scholarly journals Mild Hypertransaminasemia in Primary Care

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Said A. Al-Busafi ◽  
Nir Hilzenrat
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Common Finding ◽  
Underlying Liver Disease ◽  
Nonalcoholic Fatty Liver ◽  
Muscle Disorders ◽  
Common Causes ◽  
Antitrypsin Deficiency ◽  
Unclear Etiology ◽  
The Cost

The liver enzymes, alanine transaminase (ALT) or aspartate transaminase (AST), are commonly used in clinical practice as screening as well as diagnostic tests for liver diseases. ALT is more specific for liver injury than AST and has been shown to be a good predictor of liver related and all-cause mortality. Asymptomatic mild hypertransaminasemia (i.e., less than five times normal) is a common finding in primary care and this could be attributed to serious underlying condition or has transient and benign cause. Unfortunately, there are no good literatures available on the cost-effectiveness of evaluating patients with asymptomatic mild hypertransaminasemia. However, if the history and physical examination do not suggest a clear cause, a stepwise approach should be initiated based on pretest probability of the underlying liver disease. Nonalcoholic fatty liver disease is becoming the most common cause of mild hypertransaminasemia worldwide. Other causes include alcohol abuse, medications, and hepatitis B and C. Less common causes include hemochromatosis, α1-antitrypsin deficiency, autoimmune hepatitis, and Wilson's disease. Nonhepatic causes such as celiac disease, thyroid, and muscle disorders should be considered in the differential diagnosis. Referral to a specialist and a possible liver biopsy should be considered if persistent hypertransaminasemia for six months or more of unclear etiology.

Nonalcoholic Fatty Liver Disease Underdiagnosis in Primary Care: What Are We Missing?

2021 ◽  
Author(s):  
Ellen M. Nielsen ◽  
Kathryn P. Anderson ◽  
Justin Marsden ◽  
Jingwen Zhang ◽  
Andrew D. Schreiner
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
Nonalcoholic Fatty Liver

scholarly journals Polycystic ovary syndrome, androgen excess, and the risk of nonalcoholic fatty liver disease in women: A longitudinal study based on a United Kingdom primary care database

PLoS Medicine ◽  
2018 ◽  
Vol 15 (3) ◽  
pp. e1002542 ◽  
Author(s):  
Balachandran Kumarendran ◽  
Michael W. O’Reilly ◽  
Konstantinos N. Manolopoulos ◽  
Konstantinos A. Toulis ◽  
Krishna M. Gokhale ◽  
...  
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Longitudinal Study ◽  
Polycystic Ovary Syndrome ◽  
Fatty Liver Disease ◽  
Polycystic Ovary ◽  
Androgen Excess ◽  
Ovary Syndrome ◽  
Nonalcoholic Fatty Liver ◽  
Care Database

Nonalcoholic Fatty Liver Disease is Underrecognized in the Primary Care Setting

2015 ◽  
Vol 110 (1) ◽  
pp. 10-14 ◽  
Author(s):  
Pierre Blais ◽  
Nisreen Husain ◽  
Jennifer R Kramer ◽  
Marc Kowalkowski ◽  
Hashem El-Serag ◽  
...  
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
Care Setting ◽  
Primary Care Setting ◽  
Nonalcoholic Fatty Liver

scholarly journals Cross-sectional pilot study to assess primary healthcare workers’ knowledge of nonalcoholic fatty liver disease in a marginalized community in Mexico

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Paulina Vidal-Cevallos ◽  
Ana L. Ordóñez-Vázquez ◽  
Omar Procopio-Mosso ◽  
Rafael Cardoso-Arias ◽  
Misael Uribe ◽  
...  
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Primary Healthcare ◽  
Fatty Liver Disease ◽  
Healthcare Workers ◽  
Healthcare Professionals ◽  
Cross Sectional ◽  
Nonalcoholic Fatty Liver

