What to expect : The care we provide to our fatty liver pati
At fatty liver clinic, we have designed a structured paradigm to identify all the key underlying issues or diseases behind the fatty liver and address them with multidisciplinary approach. The scaffold and the content of the program is utterly based on scientific evidence.
The fundamental goal of the treatment of fatty disease of any kind or type/subtype is the healing of liver by identifying and correcting the underlying metabolic dysfunctions.
Fatty liver evaluation and treatment is a structured program at fatty liver clinic. You should expect the following
Step 1
Receiving the referral from your doctor or provider or a patient may refer oneself.dysfunctions.
Step 2
Registration at fatty liver clinic
Our scheduler will contact you to set up an appointment and have you sign the release of information/record form. Also, you should be asked to provide the consent to share your record or the medical information to your family members if you wish.
Step 3
Initial visit with the provider
The provider will
take a detailed medical history including details about your lifestyle,
perform medical examination,
review prior medical records
explain the key findings and
set up plan of care.
Order comprehensive liver disease fasting lab panel testing, ultrasound of the liver, fat content of the liver and stiffness score of the liver tests.
A follow-up appointment will be set in 3-5 weeks to go over all the results
Step 4:1st follow-up visit with the provider.
During this visit, you should expect the following,
Provider will review all the test results in particular abnormal
Provider will set a plan to address all the abnormalities, which may include the following
a) further testing such as liver biopsy, MRI, CT, ECHO, sleep study, EGD etc.
b) setting the goals of care: symptoms, labs and imaging parameters and overall acre
c) management by lifestyle intervention: A detailed discussion on LI that consists of
the contents
the purpose
the risks and benefits
d) management and treatment by alcohol rehabilitation. A detailed discussion on alcohol and substance abuse and dependence that consists of
the contents
the purpose
the risks and benefits
e) identification and elimination of liver toxic medications
f) addressing metabolic syndrome with focus on fatty liver: optimizing the care
g) addressing other non-liver related issues: guiding to appropriate providers
Step 5: 2nd follow-up visit
It is usually set at 4 weeks from the 1st visit. During this visit, you should expect the following,
a) discussion on the findings of additional testing ordered on the last visit and their association with fatty liver
b) reassessment of adherence to the changes in lifestyle intervention on previous visit and precisely identifying the gaps
c) identifying the reason behind the gaps; the barriers and the stressors
d) Establish strategic plan to overcome each gap and barrier with focused attention
Step 6: 3rd follow-up visit
It is usually set at 4 weeks from the 2nd follow-up visit. During this visit, you should expect the following,
a) review the results of echo, biopsy and other tests done last visit
b) formulate the care and treatment
c) set or reset the ultimate parameters of success
d) troubleshooting plan to set
e) preventive care plan to set in place
Step 7: Subsequent follow-up visits
The purpose of subsequent visits are the following
a) Patient will visit every 3 months, sooner if significant gaps are identified.
b) Treatment response will be monitored against pre-defined set parameter as below
a. Subjective improvement of fatigue
b. Improvement in physical & emotional symptoms
c. weight loss 10% from baseline
d. maintenance of weight loss for more than a year
e. normalization of
i. Liver enzymes
ii. Lipids
iii. Iron studies
iv. Platelets ???
v. Ferritin
vi. HOMA-IR
vii. A1c
viii. UDFF
ix. Stiffness (elastography) score
x. Spleen volume reduction to <100 ml
xi. Improvements in Live Volumetrics
c) Parameters not meeting the criteria will be identified and reasons behind lack of improvement will be explored and addressed.
d) Provider will assure that patient has grasped the concept and the recommendations.
e) Typically, provider may ask to verbalize the recommendation to have better assurance.
