Online Health Chat with Bobby Zervos, DO

Tuesday, September 15, 2015


Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. The liver helps fight infections and cleans your blood. It also helps digest food and stores energy for when you need it. A healthy liver has the amazing ability to grow back, or regenerate, when it is damaged. Anything that keeps your liver from doing its job – or from growing back after injury – may put your life in danger.

There are many different types of liver disease. But no matter what type you have, the damage to your liver is likely to progress in a similar way. Whether your liver is infected with a virus, injured by chemicals, or under attack from your own immune system, the basic danger is the same – that your liver will become so damaged that it can no longer work to keep you alive.

Factors that may increase your risk of liver disease include:

  • Heavy alcohol use
  • Injecting drugs using shared needles
  • Tattoos or body piercings
  • Blood transfusion before 1992
  • Exposure to other people's blood and body fluids
  • Unprotected sex
  • Exposure to certain chemicals or toxins
  • Diabetes
  • Obesity
  • High levels of triglycerides in your blood

Complications of liver disease vary, depending on the cause of your liver problems. Untreated liver disease may progress to liver failure, a life-threatening condition that necessitates the need for liver transplantation.

Cleveland Clinic’s multidisciplinary team of experts provides the highest quality of care for patients and their families facing transplantation. Hepatologists collaborate closely with surgeons to evaluate patients’ treatment options, including transplantation candidacy. Cleveland Clinic Florida’s transplant physicians are board certified and recognized research leaders.

About the Speaker

Bobby Zervos, DO is a transplant hepatologist in the Department of Gastroenterology at Cleveland Clinic Florida. He is board-certified in internal medicine, gastroenterology and transplant hepatology. Dr. Zervos specializes in the diagnosis and treatment of liver disease, including liver transplantation. His specialty interests include cirrhosis, hepatic encephalopathy, ascites, Hepatitis B & C, hepatocellular carcinoma, Alpha-1-Antitrypsin, cholangiocarcinoma, drug hepatitis, fatty liver disease, nonalcoholic steatohepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, carcinoid, autoimmune hepatitis, portal hypertension and Budd-Chiari syndrome.

Let’s Chat About Management of Liver Disease

Welcome to our Online Health Chat "Management of Liver Disease" with Bobby Zervos, DO. We are thrilled to have him here today for this chat. Let’s begin with the questions.

Fatty & Alcoholic Liver Diseases

JoyD: What is fatty liver disease and does it lead to more serious conditions?

Bobby_Zervos,_DO: Fatty liver disease may lead to chronic liver disease through hepatitis caused by the actual presence of the fat in the liver. Over time this can lead to cirrhosis, which is quickly becoming the number one cause in the United States for chronic liver disease.

JoyD: What is fatty liver disease? Does this lead to permanent reduction of liver function? Is there any options to reverse damage?

Bobby_Zervos,_DO: It is quickly becoming the number cause of chronic liver disease in the Unites States. It is fat deposited within the liver that causes a "fatty hepatitis" leading to chronic inflammation and over many years to cirrhosis. If detected early, life style modfication with diet and exercise are the most effective way to combat this disease.

zoraida67: I would like to know what your clinic can offer for me. I have liver fibrosis. At first I was told it was nash after I was told I had alfa 1. Had three biopsies and have incomplete cirrhosis.

Bobby_Zervos,_DO: We would be happy to see you. Please make an appointment. We would like to see you liver biopsy slides for ourselves to determine if you have NASH of A-1-A. Thank you.

zoraida67: I am 66 years old with a history of mild elevated enzymes since 1999. I had three liver biopsies done. I have been in a clinical trial, but I pulled out of it. Are there any new things for alfa1 or fatty liver that is close to causing cirrhosis? I had been told both nash and alfa 1.

Bobby_Zervos,_DO: We would like to review you liver biopsy slides as NASH and A-1-A are very different from one another. Call our office 954.659.5133.

LionsDen10: Are there complications associated with alcoholic liver disease?

Bobby_Zervos,_DO: Yes. Acute alcoholic hepatitis and cirrhosis of the liver.

Liver Cancer

denise8000: My father has recently been diagnosed with liver cancer. Are there non-surgical treatment options such as chemotherapy or radiation? How effective are those?

Bobby_Zervos,_DO: Liver cancer treatment and options are dependent on the size, location and number of cancer within the liver. Can you provide more detail about the cancer as there are many more options based off of what I mentioned above?

denise8000: He was diagnosed with hepatocellular carcinoma...don't know much about this type of cancer and wondering what his options are going forward.

Bobby_Zervos,_DO: Have him see a liver specialist as there are potentially many options depending on the three factors I mentioned. The sooner he sees someone with knowledge of what to do the more likely of a good outcome.

Heart Disease & Liver Function

govols123: I'm a 54-year-old male who underwent isolated tricuspid repair surgery in November of 2014 at Cleveland Clinic Florida. I've always had normal liver enzymes until last year when they became mildly elevated (alt, ast, ggt). ALP also became elevated later in 2014. The enzyme warning lead to a diagnosis of severe tricuspid regurgitation (four doctors missed my diagnosis, but I knew the elevations weren't right and kept digging until I was able to determine why enzymes were up). I'm doing pretty good post-op and all enzymes are back in normal range. I have had a slight reduction in the left ventricle ejection fraction (LVEF) recently but cardiologist is not too concerned and believes it will normalize. Only the ast enzyme was a point or two high on recent blood work and it has typ. been on the high side of normal range anyway. Had a couple of questions:
1. What enzymes typically get out of range if there is significant reductions in LVEF?
2. What is an average AST & ALT value for males my age?

