The Curbsiders Internal Medicine Podcast REBOOT: #452 NAFLD/MASLD with Dr. Elliot Tapper
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Aug 4, 2025 Dr. Elliot Tapper, Chief of Hepatology at the University of Michigan, brings his expertise in liver disease to the table. He discusses the importance of understanding Non-Alcoholic Fatty Liver Disease (NAFLD) and introduces effective treatment strategies that include lifestyle changes and medications. The conversation highlights the significance of clear communication with patients about liver health and the complexities of diagnostic approaches. Dr. Tapper also shares innovative tools like AI medical scribes to enhance patient care.
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Interpreting Abnormal Liver Enzymes
- The most common cause of abnormal liver enzymes with fat in the liver is metabolic dysfunction-associated steatotic liver disease (MASLD).
- AST higher than ALT in a young person can signal chronic alcohol use or cirrhosis, raising concern.
Alcohol Use Assessment Tips
- Always ask detailed questions about the type and quantity of alcohol consumed and confirm with a phosphatidylethanol blood test.
- Tell patients beforehand to maintain trust and encourage honest alcohol disclosure.
Using FIB4 for Fibrosis Risk
- Use the FIB4 score to assess fibrosis risk in MASLD patients to guide prognosis and management.
- A FIB4 <1.3 means low fibrosis risk; >2.67 indicates higher risk needing further evaluation.