Who to screen for NAFLD?

• Risk factors: obesity, DM, HLD
• Known steatosis on imaging
• History of abnormal transaminases

How to screen?

• Order Fib4 blood test, or
• Enter .fib4 if your note (this will pull AST, ALT, plts if done in last 1 year)

Next step?

• If < 1.3 low likelihood of significant fibrosis at this time. Can be followed by primary care. Recommend fibrosis assessment every 2-3 years unless change in clinical status.
• If > 1.3 consider FIBROSCAN referral. Patient will automatically be referred to hepatology if fibroscan suggestive of significant fibrosis. 
• If > 2.67 consider HEPATOLOGY referral. Needs further evaluation and liver cancer screening.

How to refer?

• Order 'Referral for Fibroscan'
• FibroScan takes place on 8th Floor CAM East (they will have to fast 2-3 hours prior)
• Patients can call 212-241-7270 for an appointment. Walk-ins are occasionally accommodated
• Patient must be fasting for 3 hours prior to the test