Chapters Transcript What's new in family medicine Hi and welcome to the what's new in Family Medicine Mayo clinic cmi Online course for 2021. We're thrilled to be here today. Talking to you about the fatty elephant in the room will be going over a primer on non alcoholic fatty liver disease. I'm bob jet ski and here with my colleague Aaron Westfall. We are both faculty at the Mankato Family Medicine residency program. Mhm. As a matter of housekeeping, we've got our disclosures. We have no financial disclosures. Uh Also as far as off label use goes, there is currently no FDA approved treatments for medications for use and non alcoholic fatty liver disease and therefore we will not be recommending any medications for treatment of non alcoholic fatty liver disease. Also, as another disclosure will only be discussing non alcoholic fatty liver disease in adults and we will not be touching on pediatric patients. So, over the course of this lecture, we hope to share some information with you and our objectives include helping you to understand the scope of the problem, identifying risk factors and screening recommendations for non alcoholic fatty liver disease. Hopefully you'll have an outline of the initial evaluation of suspected non alcoholic fatty liver disease and then will give you a game plan to formulate management plan in primary care for non a non alcoholic fatty liver disease or N. A. F. L. D. Hello, I'm ERin Westfall and we'll first start by defining N. A. F. L. D. To determine that someone has NFLD. You first have to have evidence of hepatic stenosis. Either on imaging or via histology. You have to rule out significant alcohol consumption and there really is not an international consensus for amount of alcohol consumption. But the american association of the study of the liver recommends defining Excess alcohol consumption is greater than 21 standard drinks per week in men and greater than 14 standard drinks per week in women. You also need to rule out secondary causes of hepatic stenosis. NFLD essentially is the definition for fat identified within the liver. It is separated into non alcoholic fatty liver and non alcoholic stata. Hepatitis NFL is the more indolent course. That is when you see 5% or greater hepatic stenosis in the liver but there is no hepatic cellular injury or fibrosis. Nash has 5% or greater hepatic stato sis but you now see him paddy cellular injury and inflammation. Nash can be with or without fibrosis. And fibrosis is the most important predictor of long term outcomes. I'll now cover the scope of the problem and the importance of talking about this issue with you. So this data comes from a meta analysis in hepatology on the global burden of NFLD and uh N. N. F. L. D. Is the most common form of liver disease in the U. S affecting up to 30% of the adult population. It is Reported prevalence rates around the world of 10 to 30 and rates in developed countries including the United States, european countries and asian countries were all found to have similar prevalence of this disease. It is currently the second leading indication for liver transplantation in THE US. According to a systematic review in Jama, there uh is around 75-100 million people in the United States are estimated to have N. F. L. D. And Study that modeled medical costs, estimated direct medical costs to be at around $103 billion dollars per year. Uh huh for non alcoholic fatty liver disease, the study in The Journal of Gastroenterology, which collected data from the United Network for organ sharing and organ procurement. Published Created by
