Non alcoholic fatty liver disease (NAFLD)

Question 1

What is NAFLD?

Answer 1

Chronic liver disease not due to alcoholism

Question 2

RF for NAFLD?

Answer 2

Obesity, htn, Hyperlipidemia, T2DM, fHx, Endocrine disorders, Drugs (NSAIDS, Amiodarone)

Question 3

What happens to the liver in NAFLD?

Answer 3

Hepatosteatosis (NAFLD)
then
Non alcoholic steatohepatitis
then
Fibrosis
then
Cirrhosis

Question 4

Patient Sx?

Answer 4

Typically aSx, any findings are incidental usually
If v severe, present with signs of liver failure

Question 5

Dx of NAFLD?

Answer 5

Deranged LFT (high PT/INR, low albumin, high bilirubin)
FBC - Thrombocytopenia, hyperglycemia

1st line - Imaging
For suspected NAFLD = abdo Ultrasound (94% sensitivity for mod/severe steatosis)

Question 6

What do you assess risk of fibrosis with?

Answer 6

Non invasive scoring system (avoid biopsy unless absolutely necessary)
eg. FIB-4 (fibrosis 4 score) , >2.67 = advanced , refer to hepatology specialist

Question 7

Tx for NAFLD

Answer 7

Lose weight (lower BMI) + control risk factors (statins, metformin, ACE-i)
VITAMIN E - recommend by NICE

Question 8

Why is Vit E recommended by NICE?

Answer 8

Improves histological steatotic - fibrotic liver appearance

Question 9

this common condition should be suspected in ….

Answer 9

anyone obese/T2DM with deranged LFTs

Question 10

Complications?

Answer 10

HE, ascites, HCC, portal htn + oesophageal varices