From the Guidelines
The management of a patient with a wavy liver suggestive of liver disease should prioritize lifestyle modification, including weight loss, dietary changes, and physical exercise, alongside optimal management of comorbidities, as recommended by the latest clinical practice guidelines 1. The approach to managing a wavy liver, indicative of underlying liver disease, involves a stepwise strategy starting with case-finding using non-invasive tests such as the fibrosis-4 index (FIB-4) and transient elastography to rule out advanced fibrosis, which is predictive of liver-related outcomes 1. Key considerations include:
- Identifying and managing cardiometabolic risk factors, particularly in individuals with type 2 diabetes or obesity and additional metabolic risk factors.
- Implementing lifestyle modifications, including weight loss, dietary changes, physical exercise, and discouraging alcohol consumption.
- Optimal management of comorbidities, such as the use of incretin-based therapies (e.g., semaglutide, tirzepatide) for type 2 diabetes or obesity, if indicated.
- Considering bariatric surgery as an option in individuals with liver disease and obesity.
- For adults with non-cirrhotic metabolic dysfunction-associated steatohepatitis (MASH) and significant liver fibrosis, considering a MASH-targeted treatment with resmetirom, if locally approved and dependent on the label, due to its demonstrated histological effectiveness on steatohepatitis and fibrosis with an acceptable safety and tolerability profile 1. The goal of these interventions is to prevent the progression of liver disease, manage complications, and improve the patient's quality of life, emphasizing the importance of early diagnosis and treatment to avoid the development of cirrhosis and liver failure.
From the Research
Management and Treatment Approach
The management and treatment approach for a patient with a wavy liver suggestive of liver disease involves several steps:
- Diagnosis: Liver disease can be diagnosed with a history, physical examination, and noninvasive testing, which includes laboratory tests, combination scoring indices, and imaging (eg, ultrasonography, transient elastography) 2.
- Counseling: Clinicians should counsel patients about alcohol use, obesity management, and prevention of infection. Drugs with potential for hepatotoxicity should be avoided 2.
- Clinical Assessment: Clinical assessment with laboratory tests and calculation of the Child-Pugh and Model for End-stage Liver Disease (MELD) scores should occur every 6 months 2.
- Complications Management: Clinicians should evaluate for and manage cirrhosis-related complications, including hepatocellular carcinoma, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, esophageal varices, and other complications 2.
Treatment Options
Treatment options for liver disease include:
- Lifestyle modification: The standard treatment for patients with nonalcoholic fatty liver disease (NAFLD) is lifestyle modification, which includes diet and exercise 3.
- Ursodeoxycholic acid (UDCA): UDCA has been shown to have a beneficial effect on dyslipidemia and atherosclerotic cardiovascular disease (ASCVD) risk in patients with NAFLD 4.
- Vitamin E and Pioglitazone: These substances have been shown to have numerous benefits in the prevention and treatment of NAFLD 3.
Evaluation and Monitoring
Evaluation and monitoring of liver disease include:
- Liver function tests: Incidentally detected abnormality in liver function tests is a common situation encountered by physicians, and a combination of a careful history and clinical examination along with interpretation of pattern of liver test abnormalities can often identify type and aetiology of liver disease 5.
- Imaging: Imaging tests such as ultrasonography and transient elastography can be used to evaluate liver disease 2.
- MELD score: The MELD score is a useful tool for assessing the severity of liver disease and predicting mortality 2.
Liver Transplantation
Liver transplantation is indicated for patients with a MELD score of 15 or greater, complications of cirrhosis, or hepatocellular carcinoma 2.