patient with Cirrhosis: Understanding and Mitigating Risk, Kristin Mekeel, MD

Learning Objectives: The audience will learn various means of estimating risks associated with undergoing surgery for patients with underlying cirrhosis. They will understand how different patient characteristics and type of surgery interact to predict outcomes. Finally, the audience will understand how optimization of patient care before, during, and after surgery may impact patient outcomes.

12:00 PM Panel Discussion
12:30

LUNCHEON AND SPECIAL LECTURE

Challenges in Hepatitis B Management: An Interactive Case Discussion, Heather Patton, MD and Robert Gish, MD

Management of Patients with Decompensated Cirrhosis
1:30 Hepatic Encephalopathy, Jasmohan Bajaj, MD

Learning Objectives: The audience will understand how both covert and overt hepatic encephalopathy may impact quality of life, healthcare expenditures, and patient outcomes. They will also leave with an understanding of the available tools for assessment of HE severity and optimal medical management.

2:10 Endoscopic Assessment and Management of Portal Hypertensive Bleeding, Syed Fehmi, MD

Learning Objectives: The audience will understand the risk of portal hypertensive bleeding as it relates to the natural history of cirrhosis. Current evidenced-based guidelines for surveillance and management will be reviewed. The audience will also understand alternative options for difficult to manage cases and guidelines regarding when these cases may be appropriate for referral to a tertiary care center.

2:30 Ascites, Hyponatremia and Spontaneous Bacterial Peritonitis, Michel Mendler, MD

Learning Objectives: The audience will understand that ascites formation is one of the earliest complications of cirrhosis, how development of ascites impacts survival, and current options for medical management. The audience will gain appreciation for the significance of development of hyponatremia in patients with cirrhosis and ascites, review means of management, and understand how this variable could be incorporated into current organ allocation systems. Finally, the audience will learn the importance of prompt diagnosis and treatment of peritonitis, shifting trends in organisms causing SBP, and identification of patients eligible for prophylaxis against this complication.

2:50 Panel Discussion
3:10 Break
3:30 Extrahepatic Manifestation of Cirrhosis, Michael Fallon, MD

Learning Objectives: The audience will review the common extrahepatic manifestations of cirrhosis with special emphasis on the pulmonary complications of advanced liver disease. The audience will gain an understanding of the early indicators of these pulmonary complications specific to patients with cirrhosis and how early recognition and management may impact transplant outcomes.

4:15 Interventional Radiology Management Options for Portal Hypertensive Complications, Hamed Aryafar, MD

Learning Objectives: The audience will gain an up-to-date review of data for the role and timing of tranajugular intrahepatic portosystemic shunt (TIPS) as well as a review of long-term outcomes and patency with newer coated stents. The audience will also learn about new techniques to assist in placement of TIPS in patients with thrombus or difficult anatomy. Finally, the audience will learn about alternative techniques for management of bleeding gastric varices.

4:35 Coagulopathy in Cirrhosis and Associated Vascular Complications, Robert Gish, MD

Learning Objectives: The audience will gain understanding of the complexity of pro- and anti-coagulation defects that occur in cirrhosis. Based on this complexity, they will also become familiar with techniques for accurately assessing risk for bleeding and thombosis such as the thromboelastogram. Finally the audience will understand the incidence, prevalence, and significance of vascular thromboses in patients with cirrhosis.

5:00 Panel Discussion
5:30 PM Welcome Reception

 

Sunday, September 30, 2012

7:30 AM Breakfast
Management of Patients with Decompensated Cirrhosis (Continued)
8:00 Acute Kidney Injury in Cirrhosis, Ravindra Mehta, MD

Learning Objectives: The audience will review the most common and serious causes of acute kidney injury in patients with decompensated cirrhosis. They will learn the most common triggers for AKI in this population and how this translates to early recognition and management of this complication. Finally, the audience will understand the current data for optimal medical management as well as the cases in which early institution of renal replacement therapy may be indicated.

8:30 Infectious Complications in Patients with Cirrhosis, Sanjay Mehta, MD

Learning Objectives: The audience will understand to recognize the increased propensity to infectious complications in patients with cirrhosis and how infectious complications may trigger a cascade of events that results in multi-organ failure. The audience will learn the most common and serious infectious complications in cirrhotics and optimal means for early recognition and management.

8:50 Cirrhotic Cardiomyopathy, Jorge Silva Enciso, MD

Learning Objectives: The audience will become familiar with the increasingly recognized entity of cirrhotic cardiomyopathy, current hypotheses regarding its pathogenesis, means of establishing diagnosis, and impact on patient outcomes.

9:10 Panel Discussion
9:30 Break
9:50 Bioartificial Liver Devices: Where Does the Technology Stand in 2012, Heather Patton, MD

Learning objectives: The audience will review the type of devices studied to support liver function and results of trials using these devices for specific indications. The audience will gain an understanding of the potential role such support devices may provide in clinical care in the future and latest developments in this technology.

10:10 Estimation of Prognosis and Need for Transplant Evaluation, Alexander Kuo, MD

Learning Objectives: The audience will appreciate the importance of recognizing appropriate timing for transplant referral in achieving optimal patient outcomes. They will also have an understanding of the available techniques to estimate prognosis in this patient population.

Acute or Chronic Liver Failure
10:30 Palliative Care in Cirrhosis, Julia Cain, NP

Learning Objectives: The audience will appreciate the important but difficult balance of planning for end of life while awaiting transplant due to the significant shortage of organs available. This will include a discussion of recognizing when patients have become too sick to safely undergo transplant surgery and the difficult task of redirecting goals of care in these circumstances. Finally, the audience will appreciate the complementary roles that hepatology and palliative care specialists can play in care of patients with decompensated cirrhosis.

10:50 Panel Discussion
11:15 am Final Adjournment

 

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