DQ Reply 6 634

Need help to reply three post.


1- Each reply should be at least 200 words.

2- Minimum One scholarly reference ( NO MAYO CLINIC/ AHA)

3- APA 6th edition style needs to be followed.

4- Each response should have reference at the end of each reply

5- Reference should be within last 5 years


Non-alcoholic fatty liver diseases (NAFLD).

NAFLD is a spectrum of hepatic disorders not associated with excessive alcohol intake, ranging from steatosis to cirrhosis and hepatocellular carcinoma, with hepatic cell inflammation and injury thought to result from the accumulation of triglycerides in the liver (Ball, Daines, Flynn, Solomon, & Stewart, 2015). Genetic and environmental factors are likely to contribute to disease development and insulin resistance is an important factor and associated with metabolic syndromes such as obesity, hypertriglyceridemia, and diabetes (Ball, Daines, Flynn, Solomon, & Stewart, 2015). Chronic liver disease in the United States occurs fairly equal in males and females and ethnically high prevalence in Hispanic individuals, most patients are asymptomatic, but some describe right upper quadrant pain, fatigue, malaise, and jaundice (Ball, Daines, Flynn, Solomon, & Stewart, 2015).

In history, patients may present with a history of metabolic syndromes such as diabetes, hyperlipidemia, and obesity (weight gain). On physical examination other than elevated body mass index (BMI), overweight or obese by criteria, may have a typical unremarkable finding, about half of the patient may have hepatomegaly and in severe disease, the patient may have jaundice and ascites (Ball, Daines, Flynn, Solomon, & Stewart, 2015). Lab findings show abnormal liver function tests, most patients will have elevated transaminase with aspartate aminotransferase (AST) and alanine aminotransferase (ALT) being two to three times the upper limit of the normal (Ball, Daines, Flynn, Solomon, & Stewart, 2015). Another diagnostic tool that could be in use will be magnetic resonance spectroscopy (MRS) and liver biopsy are most sensitive (Ball, Daines, Flynn, Solomon, & Stewart, 2015).

Hepatocellular carcinoma screening in NAFLD patients with cirrhosis is mandatory and low incidence is NAFLD patients without cirrhosis (Reig, Gambato, Man, Roberts, Victor, Orci, & Toso, 2019). According to Mcpherson et al, (2017), Fibrosis progression rates are variable in NAFLD and the severity of steatosis is an important histological factor in predicting fibrosis progression, irrespective of baseline fibrosis stage. High prevalence of chronic kidney diseases and hypertension had been reported among NAFLD patients and a C-reactive protein (CRP) and expression of intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule -1 (VCAM-1) are strong independent predictors of hypertension risk (Tsai et al 2020). A population-based cohort study among 4,629 participants that non-overweight individuals with NAFLD had a high risk of incident type 2 diabetes mellitus (González-Moreno, García-Compean, González-González, & Maldonado-Garza, 2017).

Summary and plan.

Based On these study findings I will screen them for diabetes by doing an HbA1C, baseline liver function panel, cholesterol panel, and screen patient for high blood pressure and will do CRP, ICAM-1, VCAM-1to rule out hypertension risk. If the liver enzymes such as AST, ALT were high, then An MRS and a liver biopsy will be done if lab findings are positive. The recommendations will be mainly lifestyle changes including, weight reduction with dietary modification, regular exercises, and cessation of smoking and drinking if the patients have a history of them with the patient involvement. I would suggest a cholesterol-lowering agent such as atorvastatin 20 mg daily and omega-3-fatty acids twice a day to reduce triglycerides will be started, and depends on the level of HbAIC, if its above > 7 will add an agent such as metformin and management of hypertension with a beta-blocker (metoprolol tartrate50 mg bid) in addition to the above lifestyle modifications.


Ball, J.W., Daines, J.E., Flynn, J.A. Solomon, B.S., & Stewart, R.W. (2015). Seidel’s guide to physical examination (8th. Eds., pp. 406.) St. Luis, Missouri: Elsevier.

Mcpherson, S., Pais, R., Valenti, L., Schattenberg, J. M., Dufour, J. F., Tsochatzis, E., … & Ratziu, V. (2017). Further delineation of fibrosis progression in NAFLD: evidence from a large cohort of patients with sequential biopsies. Journal of Hepatology, 66(1), S593-S593.

