NAFLD Flashcards
What does NAFLD stand for?
How could you define it?
Non-alcoholic fatty liver disease
Fatty infiltration of the liver in the absence of a secondary cause
It is part of the metabolic syndrome:
What are other components of this syndrome? - 3
Hypertension
T2DM
Obesity - usually sedentary
Most are asymptomatic so usually undiagnosed and abnormal LFT’s are usually not reported.
How can it be identified? - 3
Raised liver enzymes
Imaging evidence of steatosis
Present with imaging evidence of cirrhosis/HCC
Diagnosis:
There are 3 things needed for clinical diagnosis:
(1) Raised ALT and/or GGT and evidence of steatosis on imaging
(2) Imaging evidence of steatosis
(3) Raised ALT and/or GGT and evidence of insulin resistance / central obesity / metabolic risk factors
What else must they not have as part of the history or investigations? - 4
Why is GGT used here instead of AST?
What imaging is used to look for and how does it work?
No history of excess alcohol (<14/21 units/week)
No known pre-existing liver disease
No hepatotoxic drugs
Negative blood screen for other liver diseases (viral, autoimmune etc)
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ALT can be in normal range for 80% of those with NAFLD. So GGT used in conjunction.
USS or MRI
Fibroscan (Assesses elasticity of the liver or liver fibrosis)
Staging:
What score can be used to stage disease? ***
FIB-4 score
NAFLD fibrosis score - more accurate
Treatment:
How is it managed?
Lifestyle intervention Specialist diet/exercise advice Weight loss and adjuncts - orlistat Modify CVD risk Bariatric surgery
