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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...
The evaluation of patients with elevated transaminase levels should be individualized based on the presence of symptoms or physical examination findings that suggest serious disease or hepatic decompensation.
Sep 1, 2012 Issue
Weight Loss for Patients with Nonalcoholic Fatty Liver Disease [Cochrane for Clinicians]
There are insufficient high-quality studies to determine patient-oriented outcomes of weight loss for the treatment of fatty liver disease. Nonetheless, weight loss remains a reasonable goal because it may reduce liver inflammation and improve comorbidities. In two of the studies reviewed, liver enz...
Cirrhosis is the 12th leading cause of death in the United States. It accounted for 29,165 deaths in 2007, with a mortality rate of 9.7 per 100,000 persons. Alcohol abuse and viral hepatitis are the most common causes of cirrhosis, although nonalcoholic fatty liver disease is emerging as an increasi...