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Fatty Liver

Neda Frayha, MD and Aisha Lofters, MD
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14:31
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No me gusta!

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One of our listeners wrote in asking about updates in fatty liver, so Aisha and Neda discuss this common primary condition in the introduction to our June 2019 episode.

 

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Stephen P. -

Given the prevalence of nafld and the potential for progression, I am concerned about monitoring patients with known or presumed nafld. My local expert hepatologist is not impressed by serum markers for progression in NAFLD. He suggested annual shea wave elastography ultrasounds to evaluate for fibrosis. If the fibrosis gets to higher levels, then he suggests that patient be seen by hepatology. Would be interested in colleague's perspectives on monitoring for progression. Thank you for this important update.

Neda F., MD -

Hi Stephen. What a great question. Based on the literature, it seems that shear wave elastography US has potential as a monitoring tool but is not yet part of the guidelines. It is being studied currently in clinical trials and has some fans and some detractors when you look at the literature as a whole. It should be interesting to follow this topic and see what we learn in the months/years ahead. Here are two articles I found that offer some helpful information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112406/ and https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.28504. -- Neda

Anastasia P. -

Just to follow-up on Stephen's question. I've reviewed both articles above, but still am a bit unclear what's the best way to monitor these patients? Annual BW/Ultrasound or fibroscan? Thank you - this is a great topic and I'm glad you covered it!

Neda F., MD -

Thanks, Anastasia. There is no clear answer here, unfortunately. All the articles I’ve read point to a need for clearer guidelines and greater consistency on this issue. Some recommend BW/US every 3-4 years depending on the risk of fibrosis in patients with biopsy proven NASH; others talk about elastography every two years; others say no routine monitoring is needed if the patient doesn’t have biopsy proven NASH. There is a lot of practice variation here, and no clear answer yet.

Julia S. -

Hi
Regarding canabis and breastfeeding, I have had some patient choose to formula feed instead of breasfeeding because of their canabis use. In a patient that decides not to modify their canabis use, my thoughts are that there are still advantages to breasfeeding if the mother wishes this, but I can’t find data to support or refute this.
Is there anything out there? Expert opinions?

Neda F., MD -

Hi Julia. Thanks for your question. We did a segment on cannabis in pregnancy and breastfeeding in June 2019 with Dr. Erin Lurie. Some notes from that segment are pasted below. If you're able to find any other resources that are more encouraging of breastfeeding while using cannabis, please share them with us - we'd love to read them.

What about cannabis when breastfeeding?

Discouraged by SOGC and ACOG

Studies suggest THC concentration may be 2.5% after an hour of exposure and was detectable up to 6 days after use

THC is lipophilic, meaning the potential to really concentrate in fatty breast milk like colostrum and fatty babies

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Does My Liver Look Fat? Full episode audio for MD edition 182:56 min - 86 MB - M4AHippo Primary Care - June 2019 Summary 666 KB - PDF