NAFLD and Jaundice

Question 1

What is NAFLD?

Answer 1

Excessive fat in the liver cells (specifically triglycerides)

Question 2

What can NAFLD progress to?

Answer 2

Hepatitis and liver cirrhosis

Question 3

What are the stages of NAFLD?

Answer 3

1.Non-alcoholic fatty liver disease
2.Non-alcoholic steatohepatitis (NASH)
3.Fibrosis
4.Cirrhosis

Question 4

What are the risk factors for NAFLD (HINT: are similar to risk factors of cardiovascular disease and diabetes)

Answer 4

Middle age onwards
Obesity
Poor diet and low activity levels
Type 2 diabetes
High cholesterol
High blood pressure
Smoking

Question 5

What syndrome is NAFLD associated with?

Answer 5

Metabolic syndrome. It is a combination of hypertension, obesity and diabetes.

Question 6

What are the investigations for NALFD?

Answer 6

LFTs (Raised ALT)
Often first indication of NAFLD

Ultrasound (indicates hepatic steatosis)—> is seen as INCREASED echogenicity (it does NOT indicate severity, function of liver or fibrosis).Ultrasound may be normal in NALFD

ELF blood test (first-line investigation for assessing fibrosis in NAFLD).
Looks for advanced fibrosis (≥ 10.51)

NAFLD Fibrosis score (NFS)

Fibrosis 4 (FIB4) score
Takes into account age, liver enzymes (AST/ALT) and platelet count

Liver biopsy (to confirm diagnosis)

Question 7

How often should you do the ELF test if someone has NAFLD?

Answer 7

Every 3 years

Question 8

What are the factors in the NAFLD Fibrosis score?

Answer 8

Age
BMI
Liver enzymes (AST/ALT)
Platelet count
Albumin
Diabetes

Question 9

Why would transient elastography be used to investigate NAFLD?

Answer 9

To assess the stifness of the liver
Uses high frequency waves
You look at the degree of fibrosis to test for liver cirrhosis

Question 10

At what point would you use transient elastography for NAFLD?

Answer 10

When the ELF blood test comes out to indicate advanced fibrosis (≥10.51)

Question 11

The AST:ALT ratio can be used to assess the severity of liver fibrosis. The normal ratio is less than 1. What does an AST:ALT ratio GREATER than 1.5 indicate?

Answer 11

It indicates alcohol-related liver disease rather than NAFLD.

Question 12

What is the GOLD standard test for NAFLD?

Answer 12

Liver biospy (but is not reuquired sometimes)

Question 13

How do you manage NAFLD?

Answer 13

Weight loss
Healthy diet (Mediterranean diet is recommended)
Exercise
Avoid/limit alcohol intake
Stop smoking
Control of diabetes, blood pressure and cholesterol
Refer patients where scoring tests indicate liver fibrosis to a liver specialist

Specialist management may include vitamin E, pioglitazone, bariatric surgery and liver transplantation