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Initial evaluation of nonalcoholic fatty liver disease includes excluding other possible causes of hepatic steatosis such as alcohol or hepatotoxic medication use. Noninvasive tests such as a clinical decision aid or elastography can be used to determine the likelihood of fibrosis and guide further evaluation. Weight loss through diet and exercise is the primary treatment. Comorbidities should also be managed.
Jan 1, 2020 Issue
Branched-chain Amino Acids for Patients with Hepatic Encephalopathy [Medicine by the Numbers]
Hepatic encephalopathy is a brain dysfunction that can be mild with minimal confusion, or overt and severe with coma. Learn more about branched-chain amino acids for the treatment of hepatic encephalopathy.
Cirrhosis is the 12th leading cause of death in the United States. New research shows that in early stages, it may be reversible. The most common causes are viral hepatitis, alcoholic liver disease, and nonalcoholic steatohepatitis. Most patients are asymptomatic until decompensation onset; evaluation should begin when symptoms appear. Noninvasive tests are most useful in identifying patients. Management includes counseling, laboratory testing, and ultrasound monitoring.
Feb 15, 2019 Issue
Metformin for Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis [FPIN's Clinical Inquiries]
Metformin does not seem to be an effective treatment for nonalcoholic steatohepatitis. There are no studies evaluating whether metformin improves long-term patient-oriented outcomes such as progression from NAFLD to nonalcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma, or death from liver failure.
Mild, asymptomatic elevations in transaminase levels are common in primary care. Nonalcoholic fatty liver disease is the most common cause and is often benign and treated with lifestyle modification. Learn about this and other less common causes of transaminase elevations.
NAFLD is defined as hepatic steatosis on imaging or histology in the absence of other etiologies for secondary fat accumulation. It is usually identified during the evaluation of elevated transaminase levels in a patient without heavy alcohol intake, or found incidentally on imaging studies.
May 1, 2017 Issue
Antibiotic Prophylaxis in Patients with Cirrhosis and Upper Gastrointestinal Bleeding [FPIN's Help Desk Answers]
Antibiotics should be used for prophylaxis in hospitalized patients with cirrhosis and upper gastrointestinal bleeding. Prophylaxis reduces all-cause mortality by 21%, as well as bacterial infections and rebleeding.
Jaundice can indicate significant underlying disease. Review key components of the history, physical examination, laboratory evaluation, and imaging tests to determine the cause.
Nonalcoholic fatty liver disease is characterized by excessive fat accumulation in the liver (hepatic steatosis). Nonalcoholic steatohepatitis is characterized by steatosis, liver cell injury, and inflammation. The mechanism of nonalcoholic fatty liver disease is unknown but involves the development...
Hereditary hemochromatosis is an autosomal recessive disorder that disrupts the body’s regulation of iron. It is the most common genetic disease in whites. Men have a 24-fold increased rate of iron-overload disease compared with women. Persons who are homozygous for the HFE gene mutation C282Y compr...