In this episode of The Good GP, Dr Krystyna de Lange welcomes Dr Jonathon Mitchell, hepatologist from Cairns Base Hospital, to discuss metabolic dysfunction-associated steatotic liver disease (MASLD), formally known as Non Alcoholic Fatty Liver Disease or NAFLD. They explore the updated terminology, highlight the role of GPs in diagnosis and management, and frame MASLD as largely a metabolic rather than a primary liver disease.

Dr Mitchell outlines the main risk factors for MASLD, including excess weight, metabolic syndrome, dietary quality, and family history. The importance of screening for other liver conditions in patients with abnormal LFTs, including viral hepatitis, autoimmune liver diseases, haemochromatosis, and coeliac disease.

Non-invasive fibrosis assessment, primarily through the FIB-4 score, is discussed as an accessible tool for GPs. Liver biopsy is rarely required and reserved for cases with diagnostic uncertainty. Management focuses on lifestyle interventions, mainly dietary change and weight loss, with no approved pharmacological treatments currently available in Australia. Monitoring frequency depends on fibrosis status and response to lifestyle changes.

They reinforce the importance of holistic care in primary practice, addressing both liver health and associated metabolic risks.

Links & Resources:

1. https://www.racgp.org.au/afp/2013/july/fatty-liver-disease

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