{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 21, Ep 1 of 2: MASLD: Diagnosis Through Pharmacotherapy","html":"","width":"100%","height":180,"duration":1018,"description":"Episode one of the Steatotic Liver Disease chapter reframes fatty liver as MASLD, a positive diagnosis built on hepatic steatosis plus at least one of five cardiometabolic criteria rather than an exclusion. The organizing idea: fibrosis stage, not the transaminase or the degree of steatosis, is the prognostic anchor, so the workup runs a tiered noninvasive sequence and management is graded by how much fibrosis is present. It walks the biology of insulin resistance and lipotoxicity, the PNPLA3 and TM6SF2 variants, lean disease and cryptogenic cirrhosis as the same entity, then the FIB-4 into elastography algorithm. Management climbs from weight-loss targets through bariatric surgery, including compensated cirrhosis, to the newly on-label drugs resmetirom and semaglutide.\n \nTopics covered\n\nPositive cardiometabolic diagnosis and the five criteria\nSteatohepatitis versus bland steatosis and fibrosis as the prognostic anchor\nAlcohol continuum and the intermediate category\nInsulin resistance, lipotoxicity, and the PNPLA3 and TM6SF2 variants\nLean disease and cryptogenic cirrhosis\nNoninvasive fibrosis testing: FIB-4, transient elastography, MR elastography\nLifestyle, diet, and weight-loss targets\nBariatric surgery including compensated cirrhosis\nPharmacotherapy: resmetirom, semaglutide, pioglitazone, vitamin E\n \n \nKey decisions\n\nMASLD requires hepatic steatosis on imaging or biopsy PLUS at least one of five cardiometabolic criteria; one criterion is enough, a deliberate change from metabolic syndrome requiring three.\nRead prognosis through fibrosis stage, not the inflammatory grade or the transaminase level, because liver-related mortality climbs steeply with fibrosis while ALT does not track outcome.\nFIB-4 under one point three rules out advanced fibrosis and over two point six seven flags high risk, with the cutoff shifting to two point zero over age sixty-five; transient elastography under eight kilopascals rules out advanced fibrosis and over twelve to fourteen...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}