Non- Alcholiv Fatty Liver Disease

Question 1

Which group of people are a higher risk of developing non-alcoholic fatty liver disease (NAFLD)

Answer 1

*Diabetes type 2
*Metabolic Syndrome

Question 2

How do you diagnose NAFLD in children and young people

Answer 2

*Ultrasound to test children any young adult with diabetes type 2 and metabolic syndrome
*young adults who do not misuse alcohol
* refer children to the paediatric specialist in hepatology in tertiary care
* diagnose NAFLD if ultrasound shows they have fatty liver

Question 3

After how many years should children and young adults be retested for liver ultrasound

Answer 3

3 years

Question 4

How do you assess the people living with advanced liver fibrosis mention Atleast 4

Answer 4

*offer testing for advanced liver fibrosis to people with NFLD
* consider using enhanced liver fibrosis (ELF) test for who have been diagnosed with NFlD
*Diagnose people with advanced liver fibrosis if they have an ELF score of 10.51 or above and NAFLD
*Do not use routine liver blood tests to assess for advanced liver fibrosis in patients with NAFLD

Question 5

Offer retesting for advanced liver fibrosis for people with an ELF score below 10.51 ,how many years for adults and children

Answer 5

3 years for adults
2 years for children and young people

Question 6

Non alcoholic fatty liver disease is a Risk Factor for which diseases

Answer 6

Diabetes type 2
Hypertension
Chronic Kidney Disease

Question 7

Patients with diabetes type 2 with NAFLD have risks for which diseases

Answer 7

Atrial fibrillation
Myocardial infarction
Ischemic stroke

Question 8

What lifestyle modifications would you recommend to your patients

Answer 8

• stop alcohol
  *physical exercise
• patients taking statins should continue unless their liver enzymes levels double within 3 months of starting statins they can stop

Question 9

Which drug’s according to guidelines is recommended

Answer 9

*pioglitazone
*vitamine E

Question 10

What are the necessary cautions you need to take before prescribing pioglitazone and vitamin E( 4)

Answer 10

Pioglitazone is contraindicated in patients with history of heart failure,previous or active bladder cancer
In tertiary care settings only consider vitamin E for children with advanced liver fibrosis whether they have diabetes or not
Consider using ELF to assess if the pharmacological therapy is effective
If a child’s or young persons ELF score has risen stop vitamin E
Stop pioglitazone or vitamin E if ELF test score has risen

Question 11

What terms are used in advanced liver fibrosis

Answer 11

A grade of F3 or above using the Kleiner (NASH-CRN) or the steatosis, activity and fibrosis (SAF) score. This is referred to as bridging fibrosis (the presence of fibrosis linking hepatic veins to portal tracts)

Question 12

What is metabolic syndrome

Answer 12

A group of chronic conditions that indicates increased cardiovascular risk. It includes central obesity (excessive abdominal fat), insulin resistance or type 2 diabetes, hypertension and dyslipidaemia.

Question 13

What is non alcoholic fatty liver disease (NAFLD)

Answer 13

Primary non-alcoholic fatty liver disease (NAFLD) is an excess of fat in the liver (steatosis) that is not a result of excessive alcohol consumption or other secondary causes. NAFLD ranges from hepatic steatosis, through inflammatory non-alcoholic steatohepatitis (NASH), to fibrosis or cirrhosis.

Question 14

Causes of non fatty liver disease include

Answer 14

Certain medications
Hepatitis c virus
Certain endocrine diseases

Question 15

What is non invasive tests for NAFLD in adults

Answer 15

MRI is noninvasive but expensive Gold standard for diagnosis is liver biopsy

Question 16

What causes sphincter of Oddi spasms?

Answer 16

Sphincter of Oddi dysfunction can be caused by scarring, spasm, strictures, or relaxation of the valve. When this happens, the bile and pancreatic juice can’t flow forward. This causes a backup of digestive juices that causes severe abdominal pain.

Question 17

There are two main types of sphincter of Oddi dysfunction:?

Answer 17

*Biliary dyskinesia (dysfunction). In this situation, the backup of the digestive juices occurs in the bile ducts from the liver.
*Pancreatitis. In this condition, the backup of the digestive juices happens in the pancreas, making it inflamed.

Question 18

What Are the Risk Factors for Getting Sphincter of Oddi Dysfunction?

Answer 18

The sphincter of Oddi dysfunction is mainly observed in women ages 30 to 50. Those who have had their gallbladders removed in surgery also have a higher risk of developing this condition.

Question 19

How Is Sphincter of Oddi Dysfunction Diagnosed?

Answer 19

The doctor then examines your sphincter of Oddi to ensure its normal working. The procedure is called sphincter of Oddi manometry (SOM).

Before the examination, you will be given medicine to relax. Then, the doctor will insert a small plastic tube near the sphincter of Oddi, either in the pancreatic or bile duct. This helps them see how well the valve is contracting and expanding.

Question 20

What Is the Treatment for Sphincter of Oddi Dysfunction?

Answer 20

*If you are in the category III sphincter of Oddi dysfunction, you may not be experiencing severe pain. In such cases, doctors opt for medical treatment and prescribe some medications.
* If your condition is in category I or II, where the pain is quite severe, your doctor may suggest an endoscopic procedure called endoscopic retrograde cholangiopancreatography (ERCP).
* Some doctors also perform sphincterotomy with ERCP. For sphincterotomy, the doctor will sedate you or put you to sleep with anesthesia. When the process starts, they will insert a thin instrument into your small intestine to cut the sphincter of Oddi.

The surgeon will also make sure that your gallbladder (if it’s not removed) or bile ducts don’t have any stones.

Question 21

Special instrumental device for liver imaging

Answer 21

-Fibroscan