Reig, M., Gambato, M., Man, N. K., Roberts, J. P., Victor, D., Orci, L. A., & Toso, C. (2019). Should patients with NAFLD/NASH be surveyed for HCC?. Transplantation, 103(1), 39-44. Retrieved from https://journals.lww.com/transplantjournal/Abstract/2019/01000/Should_Patients_With_NAFLD_NASH_Be_Surveyed_for.13.aspx

Tsai, Y. L., Liu, C. W., Huang, S. F., Yang, Y. Y., Lin, M. W., Huang, C. C., … & Lin, H. C. (2020). Urinary fatty acid and retinol binding protein-4 predict CKD progression in severe NAFLD patients with hypertension: a 4-year study with clinical and experimental approaches. Medicine, 99(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959901/

González-Moreno, E. I., García-Compean, D., González-González, J. A., & Maldonado-Garza, H. J. (2017). How to screen NAFLD patients for diabetes? Annals of hepatology, 15(5), 801-802. Retrieved from https://www.medigraphic.com/cgi-bin/new/resumenI.cgi?IDARTICULO=69581


Cyclic vomiting syndrome (CVS) is a disorder is characterized by sudden and violent periods of vomiting with no apparent cause, lasting a few hours to a few days. The vomiting is typically projectile and contains bile, mucus, and, occasionally, blood. Patients can experience between six and 12 episodes a year, with the additional symptoms of headache, motion sickness, sweating, agitation, photophobia, and abdominal pain which is mostly located to the periumbilical or epigastric region. It occurs in a variety of age groups and is more prevalent in Caucasians and slightly more in males. Individuals with CVS make repeated trips to Emergency Departments seeking relief of the vomiting and the often-accompanying abdominal pain and dehydration. Episodes of vomiting can be triggered by infection, psychosocial stress, diet, and menstruation. It is also commonly associated with cannabinoid hyperemesis syndrome (CHS), which presents similarily and is associated with heavy, chronic marijuana use(Hayes, VanGilder, Berendse, Lemon, & Kappes, 2018).

Diagnosis of CVS based on history and clinical symptoms, and remains largely one of exclusion. Tests that are routinely done during the work-up include both blood and imaging. Serum electrolytes, liver function tests, and lipase are often assessed in the acute setting, prior to starting intravenous fluid therapy. Esophageal pH testing may dismiss vomiting as an atypical presentation of GERD. Some individuals may also be screened for alcohol or drug use (Tan, Liwanag, & Quak, 2014). Upper endoscopy, small bowel radiography, computed tomography, or magnetic resonance enterography can assess for gastroduodenal disease and small bowel obstruction. Peptic esophagitis and hemorrhagic lesions of the gastric mucosa can be found as a result of the vomiting episodes. If these tests are unremarkable, brain imaging is often done to rule out tumors of the central nervous system, especially if there are early morning emesis and neurological findings on examination (Hayes et al., 2018).


Hayes, W. J., VanGilder, D., Berendse, J., Lemon, M. D., & Kappes, J. A. (2018). Cyclic vomiting syndrome: diagnostic approach and current management strategies. Clinical and experimental gastroenterology11, 77–84. https://doi.org/10.2147/CEG.S136420

Tan, M. L., Liwanag, M. J., & Quak, S. H. (2014). Cyclical vomiting syndrome: Recognition, assessment and management. World journal of clinical pediatrics3(3), 54–58. https://doi.org/10.5409/wjcp.v3.i3.54


Irritable bowel syndrome (IBS) is a chronic gastrointestinal (GI) disorder that causes cramping, abdominal pain, and bloating with altered changes in bowel habits including constipation, diarrhea, or both; also defined as a disorder of the gut-brain interaction (Berens et al., 2019). IBS can result from biological factors, in which altering bacterial flora and increasing gut permeability, environmental factors including intestinal infections and food allergies or intolerances, and psychological factors, such as depression and stress (Berens et al., 2019). Clinical manifestations of IBS include pain in the lower abdominal quadrants, bloating, abdominal distention, and constipation and/or diarrhea. Though, alarming symptoms may include rectal bleeding, nocturnal pain, and weight loss (Soncini et al., 2018).

Labs including CBC to screen for anemia or infection, sedimentation rate to detect inflammation, and CMP to evaluate for electrolyte and fluid abnormalities. Additionally, a tissue transglutaminase antibody (tTG-IgA) test can be done for celiac disease (Soncini et al., 2018). A stool examination can rule out ova and parasites, C. difficile, and occult blood. A CT scan can be helpful to determine fecal impaction, enteritis, or evidence of a tumor. For constipation, an anorectal manometry can be done to measure how well the rectum and anal sphincter are working (Soncini et al., 2018). A colonoscopy would be essential to rule out other GI disorders.



Berens, S., Rainer, S., Baumeister, D., Gauss, A., Eich, W., & Tesarz, J. (2019). Does symptom activity explain psychological differences in patients with irritable bowel syndrome and inflammatory bowel disease? Results from a multi-center cross-sectional study. Journal of Psychosomatic Research, 126, 109836. doi:10.1016/j.jpsychores.2019.109836

Soncini, M., Stasi, C., Satta, P. U., Milazzo, G., Bianco, M., Leandro, G., … Bellini, M. (2018). IBS clinical management in Italy: The AIGO survey. Digestive and Liver Disease, 51(6), 782-789. doi:10.1016/j.dld.2018.10.006

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