AbstractThe registered incidence of nonalcoholic fatty liver disease (NAFLD) in primary healthcare centers is lower than expected, suggesting a lack of awareness by primary care healthcare professionals. The implementation of educational tools for healthcare workers has been found to increase timely referral and treatment of patients. We aimed to determine healthcare workers’ knowledge of NAFLD to identify their educational needs in one marginalized region. We performed a cross-sectional survey of 261 healthcare professionals in Tlapa de Comonfort, Guerrero, Mexico from October 2019 to December 2019. We created a questionnaire that assessed domains most relevant to NAFLD knowledge. Two hundred and forty-six questionnaires were completed. Of the respondents, 38.3% were nurses and 63.4% were women. Most nurses identified NAFLD as a prevalent (89%) and preventable (93%) disease. Hypertension (33%) and obesity (84%) were recognized as risk factors. The associations between NAFLD and cancer, cirrhosis and cardiovascular disease were identified by 53%, 67% and 72% of respondents, respectively. The largest gaps were found in diagnostic workup, therapeutic approach and the current treatments. We identify modifiable knowledge gaps in NAFLD. Educational strategies for primary care workers could enhance the identification of patients with NAFLD and prevent complications.

Awareness, management, and practice patterns of pediatric NAFLD by primary care physicians

2021 ◽  
Author(s):  
Victoria Lee-Kim ◽  
Rachael Morkem ◽  
David Barber ◽  
Jennifer A Flemming ◽  
Mohit Kehar
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Clinical Guidelines ◽  
Primary Care Physicians ◽  
Practice Patterns ◽  
Dissemination And Implementation ◽  
Lifestyle Modifications ◽  
Nonalcoholic Fatty Liver ◽  
The North ◽  
Specialist Referral

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children. Primary-care physicians (PCPs) play a key role in identifying patients requiring specialist referral. In this study, we aim to determine PCPs’ practice patterns for paediatric NAFLD, as knowledge gaps have been reported for adult NAFLD. Methods A survey was sent to 60 PCPs in the Eastern Ontario Network from July 2019 to January 2020. Results Thirty-seven (62%) PCPs responded to the survey. Twenty-one incorrectly considered the prevalence of paediatric NAFLD to be ≤10%. The majority (35/36) cared for less than five paediatric NAFLD patients. Thirty-four (92%) were only ‘slightly familiar’ or ‘not familiar at all’ with paediatric NAFLD. Only one PCP routinely screens for NAFLD. Only one PCP was aware of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) clinical guidelines for paediatric NAFLD. Twenty-five (68%) correctly selected lifestyle modifications as a treatment option. Lack of confidence in the knowledge of NAFLD was the most common barrier for managing paediatric cases. Conclusion The majority of PCPs are not screening for paediatric NAFLD and are not familiar with its clinical spectrum, citing a lack of knowledge regarding NAFLD as the greatest barrier. This may cause delays in diagnosis and a presentation with advanced fibrosis at the time of specialist referral. Dissemination and implementation of clinical guidelines have the potential to improve knowledge and screening rates for NAFLD in children at the primary-care level.

Nonalcoholic Fatty Liver Disease (NAFLD) for Primary Care Providers: Beyond the Liver

2020 ◽  
Vol 16 ◽  
Author(s):  
Eddison Godinez-Leiva ◽  
Fernando Bril
Keyword(s):  
Primary Care ◽  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
Systemic Disease ◽  
Primary Care Providers ◽  
Major Public Health Problem ◽  
Care Providers ◽  
Nonalcoholic Fatty Liver

Abstract:: Nonalcoholic fatty liver disease (NAFLD) has consolidated as a major public health problem, affecting ~25% of the global population. This percentage is significantly higher in the setting of obesity and/or type 2 diabetes. Presence of NAFLD is associated with severe liver complications, such as nonalcoholic steatohepatitis (NASH; i.e., presence of inflammation and necrosis), cirrhosis and hepatocellular carcinoma. However, the majority of these patients die of cardiovascular disease. For this reason, management of this condition requires a multidisciplinary team, where primary care providers are at center stage. However, important misconceptions remain among primary care providers, preventing them from appropriately approach these patients. Nonalcoholic fatty liver disease should be understood as part of a systemic disease, characterized for abnormal accumulation of fat in tissues other than the adipose tissue. This, in turn, produces dysfunction of those organs or tissues (process sometimes referred to as lipotoxicity). Therefore, due to the systemic nature of this condition, it should not surprise that NAFLD is closely related to other metabolic conditions. In this review, we will focus on the extrahepatic manifestations of NAFLD and its metabolic and cardiovascular implications. We believe these are the most important issues primary care providers should understand, in order to effectively manage these complicated patients. In addition, we have provided a simple and straightforward approach to the diagnosis and treatment of patients with NAFLD and/or NASH. We hope this review will serve as a guide for primary care providers to approach their patients with NAFLD.

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