Pain Management in Patient with Newly Diagnosed NAFLD

Case at a Glance

A 42-year-old female presents with concerns about analgesic use following recent diagnosis of non-alcoholic fatty liver disease (NAFLD) discovered incidentally during imaging for abdominal pain.

Patient's Story

The patient was recently diagnosed with NAFLD after undergoing abdominal ultrasound for right upper quadrant discomfort. She has a history of cholecystectomy, which ruled out gallbladder-related causes for her symptoms. She seeks guidance on the safety of using over-the-counter pain medications, specifically ibuprofen and acetaminophen, for intermittent headaches and menstrual cramps. She emphasizes that usage would not be daily but rather as-needed basis.

Initial Assessment

Patient underwent abdominal ultrasound due to right upper quadrant discomfort, which revealed hepatic steatosis consistent with NAFLD. Laboratory workup showed normal ALT and AST levels. Her physician determined that fibroscan was not indicated at this time, suggesting early-stage disease without significant fibrosis concerns.

The Diagnostic Journey

The diagnosis of NAFLD was made incidentally during evaluation of abdominal pain. Given her history of cholecystectomy, other causes of right upper quadrant pain were systematically ruled out. Normal liver enzymes and clinical assessment suggested simple hepatic steatosis rather than non-alcoholic steatohepatitis (NASH).

Final Diagnosis

Non-alcoholic fatty liver disease (NAFLD) - simple steatosis without evidence of inflammation or fibrosis

Treatment Plan

Patient counseling regarding medication safety in NAFLD was provided. Given normal liver function tests and presumed simple steatosis, occasional use of both acetaminophen and NSAIDs was deemed acceptable. Patient was advised to use lowest effective doses for shortest duration possible and avoid daily chronic use.

Outcome and Follow-up

Patient was reassured about the safety of intermittent analgesic use given her current liver status. Follow-up plan includes monitoring liver enzymes and lifestyle modifications to prevent disease progression. No immediate need for specialized hepatology consultation given stable liver function and early-stage disease.