Fatty Liver Disease Care in Southlake, TX

Fatty liver is one of the most common findings in primary care and one of the least often explained. An ALT of 62 gets noted, nobody mentions it, and five years later it is still there. We treat it as a real diagnosis, score the scarring risk, and address what is driving it.

How we find it

Usually on routine labs. Mildly elevated ALT and AST, often with ALT higher than AST, in someone with a larger waist, high triglycerides and a borderline A1c.

Sometimes it turns up incidentally on an ultrasound or CT ordered for something else, reported as a “fatty liver” or “hepatic steatosis” in a line most people never read.

Ruling out the other causes

Before calling it metabolic fatty liver we check the things that mimic it, because some of them are treatable in completely different ways.

• Alcohol, asked about in actual numbers rather than “socially.” An AST higher than ALT points this direction.
• Hepatitis B and C. Hepatitis C is curable and every adult should be screened once.
• Medications. Amiodarone, methotrexate, tamoxifen, valproate and long-term steroids.
• Thyroid disease, celiac disease, and iron overload from hemochromatosis.
• Autoimmune hepatitis, in the right clinical picture.

Scoring the risk

The important question is not whether you have fat in your liver. It is whether you have scarring.

We calculate a FIB-4 score from your age, AST, ALT and platelet count. It costs nothing because we already have those numbers. A low score is genuinely reassuring and means routine monitoring. An intermediate or high score means further testing with elastography, which measures liver stiffness painlessly, and often a hepatology referral.

This step is skipped almost everywhere, and it is the whole point. It separates the large majority who will be fine from the minority who need real attention.

Treatment

There is no pill that fixes this for most people, and the treatment is genuinely effective anyway.

• Weight loss of 7 to 10 percent reduces liver fat substantially and can reverse inflammation. Very few chronic conditions respond that well.
• Treating the metabolic drivers. Managing prediabetes and insulin resistance directly improves the liver.
• GLP-1 medications improve liver fat and enzymes meaningfully, which makes our medical weight management program the main treatment route for many patients.
• Cutting liquid sugar and fructose. Sweetened drinks are metabolized in the liver and are the highest-yield dietary change.
• Alcohol reduction, even if alcohol is not the cause. A liver already under metabolic stress does not need more.
• Exercise, which reduces liver fat even without weight loss.

Vitamin E has a role in selected non-diabetic patients with confirmed inflammation, and newer targeted agents are becoming available for advanced disease. Both are conversations rather than defaults.

Why it matters beyond the liver

The leading cause of death in people with fatty liver is cardiovascular disease, not liver disease.

So finding it should trigger a full cardiovascular risk assessment, not just liver monitoring. We check lipids, blood pressure and A1c, and treat accordingly. See high cholesterol and heart disease prevention.

Follow-up

Liver enzymes and a repeat FIB-4 every six to twelve months depending on your starting point. Weight, waist and A1c tracked alongside.

If your enzymes normalize and your weight is down, that is a real result and we will tell you so.

Fatty liver is followed through our chronic condition management program. See our primary care Southlake practice overview.