Fatty Liver Follow-up

  • Author: Dawn Sears, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jun 24, 2011
 

Further Outpatient Care

All patients with chronic liver disease should be tested for hepatitis A total antibodies and vaccinated if needed. Physicians should also consider testing for hepatitis B surface antibody and vaccinating in the appropriate clinical situation (ie, life expectancy, >20 y).

All patients with chronic liver disease are at risk of liver disease progression.

Patients should be educated to avoid alcohol and other hepatotoxic substances. If patients have a liver insult from another liver problem, they may have a longer recovery than a person without fatty liver disease.

Patients with fatty liver disease should be seen regularly by a primary care physician who may be able to detect disease progression through physical examination findings (eg, spider telangiectasia, palmar erythema, splenomegaly), laboratory findings (eg, decreasing platelets, elevated bilirubin, decreasing albumin), patient complaints (eg, encephalopathy, ascites, fatigue), or incidental imaging study findings (eg, cirrhotic liver, splenomegaly, varices, ascites).

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Deterrence/Prevention

Fatty liver disease can be prevented in the most patients by taking the following measures:

  • Eating appropriate portions
  • Eating healthy choices
  • Exercising regularly
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Complications

  • Steatohepatitis may progress to cirrhosis, with complications that include variceal bleeding, ascites, encephalopathy, and liver failure.
  • The rate of progression appears to be worse if more than one liver disease (eg, alcoholic liver disease, chronic viral hepatitis) is present. Also, the lack of control of diabetes and hypertriglyceridemia appears to predict worse fibrosis.[58, 59, 60, 61]
  • The rate of formation of hepatocellular carcinoma appears to be the same as with other forms of liver disease.[62]
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Prognosis

  • Steatosis may be reversible with weight loss and/or stopping alcohol use.
  • Of patients with steatohepatitis, 10% will progress to fibrosis and cirrhosis. This rate is the same as that of alcoholics progressing to cirrhosis.
  • Long-term natural history studies of patients with NAFLD who undergo repeat biopsies have shown that 30% progress, 30% remain stable, and 30% improve over a 3-year period without pharmacologic intervention.[63]
  • Abnormal glucose tolerance testing is an independent risk factor for progression of NASH.[64]
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Patient Education

  • For excellent patient education resources, visit eMedicine's Liver, Gallbladder, and Pancreas Center and Hepatitis Center. Also, see eMedicine's patient education article Cirrhosis.
  • The American Diabetes Association has excellent dietary and lifestyle advice for patients who would like to lose weight and to make better lifestyle choices.
  • Nutrition and lifestyle education are the mainstay of therapy. Ideally, during every health care provider encounter, the issues of food choices, food portions, and exercise, including weight-bearing exercise, should be emphasized and reviewed.
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Contributor Information and Disclosures
Author

Dawn Sears, MD  Associate Professor of Internal Medicine, Division of Gastroenterology and Hepatology, Scott and White Memorial Hospital

Dawn Sears, MD is a member of the following medical societies: American Association for the Study of Liver Diseases and American College of Gastroenterology

Disclosure: Nothing to disclose.

Specialty Editor Board

John Gunn Lee, MD  Director of Pancreaticobiliary Service, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, University of California at Irvine School of Medicine

John Gunn Lee, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Simmy Bank, MD  Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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