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Leading Medicine Magazine, Vol 7, No 1 - 2013

GROWING PROBLEM GROWING CONCERN By Michael E. Newman atty liver disease. Never heard of it? Neither had Kathy Bourquardez, office manager for a Houston oilfield equipment company and a longtime diabetic. For five F years straight, the blood work during Bourquardez’s annual physical had shown elevated levels for her liver enzymes. However, the physician she had trusted for three decades never recommended that the abnormality be studied more thoroughly. “He just wanted to keep an eye on it to wait and see if the numbers got better or worse,” Bourquardez says. It wasn’t until Bourquardez was referred by a family member to Dr. Kathleen Wyne, an endocrinologist at The Methodist Hospital, that the seriousness of her condition was suspected. “Dr. Wyne suggested that because of my diabetes, I also might be suffering from fatty liver disease and that might explain the elevated enzymes,” Bourquardez says. “After an ultrasound and a liver biopsy, I learned that not only did I have fatty liver disease, but it had already progressed to cirrhosis (scarring and hardening of the liver) that was starting to destroy my liver.” Ultimately, her diagnosis was of an advanced form of nonalcoholic fatty liver disease (NAFLD) known as nonalcoholic steatohepatitis, or NASH. AN UNFAMILIAR DIAGNOSIS, A COMMON PROBLEM Unfortunately, Bourquardez’s story is not that rare. “NAFLD is currently the most prevalent liver disease in the United States, and the number of patients being diagnosed is growing rapidly in parallel with the epidemic of obesity,” says Dr. Howard Monsour Jr., chief of hepatology at The Methodist Hospital. “Even more serious is the fact that fatty liver disease is quickly overtaking hepatitis C as the major reason for patients to need a liver transplant.” NAFLD exists in two states. The first, a simple form known as bland fatty liver or steatosis, is defined as abnormal retention of lipids (fats) within the liver cells. NASH — Bourquardez’s diagnosis — is the second type. This is a more complex, more dangerous form in which the body responds to the fat deposits with inflammation. NASH can, in turn, progress to cirrhosis and hepatocellular carcinoma (liver cancer). “Texas is number two in the nation for fatty liver disease, a treatable condition that is strongly linked to hepatocellular carcinoma. Liver cancer is the eighth deadliest cancer in the United States, and rising. To answer this challenge, Methodist doctors have developed a sophisticated program focused on improved care for patients with liver disease and cancer,” says Dr. R. Mark Ghobrial, director of Methodist Center for Liver Disease and Transplantation. “Studies have shown that 5 to 20 percent of patients diagnosed with steatosis will eventually get NASH if the fat deposits in the liver are not treated, and up to 25 percent of those people will die or need a liver transplant,” Monsour says. ENDANGERING A CRUCIAL ORGAN The liver is the second-largest organ in the body. It is located under the rib cage and carries out a number of functions critical to survival. The biggest threats to healthy liver function include heavy alcohol use, drug abuse and hepatitis C. All three can lead to cirrhosis and liver failure and, ultimately, a choice between transplant or death if left untreated. The fourth villain to threaten our livers — fat — is just as dangerous, but much harder to detect. When fat first begins to build up in the liver, most people don’t have any symptoms. When they begin to experience abdominal pain, numerous other possible causes must be ruled out — making a diagnosis of NAFLD what doctors call a “diagnosis of exclusion.” What’s most important about fatty liver disease, according to Monsour, is catching it early so that doctors and their patients can team up to reverse the harm already done, restore normal liver function as much as possible, and avoid having to face the prospect of a liver transplant. In many cases — including Bourquardez’s — the first sign of trouble with fatty liver disease is routine blood work that reveals elevated levels of certain liver enzymes. 30% OF ALL AMERICANS HAVE NONALCOHOLIC FATT Y LIVER DISEASE According to the National Institute of Diabetes and Digestive and Kidney Diseases 48 methodisthealth.com/leadingmedicine


Leading Medicine Magazine, Vol 7, No 1 - 2013
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