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#Phase 2.1: GI > Non-Alcoholic Fatty Liver Disease > Flashcards

Non-Alcoholic Fatty Liver Disease Flashcards

1
Q

What is NAFLD? (3 things)

A
  1. Increased fat in hepatocytes (steatosis)
  2. Fat is visualized (e.g on US)
  3. Fat can’t be assoc w other causes (e.g alcohol)
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2
Q

When should you consider that liver disease is NOT caused by alcohol? (male n female)

A 
Male = drinks less than 18 units / wk
Female = drinks less than  9 units / wk
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3
Q

What is NAFLD characterized by?

A

Fat deposited in liver cells

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4
Q

What problems does NAFLD cause? (2 things)

A
  1. Nothing initially

2. Progresses to hepatitis + cirrhosis

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5
Q

What are the stages of NAFLD? (4 things)

A
  1. NAFLD
  2. Non-alcoholic Steatohepatitis (NASH)
  3. Fibrosis
  4. Cirrhosis
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6
Q

What are the risk factors for NAFLD? (8 things)

A
  1. Middle age +
  2. Smoking
  3. Obesity
  4. Poor diet / low activity
  5. Type 2 DM
  6. HTN
  7. High cholesterol
  8. Metabolic Syndrome
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7
Q

What does it mean when you got NAFLD with inflammation (high ALT in LFT)?

A

Non-Alcoholic Steatohepatitis (NASH)

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8
Q

What processes lead to lipid accum in liver? (4 things)

A
  1. Increased fat supply (high fat diet + adipose lipolysis)
  2. Decreased fat export (reduced VLDL sec)
  3. Decreased free F.A oxidation
  4. Increased de novo lipogenesis
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9
Q

What are the pathophysiological steps of NAFLD? (4 steps)

A
  1. Processes –> lipid accum (bc risk factors)
  2. Increased Triglyceride synth. + Increased Hepatic uptake of F.A
  3. Free F.A + byproducts damage hepatocytes by oxidative stress –> lipotoxicity (cellular injury + death)
  4. Injured + dying cell induce immune response (inflamm cytokines + cells) –> to repair + replace hepatocytes
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10
Q

What are the CF of NAFLD? (4 things)

A
  1. Often asymptomatic
  2. Fatigue / malaise
  3. RUQ discomfort
  4. Hepatomegaly
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11
Q

What are the incidental findings of NAFLD? (aka stuff youll see randomly when ur not even looking for NAFLD) (2 things)

A
  1. Abn LFT

2. Hepatic stenosis @ US

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12
Q

What are the CF when NAFLD progresses to Cirrhosis? (4 things)

A
  1. Spider naevi
  2. Palmar erythema (red palms)
  3. Hepatosplenomegaly
  4. Ascites
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13
Q

What are the risk factors for progression of NAFLD to Cirrhosis? (4 things)

A
  1. Age
  2. Obesity
  3. DM
  4. NASH
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14
Q

What is the best diagnostic test for NAFLD that is RARELY done?

A 
Liver biopsy
(only done if diagnosis is unclear)
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15
Q

What is the use of liver biopsy in NAFLD? (2 things)

A
  1. Distinguishes NAFLD from NASH

2. Detects cirrhosis

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16
Q

What is used to confirm the diagnosis of NAFLD?

A

Liver US

17
Q

What does a Liver US NOT show? (3 things)

A
  1. Severity of NAFLD
  2. Liver function
  3. Fibrosis
18
Q

What is the FIRST line investigation to check for Fibrosis in NAFLD?

A

Enhanced Liver Fibrosis (ELF) blood test

19
Q

What is the SECOND line investigation to check for Fibrosis in NAFLD?

A

NAFLD Fibrosis Score

20
Q

What are the pros and cons of NAFLD Fibrosis Score?

A 
Pro = Helps RULE OUT fibrosis
Con = Doesn’t show SEVERITY of fibrosis
21
Q

What is the THIRD line investigation to check for Fibrosis in NAFLD?

A

FibroScan US

22
Q

What is the use of FibroScan US in NAFLD, and when is it done?

A

Shows severity of Fibrosis

Done when ELF or NAFLD Fibrosis Score indicate Fibrosis

23
Q

What is the management for NAFLD? (6 things)

A
  1. Weight loss (maybe bariatric surgery if obese)
  2. Exercise
  3. X Smoking
  4. Avoid alcohol
  5. Control diabetes / BP / cholesterol
  6. If fibrosis –> refer to Liver Specialist
24
Q

What will the Liver Specialist treat a NAFLD pt with Fibrosis with? (2 things)

A
  1. Vit E

2. Pioglitazone

25
Q

What complications should a NAFLD pt be monitored for in follow ups? (3 things)

A
  1. NASH
  2. Cirrhosis
  3. DM

#Phase 2.1: GI (29 decks)

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