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Steatohepatitis Plan

CBC Creatinine electrolytes TSH

ALT AST ALP Bilirubin GGT INR Albumin

Hemoglobin AIC Fasting glucose Lipid profile

Hepatitis B-C serology

Ferritin serum iron TIBC

Antinuclear antibody Smooth muscle antibody Alpha-1-Antitrypsin Ceruloplasmin

Abdominal ultrasound

CT abdomen

MRI abdomen with elastography

Liver biopsy

Lifestyle change (weight loss, healthy diet, exercise, diabetes and hyperlipidemia management)

Restrict alcohol intake

BP control

Gastroenterology referral

Repeat liver transaminases at least every 2 years

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SCORES:

NAFLD fibrosis score

http://nafldscore.com/

Score less than -1.45 excludes advanced fibrosis while score more than 0.67 suggests advanced liver fibrosis (90% Test Sensitivity)

Consider MR Elastography (or Fibroscan) for Fibrosis Score more than -1.45

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Fibrosis probability score (FIB-4 Index)

https://www.hepatitisc.uw.edu/page/clinical-calculators/fib-4

Efficacy: Test Sensitivity: 85%, Test Specificity: 65%

Score < 1.45 excludes advanced fibrosis while score > 3.25 suggests advanced liver fibrosis

Consider MR Elastography (or Fibroscan) for Fibrosis Probability Score > 1.45

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