Internal Medicine 2022

Improving post-discharge follow-up of incidental hepatic steatosis in patients admitted to Medicine service

Faculty Mentor’s Name: Dr. Bhagwan Dass
Phone Number: (352) 265-0680
Project Category: CQI
International Component or Travel: No

Research Project Description:

Non-alcoholic fatty liver disease (NAFLD) is defined as >5% of hepatic steatosis (by imaging or histology) in the absence of excessive alcohol use or other causes of liver disease. This condition may progress to liver cirrhosis and hepatocarcinoma. Hepatic steatosis is a common incidental finding noted on abdominal imaging performed for other indications (such as concern for kidney stones).

Our goal is to explore the prevalence of hepatic steatosis in a population that is infrequently associated with classical risk factors of fatty liver disease. Among patients diagnosed with NAFLD in Western countries, 10%-20% of the population will not have central obesity with a BMI >30. These patients are termed to have “lean-NAFLD.” Current recommendations only recommend screening of hepatic disease in high-risk individuals (age >50 years, type 2 diabetes mellitus, metabolic syndrome), and do not address younger patients without comorbidities. Hence, it is important that incidental findings of hepatic steatosis are followed up by a specialist accordingly as this may be the only clinical clue for investigation of liver disease and the patient may not actively undergo workup otherwise.

The first part of this project will focus on determining the prevalence of incidental hepatic steatosis noted in CT imaging and determining what percentage of this population has elevated LFTs and does not have classical risk factors of metabolic syndrome. Then, the second part of the project will focus on determining what percentage of the cohort from part one had formal follow up with a referring provider, primary care physician vs specialist and developing a screening tool (AST/ALT >40 in obese patients) that could prompt further evaluation by a primary care provider, hepatology referral of further imaging. The project has already been approved with QIPR.