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Liver Disease

Ben Pineau, M.D., F.R.C.P.

Dr Pineau graduated Magna Cum Laude and received his Doctor of Medicine from the University of Ottawa, Ottawa Ontario. He completed his gastroenterology residency in Canada as well, before attending the University of Carolina in Charleston, South Carolina where he completed his fellowship in advanced endoscopy at Wake Forest University School of Medicine in Winston-Salem, North Carolina. Dr. Pineau served as the Associate Professor of Medicine at Wake Forest University while he also completed an additional year of specialized training in Interventional Endoscopy.

In 2004, Dr. Pineau opened his solo gastroenterology practice in the St. Augustine community, and joined Borland-Groover Clinic in 2008. Dr. Pineau is board certified in gastroenterology, and remains a fellow in the Royal College of Physician and Surgeons of Canada.


Your liver is a vital organ that is needed for the digestion and absorption of nutrients, for building important bodily proteins, as well as to help filter the blood of toxic substances. There are a variety of liver disease and condition types; liver conditions often present with no symptoms and can frequently be diagnosed by routine lab work during annual physical exams. Along with blood tests, imaging tests and liver tissue tests (biopsy) can also assist in diagnosing problems. However, some patients may present with symptoms that can include fatigue, right upper quadrant abdominal pain or itchy skin associated with a liver condition. When some of these conditions are more advanced, patients may present with Jaundice, a yellow discoloration of the skin and eyes.

One of the most common liver conditions is non-alcoholic fatty liver disease (NAFLD) that can progress to non-alcoholic steatohepatitis (NASH) and subsequently liver scarring and progressive loss of function (cirrhosis). The features of these conditions can be very difficult to distinguish from another common liver disorder, alcoholic fatty liver disease (AFLD). Chronic viral Hepatitis is also quite common, especially Hepatitis C, that many patients may have for a long time without their knowledge before it is diagnosed. Viral hepatitis A and B are less commonly seen in the United States.

Women are more likely to have primary biliary cirrhosis, an autoimmune disorder that is an irritation and swelling of the bile ducts inside the liver that eventually blocks the flow of bile. In general, autoimmune disorders are more common in women than men. Pregnant women can sometimes have pregnancy associated liver diseases such as cholestatis when the flow of bile from the liver slows or stops. While it doesn’t harm the mother, it can be dangerous to the fetus and close monitoring of mother and baby is necessary. Sometimes the baby requires an emergency delivery.

Treatment for liver disorders depends on the nature of the diagnosis. Medications such as interferon, ribavirin and protease inhibitors are used in combination triple therapy to treat Hepatitis C; it is an expensive treatment with many side effects. Currently, a wide range of research is underway to discover better treatment options for Hepatitis C. For non-alcoholic liver disease, the best treatment is often a change in such lifestyle choices such as nutrition and exercise. Autoimmune liver conditions are often treated with prednisone or immune suppressants.

Still, some patients with these conditions eventually need a liver transplant. If you suspect that you have a liver problem, the first step is to see your family practice provider. If a liver condition is discovered, then you will be referred to a gastroenterologist or a hepatologist.