A Primary Care Perspective of Fatty Liver: Diagnosis, Management, Prescribing, and when to Refer

Just over 30 years ago, the burden of liver disease in primary care was confined to patients with alcohol- and hepatitis virus-related diseases. Although some of these individuals posed significant management issues, they represented only a small fraction of patients in clinical practice. However, with the advent of the non-alcoholic fatty liver disease (NAFLD, or fatty liver) epidemic, primary care physicians now face an increasing workload relating to patients with liver problems. Most of these individuals are asymptomatic; their case records usually show normal or mildly deranged liver tests and/or a liver ultrasound report of 'fatty liver'. The seemingly conflicting reports of prognosis and 'new treatments' have only served to confuse patients and primary care providers alike, generating many questions about diagnosis, the need for referral, the benefit of lifestyle measures, safety issues for prescribing medications such as statins, and the role of drug therapy. In this chapter, we address these issues and provide a framework for managing fatty liver in primary care.