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Liver Disease Research Paper

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Pediatric non-alcoholic fatty liver disease:
Increasing awareness in the primary care setting
By Hanna Sauer, RN, BSN
495 Cicada Court, Reno, NV 89521
(775) 303-4779 sauerhanna@gmail.com Abstract: Non-alcoholic fatty liver disease (NAFLD) can lead to cirrhosis and hepatocellular carcinoma in children and adolescents. Primary care providers have a unique position to identify and screen for the disease in its early stages. This article provides an overview of prevalence, expert guidelines, screening, treatment, and implications for the advanced practice registered nurse (APRN).

Introduction
Non-alcoholic fatty liver disease (NAFLD) is a major complication of childhood …show more content…

According to a landmark article by Browning et al, prevalence of NAFLD was described as being highest in the Hispanic population and lowest among Black Americans, and Caucasians with an intermediate prevalence. The differences were thought to be related to insulin resistance, visceral adiposity, genetics and socioeconomic status9.

Overnutrition, specifically excessive consumption of fructose, is fundamental to NAFLD development10. Fructose metabolism, unlike glucose, occurs nearly exclusively in the liver and is preferentially selected for lipogenesis. The triglyceride production and storage that results from fructose ingestion is highly associated with central obesity, dyslipidemia, and insulin resistance11. This relevant finding is especially important to clinicians, as this modifiable risk factor may be easily addressed.

Screening Guidelines and Recommendations
The majority of children with NAFLD are asymptomatic. Occasionally patients may complain of vague abdominal pain, fatigue, or malaise, however, liver disease is usually found incidentally on physical exam or routine lab work1. Children may have mild to moderate hepatomegaly; however, the majority of these children are overweight or obese, making liver palpation a challenge. In addition to obesity and visceral adiposity, children with NAFLD often present with acanthosis nigricans on the back of their neck or intertrigenous areas, which is suggestive of insulin

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