Fatty Liver

FATTY LIVER 1.

CHIEF COMPLAINT a. Fatty liver

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HPI

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ROS

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SYMPTOMS a. Persistent fatigue b. Malaise c. Upper abdominal discomfort d. Ascites e. Edema f. Jaundice

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HISTORY a. FAMILY HISTORY •Obesity •Diabetes b. SOCIAL HISTORY •Alcohol c. PAST MEDICAL HISTORY •Overnutrition •Severe malnutrition •Total parenteral nutrition •Starvation diet d. SURGICAL HISTORY e. CHRONIC CONDITIONS •Metabolic syndrome •Type II diabetes •Obesity •Hypertriglyceridemia •Alcohol •Galactosemia •Glycogen storage diseases •Homocystinuria •Tyrosemia •Celiac sprue •Wilson disease

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ALLERGIES

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PHYSICAL EXAMINATION •Hepatomegaly •Splenomegaly •Ascites •Edema •Spider angiomas •Varices •Gynecomastia •Menstrual disorders •Skeletal muscle wasting •Cardiomyopathy •Pancreatitis •Peripheral neuropathy

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SPECIFIC DATA LIKE GRADING ETC

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TESTS TO BE ORDERED •CBP •Liver function tests •Aminotransferases levels •Alkaline phosphatase •Lipid profile •Iron studies •Viral serological markers •ANA •Anti–smooth muscle antibody (ASMA) •Serum protein electrophoresis (SPEP) •Anti–liver-kidney antibody •Fasting insulin and glucose levels •Ultrasound •CT scan •MRI •Liver biopsy

10. ASSESSMENT /PLAN Medical Care •Abstinence from alcohol may reverse steatosis in patients with alcohol-related fatty liver.

•Weight loss and control of comorbidities appear to slow the disease and to possibly reverse some of the steatosis and fibrosis. Dieting •Diets associated with improvement include those restricted in rapidly absorbed carbohydrates and those with a high protein-tocalorie ratio. •Weight loss should be gradual, moderate, and controlled. •Exercise added to diet appears to improve results and to increase insulin sensitivity by increasing muscle mass. Surgical Care •Bariatric surgery •Roux-en-Y gastric bypass 11. EDUCATION •Abstinence from alcohol •A low-fat diet is recommended. •A weight loss goal of 1-2 pounds per week is recommended. •Exercise that includes both cardiovascular fitness and weight training should improve NASH. •Cardiovascular fitness often results in weight loss. •Weight training will increase muscle mass and improve insulin sensitivity. •Both of these activities together help relieve the underlying derangements of NASH. 12. MEDICATION •Thiazolidinediones •Rosiglitazone •Atorvastatin •Gemfibrozil •Orlistat •Vitamin E •Ursodeoxycholic acid 13. FOLLOW-UP