The Cardiology-Hepatology Axis-Fontan Associated Liver Disease

A 19-year-old male with past medical history of hypoplastic left heart syndrome s/p Fontan surgery 15 years ago is referred to be seen in hepatology clinic for screening for Fontan associated liver disease (FALD). Which of the following is the best clinical predictor of FALD?

Hepatology casts a wide NET

A 45-year-old female underwent colonoscopy for iron deficiency and chronic diarrhea with associated flushing and was found to have an erythematous region in her terminal ileum. Biopsies revealed a neuroendocrine tumor. She undergoes an abdominal MRI showing multiple hepatic lesions and a mass near the terminal ileum. She was referred to oncology and started on octreotide depot injections for symptom control. Liver biopsy confirmed metastatic well-differentiated neuroendocrine tumor with synaptophysin and chromogranin stains positive. An octreotide scan demonstrated multiple avid foci in the liver but no extrahepatic lesions. An echocardiogram showed normal LV and RV function without valvulopathies.  She now presents to Hepatology clinic for assessment.

What is the next best step?

Why do we use the model for end-stage liver disease (MELD) score?: Part 2

In Part 1 of this series, we reviewed what came BEFORE the MELD score—Child-Turcotte-Pugh classification. We additionally discussed the history behind MELD, what is included in its calculation and why, and how it is used in transplant listing. Is everyone excited for Part 2?