Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for follow-up of biopsy-proven NASH with stage [F1-F4] fibrosis. Reports [no/mild] fatigue, RUQ discomfort, or pruritus. Denies hematemesis, melena, or confusion. Current metabolic profile includes [BMI, DM2, HTN, Dyslipidemia]. Adherence to lifestyle modifications is [reported/suboptimal]. No history of significant alcohol intake.
Clinical Examination Findings
General: Patient is alert and oriented, no acute distress. HEENT: No scleral icterus. CV: RRR, no murmurs. Resp: Clear to auscultation. Abdomen: Soft, non-tender, non-distended. Liver span [cm], no palpable splenomegaly. No stigmata of chronic liver disease (no spider angiomata, palmar erythema, or caput medusae). Neuro: No asterixis, no focal deficits.
Treatment Protocol
1. Lifestyle: Weight loss target of 7-10% of body weight via caloric restriction and regular aerobic exercise. 2. Metabolic optimization: Strict glycemic control (HbA1c <7.0%), lipid management with statins as indicated. 3. Pharmacotherapy: Initiate [Pioglitazone/GLP-1 RA/Vitamin E] as per AASLD guidelines. 4. Surveillance: HCC screening via US/AFP every 6 months; EGD for variceal screening if clinically indicated.