Why See a Specialist: Nonalcoholic Fatty Liver Disease

Medically Reviewed By Kelsey Trull, PA-C

It takes a team approach to manage symptoms and prevent complications.

young Hispanic female patient sits up on exam table at medical appointment listening to female doctor holding clipboard

If you’ve received a diagnosis of non-alcohol-related fatty liver disease (NAFLD), which is now called metabolic dysfunction-associated steatotic liver disease (MASLD), symptoms such as tiredness, belly pain, or itchy skin might have led you to make an appointment with your primary care doctor.

Your doctor may have ordered tests if they were concerned that you were at risk for this condition. Getting a diagnosis is the first step in managing MASLD.

The goal is to manage the symptoms and prevent complications. Early stage MASLD might not cause any problems, but it can get worse.

Roughly 25% of people Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source with MASLD will go on to develop a progression of the disease that’s known as metabolic dysfunction-associated steatohepatitis (MASH). MASH is a form of fatty liver disease in which there is often inflammation and damage to liver cells. Inflammation and fat can lead to fibrosis (scarring). 

Eventually, MASH can cause severe scarring (cirrhosis), liver failure, and liver cancer. Treatments such as dietary changes and the medication resmetirom (Rezdiffra) can help slow down liver damage. 

As you move forward with treatment, your primary care doctor should still be an integral part of your care. However, because MASLD can progress to liver failure and can increase your risk for high blood pressuretype 2 diabetes, and chronic kidney disease, managing this condition requires a comprehensive team of specialists.

Talk with your primary care doctor about finding the right team of people to help you.

Liver specialist

A hepatologist is a doctor who diagnoses and treats liver diseases. They will work with your primary care doctor to manage your condition.

To watch for progression of fatty liver disease, hepatologists order imaging scans such as ultrasoundCT scans, and MRI scans. They also do liver biopsies, which involve removing a small piece of liver tissue and sending it to a lab for testing. 

Your hepatologist’s goal is to manage MASLD so it doesn’t progress to liver failure. If your liver stops working, you may need a liver transplant.

Hepatologists also check for complications that can happen with fatty liver disease, such as:

  • ascites (fluid in your belly)
  • liver cancer
  • varices (enlarged blood vessels in your esophagus that form when there’s a blockage in blood flow to your liver) 

Additionally, your hepatologist can refer you to a clinical trial if you’re interested in trying an experimental new treatment for fatty liver disease.

Diabetes specialist

An endocrinologist treats type 2 diabetes and its complications. Fatty liver disease increases your risk Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of developing diabetes. Checking your blood sugar regularly can help you avoid diabetes complications such as eye disease and nerve damage

If you do have diabetes, an endocrinologist can prescribe medication to treat it and monitor your progress during treatment. Glucagon-like peptide-1 (GLP-1) medications such as dulaglutide (Trulicity), exenatide (Byetta), and liraglutide (Victoza) treat diabetes by lowering blood sugar and promoting weight loss. These medications might also improve liver health.

Cardiologist

MASLD makes you more likely to have heart disease, especially if your MASLD is severe. The reverse is also true: Heart disease increases your likelihood of having liver disease. 

Heart disease is the most common cause of death in people with MASLD. A cardiologist can help you prevent or manage heart disease. They will recommend treatments to manage heart disease risk factors such as high blood pressure and high cholesterol.

Kidney specialist

MASLD may also increase your risk for chronic kidney disease. The two conditions have some of the same causes, such as inflammation and insulin resistance. A doctor who specializes in kidney disease will monitor your kidney function and treat you for kidney disease if necessary.

A team approach

Your primary care doctor can refer you to these and other specialists if necessary. A registered dietitian and a physical therapist might also be part of your treatment team since diet and exercise are important parts of the treatment for MASLD.

Summary

The healthcare professionals you work with should also work together to make sure that MASLD, diabetes, heart disease, and any other conditions you have are well managed. By monitoring your progress and managing disease progression if it happens, these professionals can help slow down your liver disease and improve your quality of life.

Editorial note:

  • NASH may also be called metabolic dysfunction-associated steatohepatitis (MASH).
  • NAFLD may also be called metabolic dysfunction-associated steatotic liver disease (MASLD).
  • Fatty liver disease may also be called steatotic liver disease.
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Medical Reviewer: Kelsey Trull, PA-C
Last Review Date: 2024 May 31
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