My wife took an elastogram and it showed she had cirrhosis. It is a fismaying diagnosis to receive. She is also diabetic, but not particularly overweight. After reading this excellent presentation. I realize that her heart may become an issue as well. 🙁
Hi Michael, and sorry if this contributes to concerns. I hope the take home point is more that this condition is just one more indicator of metabolic issues that can be targeted all together with diet, exercise if possible, weight loss, avoiding alcohol, medications that address cardiovascular risk and perhaps diabetes medications that have also shown benefit with MASLD/MASH such as the GLP-1 medicines (like Mounjaro above). If she does not already have a hepatologist it would be good to get one on her team, and maybe an endocrinologist if her primary is not thinking about the liver issues and medication optimization. Heart stuff may become an issue for the majority of us at some point, so we do what we can... hang in :)
**full of appreciation** for your sharing information.
Question, that I am trying to phrase carefully: What results from a periodic blood test (CMP/CBC etc.) might alert a person that the liver might do with some closer examination...
Hi Cheryl, thanks for stopping in. In terms of routine labs, elevations in fasting glucose or HBA1c, high triglycerides or low HDL cholesterol, elevated liver enzymes like AST/ALT, and maybe elevated CRP inflammation levels would catch my eye. In terms of screening patients, overweight/obesity are the easiest factors to consider.
The American Gastroenterological Association thinks we should use that FIB-4 index calculator (to see who needs more attention and perhaps testing) for:
all patients with type 2 diabetes
all patients with two or more metabolic risk factors (central obesity, high triglycerides, hypertension, insulin resistance, abnormal HDL levels, or prediabetes)
My daughter was told she has fatty liver after an abdominal ultrasound preceding a surgery. She is a trim, muscular, marathon runner who mostly eats a Mediterranean diet and, in recent years, doesn’t drink. Like me she has low triglycerides and high natural HDL. Her surgeon, gynocologist, and primary doc were all shocked.
Hi Joan. Interesting, and I wonder if the ultrasound results could be independently checked by another radiologist?
Given this unusual presentation in a fit marathon runner with good lipids and diet, I would consider further investigation beyond just "fatty liver." Maybe comprehensive liver function tests, viral hepatitis screening, and testing for autoimmune and genetic liver conditions? The ultrasound finding may be a false positive or could be showing something else entirely, so an elastography (elastogram/FibroScan) would be helpful to confirm and quantify any liver changes. Any medications or supplements should be reviewed as some can affect the liver. Given the atypical presentation, a hepatology referral would be appropriate to ensure nothing is being missed. Just some thoughts!
I agree with the language change - "fatty" jumps out as a particularly non-clinical sounding adjective!
This is really great, and I appreciate the "watering down" but also the peek behind how primary care doctors are thinking, beyond the patient education material we can all read everywhere. Going to cut back on alcohol even more, and work on those extra pounds after 1/1/2025.
Thanks Cindy! I’m glad it was helpful… will make a resolution to keep these posts a bit shorter in the New Year, and hope your holidays are healthy, merry and bright, too :)
My wife took an elastogram and it showed she had cirrhosis. It is a fismaying diagnosis to receive. She is also diabetic, but not particularly overweight. After reading this excellent presentation. I realize that her heart may become an issue as well. 🙁
Hi Michael, and sorry if this contributes to concerns. I hope the take home point is more that this condition is just one more indicator of metabolic issues that can be targeted all together with diet, exercise if possible, weight loss, avoiding alcohol, medications that address cardiovascular risk and perhaps diabetes medications that have also shown benefit with MASLD/MASH such as the GLP-1 medicines (like Mounjaro above). If she does not already have a hepatologist it would be good to get one on her team, and maybe an endocrinologist if her primary is not thinking about the liver issues and medication optimization. Heart stuff may become an issue for the majority of us at some point, so we do what we can... hang in :)
**full of appreciation** for your sharing information.
Question, that I am trying to phrase carefully: What results from a periodic blood test (CMP/CBC etc.) might alert a person that the liver might do with some closer examination...
Hi Cheryl, thanks for stopping in. In terms of routine labs, elevations in fasting glucose or HBA1c, high triglycerides or low HDL cholesterol, elevated liver enzymes like AST/ALT, and maybe elevated CRP inflammation levels would catch my eye. In terms of screening patients, overweight/obesity are the easiest factors to consider.
The American Gastroenterological Association thinks we should use that FIB-4 index calculator (to see who needs more attention and perhaps testing) for:
all patients with type 2 diabetes
all patients with two or more metabolic risk factors (central obesity, high triglycerides, hypertension, insulin resistance, abnormal HDL levels, or prediabetes)
all patients with elevated liver enzymes
My daughter was told she has fatty liver after an abdominal ultrasound preceding a surgery. She is a trim, muscular, marathon runner who mostly eats a Mediterranean diet and, in recent years, doesn’t drink. Like me she has low triglycerides and high natural HDL. Her surgeon, gynocologist, and primary doc were all shocked.
Hi Joan. Interesting, and I wonder if the ultrasound results could be independently checked by another radiologist?
Given this unusual presentation in a fit marathon runner with good lipids and diet, I would consider further investigation beyond just "fatty liver." Maybe comprehensive liver function tests, viral hepatitis screening, and testing for autoimmune and genetic liver conditions? The ultrasound finding may be a false positive or could be showing something else entirely, so an elastography (elastogram/FibroScan) would be helpful to confirm and quantify any liver changes. Any medications or supplements should be reviewed as some can affect the liver. Given the atypical presentation, a hepatology referral would be appropriate to ensure nothing is being missed. Just some thoughts!
Thank you! That is very helpful. I know they ran a full liver screen and found no abnormalities.
I agree with the language change - "fatty" jumps out as a particularly non-clinical sounding adjective!
This is really great, and I appreciate the "watering down" but also the peek behind how primary care doctors are thinking, beyond the patient education material we can all read everywhere. Going to cut back on alcohol even more, and work on those extra pounds after 1/1/2025.
Thank you for this excellent presentation and discussion of MASLD and MASH. Have a very Merry Christmas and Happy and Healthy New Year!
Thanks Cindy! I’m glad it was helpful… will make a resolution to keep these posts a bit shorter in the New Year, and hope your holidays are healthy, merry and bright, too :)