What to expect : The care we provide to our liver patients
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 a multidisciplinary approach. The scaffold and the content of the program is entirely based on robust scientific evidence.
The fundamental goal of the treatment of liver disease of any kind or type/subtype is the prevention of progression and, whenever possible, 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 themselves.
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, so that we may obtain important historical records from your previous providers and coordinate your care. Also, you will be asked to provide 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 specifics about your lifestyle, perform a medical examination, review prior medical records, explain the key findings and set up a plan of care.
In addition, the provider will order comprehensive liver disease fasting labs, specialized, quantitative ultrasounds of the liver, with additional, non-invasive testing to determine fat content and stiffness score of the liver.
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:
Your provider will review all the test results, focusing on any abnormalities.
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 arc
c) Management by lifestyle intervention (LI): A detailed discussion on LI including key aspects, purpose, risks, and benefits.
d) Management and treatment of substance use. A detailed discussion on alcohol and substance abuse and dependence with discussion to include rehabilitation support.
e) Identification and elimination of liver toxic medications in consultation with prescribing providers
f) Addressing metabolic syndrome with focus on fatty liver: optimizing the care
g) Addressing other non-liver related issues and guiding to additional providers as appropriate
Step 5: 2nd follow-up visit
It is usually set at 4 weeks from the 1st follow-up 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 lifestyle interventions established 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
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) Collectively troubleshooting plan
e) Preventive care plan 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 parameters to include:
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 Liver 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.
