Nonalcoholic Fatty Liver Disease

Implications for Clinical Practice and Health Promotion

Bethany Croke, FNP-BC; Deborah Sampson, FNP-BC

Disclosures

Journal for Nurse Practitioners. 2012;8(1):45-50. 

In This Article

Assessment

All patients who are obese should be assessed for NAFLD because early identification and intervention is key to stopping disease progression and limiting liver damage. The patient history should focus on risk factors and other potential causes of liver disease (Table 2). Personal and family history of NAFLD, type 2 diabetes, metabolic syndrome, and hypertriglyceridemia should be ascertained.

Because NAFLD is a diagnosis of exclusion, other causes of liver damage must be ruled out. Therefore, alcohol intake, risk factors for hepatitis B and C, autoimmune diseases, congenital causes, biliary tract disease, and exposure to toxins should be evaluated. A thorough review of patient medications is also necessary. Medications such as amiodarone, diltiazem, tamoxifen, tetracycline, valproate, methotrexate, and corticosteroids have all been linked to NAFLD. The use of highly-active antiretrovirals is of particular concern because of their tendency to cause severe insulin resistance and hyperlipidemia. Lastly, inquiries regarding weight loss efforts can also be insightful because rapid weight loss can cause both NAFLD and disease progression to NASH.

For the physical exam, the BMI should be measured and careful attention to subtle physical signs should be made, although it is unlikely that any will be found in the earliest stages of disease. If there is clinical suspicion, laboratory data will yield the most information; therefore ALT, AST, and alkaline phosphate levels and liver function tests should be ordered.[17]

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