Ultrasound can diagnose NAFLD with some notable limitations i.e. steatosis > 30%. Additionally ultrasound does not stage or grade the condition. With the risk factors and positive ultrasound findings, however, a reliable diagnosis can be made. The portable ultrasound devices make it possible for you to perform such diagnostic exams at the bedside. Have you done this? Why or why not? What criteria do you use? Do you bill?
A portable ultrasound device can be used to perform ultrasonography at the bedside. It has the same limitations than bigger devices including the fact that it is operator dependent. The criteria to judge steatosis are the same (comparison with kidney, visibility of hepatic veins, visibility of diaphragm). I think that your exam should be paid, especially if you are using your own apparatus.
Dear Thomas
I would bill it, if it makes sense to perform it (i.e. clarify why liver function tests are slightly enhanced in a fashion matching steatosis - enhanced ALT and gGT). Else, if a proper hepetological evaluation is needed, the discussion which kind of US is used becomes secondary. I am used to both devices – standard US-device and 'small' bed-side US-devices. In my experience both ways are reliable to compare a difference of echo-density between liver and kidney.
Yet, what does this information really help us? Do we have to calm down overenthusiastic clinicians who are afraid of an ALT of 50 U/l and a gGT of 90 U/l? If so, the US probably is as sensitive as the BMI, else, you have to work up the liver disease properly, and then, the discussion what US-machine is used becomes quiet irrelevant, isn't it?
I just now realise that I am responding to a leading herpetologist. Hmm, should I delete my comment? – No. Why to screen for NAFLD at bedside if the prevalence is 50%? NAFLD itself can only be treated by wight-loss (if ever), and bears no risk. To distinguish it from NASH, we both know that US doesn't help, what ever we pay for the device. If we really wanna know it, liver biopsy is the gold standard. Furthermore, NASH also is best treated by whigt-loss (sparse data, I am aware), and is most often of no prognostic relevance. NASH-patients die much more often due to cardiovascular disease then due to NASH itself.
While Vitamin E was for a short time considered to be protective against HASH, to my knowledge this enthusiasm has been abandoned because Vitamine E also seams to have pro-carcinogenic effecst. In 2014 we probably are curious about it, yet if we remember the lung cancer studies done in the 1990'es Vitamin E failed due toe a trend towards pro-carcinogenesis... I lead it open to the readers to make their conclusion, yet unawareness of 'ancient' experience is not considered a PRO in my eyes.
What ever, ignoring my sermon, why do we discuss the bed-side US for NAFLD? No distinguish between 'simple' NAFLD/NASH, no treatment for NASH, no prognostic or therapeutic consequences?
If its just the money, charge for it and discus it later with Petrus (I am a roman catholic)...
If my rationales are wrong please correct me, so I gain experience.
Best Regards,
Bruno M Strebel, MD, specialised in Hepatology, Gastroenterology, and Int. Med
Transabdominal ultrasound examination may help the diagnosis of NAFLD but only in the presence of clinical (BMI, hypertension) and laboratory (dyslipidemia, glucose intolerance, methabolic syndrome, transaminase and gamma-GT elevation) markers strongly indicating this condition. And tis investigation is unable to distinguish NASH from NAFLD. So, portable or cnventional apparatus does not make any difference. Despite limitations, why not? Finally, to bill according to the condition and location of investigation performance.
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