The Curbsiders Internal Medicine Podcast #452 MASLD aka NAFLD aka Fatty Liver aka Hepatic Steatosis with Dr. Elliot Tapper
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Sep 9, 2024 Dr. Elliot Tapper, Chief of Hepatology at the University of Michigan, dives deep into Non-Alcoholic Fatty Liver Disease (NAFLD), offering insights on its complexities and management. He discusses the importance of lifestyle modifications and introduces innovative medications like GLP-1 agonists. The conversation also touches on diagnostic tools such as the Fib4 Score and the vital role of effective communication with patients. With a mix of medical knowledge and relatable anecdotes, Dr. Tapper sheds light on liver health in a lively manner.
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Evaluating Abnormal Liver Enzymes
- Consider metabolic dysfunction, alcohol, and viral hepatitis when evaluating abnormal liver enzymes.
- Pay attention to the AST/ALT ratio, as a higher AST suggests chronic alcohol use or cirrhosis.
Prognosis in MASLD
- Prognosis in MASLD depends more on fibrosis burden than the presence of fat or inflammation.
- Assess fibrosis risk using tests like FIB-4 and elastography to predict long-term outcomes.
Ordering a PETH Test
- Always order a phosphatidylethanol (PETH) test to assess alcohol use, even if the patient denies drinking.
- Counsel the patient about the test's purpose beforehand to maintain trust and transparency.