Bobby_Zervos,_DO: Right sided heart failure is usually associated with elevation of liver function tests (LFTs) thus your LVEF would have to be significantly reduced to cause an impact/elevation in LFTs. There may be another process contributing to the rise. If they rise again, I recommend a visit with a GI/hepatologist. AST/ALT should be on average less than 35, depending on the lab used.

Lifestyle and Diet

Jules4774: If someone with cirrhosis of the liver stops drinking, is the damage done reversible?

Bobby_Zervos,_DO: It is never too late to stop drinking as the liver regenerates itself. However, there is always a limit to the ability based off of the severity and extent of damage caused that the liver is able to overcome.

PaulB1951: My wife is diabetic and has recently been diagnosed with fatty liver, she doesn't drink and is already on a strict diet. Do you have any suggestions on what she should be eating to reduce her levels?

Bobby_Zervos,_DO: Controlling her diabetes with HbA1c levels less than 6.5 are very important. In addition, cardio-vascular exercise 3-4 times a week for 30-45 minutes at a time and weight control.

Pieinthesky: What lifestyle changes should a person diagnosed with cirrhosis of the liver make?

Bobby_Zervos,_DO: The cause of the cirrhosis is important to know and what symptoms from the cirrhosis you are having. No alcohol is very important.

IleanaCL2: I’ve heard people say drinking a glass of wine a day is good for the heart, but then I hear it is bad for the liver to drink daily. Which one should I believe?

Bobby_Zervos,_DO: Everything in moderation is important. Anything excessive is not good for you. If you have liver disease, then you should not drink any alcohol.


Barney07: Is obeticholic acid available yet?

Bobby_Zervos,_DO: It is under review by the FDA for approval.

Barney07: Ursodiol has gone up in price this past year and is very expensive. I was told it is because it comes from another country. Do we have any plans to make it cheaper here in USA?

Bobby_Zervos,_DO: This is an unfortunate case of supply and demand causing the price to go way up.

Harley0056: Are there certain medications that should be avoided if you are diagnosed with Hepatitis C?

Bobby_Zervos,_DO: All medications, prescribed or over the counter, have the potential for side effects and should be reviewed with your physician before taking them.

CarlosG8074: What type of pain medications are okay to take if you've been diagnosed with cirrhosis of the liver? Is aspirin or ibuprofen okay?

Bobby_Zervos,_DO: Tylenol 500 mg one tablet every six hours is safe for your liver, if needed for more than one day, you should call your liver doctor. Ibuprofen is not safe with liver disease due to risk of bleeding and kidney failure.

Barney07: Any new findings or treatments for Primary Biliary Cirrhosis?

Bobby_Zervos,_DO: Obeticholic acid has recently been studied with promising results for PBC.

Barney07: Can you give info on primary biliary cirrhosis and what problems or symptoms to watch for as well as how long a person can live with this problem. Is Ursodiol the best drug option? What other drugs are available to treat this? Is the medicine primarily to keep the bile duct open? How heredity plays a role. Should sisters, brothers, and children be checked for this disease, and if so what labs should be used to detect this? Thank you so much!

Bobby_Zervos,_DO: PBC early on manifests with fatigue. The disease mechanism is not fully understood but thought to be a defect in a transport protein between the liver cells and the bile ducts. The disease process itself evolves over 20-30 years and Ursodiol is currently the main medication used to slow the process down. Obeticholic acid is a new medication recently studied with promising results and hopefully to be available on the market soon.

Liver Transplant

NYCNative45: My brother-in-law has been told he has end-stage hepatitis C. What does this mean? What are his treatment options now?

Bobby_Zervos,_DO: He should see a liver specialist as "end stage" has different meanings on the clinical context and really depends on his MELD score and overall physical condition. He may qualify for liver transplant.

CandyCane10: Are there specific liver diseases that are treated by having an organ transplant? If so, which types of liver disease are these?

Bobby_Zervos,_DO: The disease list for indication for liver transplant is too long to list, please be more specific.

CandyCane10: For example Hepatitis C and Liver cancers? Are these both treated by getting a transplant?

Bobby_Zervos,_DO: Both can be treated with liver transplanted. Liver cancer has strict guidelines to size, number and location within the liver.

Mikewitt: What are the different stages of cirrhosis of the liver? At what stage is someone considered for a liver transplant? Are other treatments used in earlier or later stages?

Bobby_Zervos,_DO: Cirrhosis is considered to be stage 4/4 fibrosis. Individuals can either have compensated or decompensated cirrhosis where the liver is able to maintain day to day synthetic function and the person can live a normal life, or the person has daily struggles with quality of life where we would use the MELD score to help gauge the degree of liver dysfunction and need for liver transplant.

For Appointments

To make an appointment with Bobby Zervos, DO, Transplant Hepatologist or any of the other specialists in the Department of Gastroenterology at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at

For More Information

On Cleveland Clinic Florida

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