Janice is a 45yo Caucasian female with symptoms of Non-Alcoholic Fatty Liver Disease. Her BMI is 40 and she was diagnosed with DM type 2 3 years ago. Her last HgbA1c was 7.4. She lives a sedentary lifestyle. She stated she has significant fatigue but is otherwise asymptomatic. What diagnostics would you order for Janice? Why? What treatment plan would you recommend for her? What is her prognosis?
Fatty liver disease means that you have fat inside your liver that can, over time, affect liver function and cause liver injury. Fatty liver disease is divided into two types. If you just have fat but no damage to your liver, the disease is called nonalcoholic fatty liver disease (NAFLD). If you have fat in your liver plus signs of inflammation and liver cell damage, the disease is called nonalcoholic steatohepatitis (NASH). The patient will need a thorough health history completed before starting the diagnostics testing. According to Chaney, a complete history should be obtained in the patient who has liver disease when NAFLD is suspected. (Amanda Chaney, 2015)This includes determining present symptoms, lifestyle, dietary habits, and social history. Next, it is important to complete a physical examination including vitals, body mass index, height, weight, blood pressure and waist circumference. The necessary labs for determining if the patient has NAFLD includes total protein, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, albumin, total bilirubin, hepatitis B surface antigen, hepatitis C antibody, ferritin, iron, fasting blood glucose, hemoglobin A1C, lipid panel, and low-density lipoprotein cholesterol, prothrombin time, and insulin levels. (Amanda Chaney, 2015) The next step is to order imaging studies which consist of ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). All the diagnostics will be helpful in determining if liver biopsy is necessary. According to the article, liver biopsy is the gold standard for determining if NAFLD is present and for staging severity of disease. Since this is possibly a new diagnosis, the recommendation for treatment is lifestyle modification. According to the article, initial treatment should include lifestyle changes, such as increased physical activity, a low cholesterol/low-fat diet, decreased caloric consumption, avoidance of trans fats, and weight loss. The prognosis of the patient would be based on compliance with the treatment plan.
