Non-Alcoholic Fatty Liver Disease

Question 1

What is non-alcoholic fatty liver disease (NAFLD)?

Answer 1

It is defined as a group of conditions in which there is fat deposition in liver cells

These fat deposits can interfere with the functioning of the liver cells

Question 2

What is the pathophysiology of non-alcoholic fatty liver disease?

Answer 2

Insulin resistance, which leads to steatosis

Question 3

What are the four stages of non-alcoholic fatty liver disease?

Answer 3

Non-Alcoholic Fatty Liver Disease (NAFLD)

Non-Alcoholic Steatohepatitis (NASH)

Liver Fibrosis

Liver Cirrhosis

Question 4

What is non-alcoholic steatohepatitis (NASH)?

Answer 4

It is defined as the deposition of fat within the liver, which results in inflammation

Question 5

What are the ten risk factors of non-alcoholic fatty liver disease?

Answer 5

Older Age > 50 Years Old

Obesity

Smoking

Type Two Diabetes Mellitus

Hypothyroidism

Hypertension

Hypercholesterolaemia

Metabolic Syndrome

Jejunoileal Bypass

Sudden Weight Loss/Starvation

Question 6

What is metabolic syndrome?

Answer 6

It is a combination of diabetes, hypertension and obesity

Question 7

In general how does non-alcoholic fatty liver disease present?

Answer 7

Asymptomatically

However, it becomes symptomatic one it progresses to the NASH, fibrosis and cirrhosis stages

Question 8

What are the seven clinical features of non-alcoholic fatty liver disease?

Answer 8

Right Upper Quadrant Pain

Jaundice

Pruritis

Oedema

Hepatomegaly

Unexplained Weight Loss

Type Two Diabetes Mellitus Features

Question 9

Do we screen for non-alcoholic fatty liver disease?

Answer 9

No

In most cases non-alcoholic fatty liver disease is diagnosed through incidental findings on liver ultrasound scans

Question 10

What are the five investigations used to diagnose non-alcoholic fatty liver disease?

Answer 10

Ultrasound Scan

Blood Tests

NAFLD Fibrosis Score

Fibroscan

Liver Biopsy

Question 11

How are ultrasound scans used to investigate non-alcoholic fatty liver disease?

Answer 11

It is used to confirm the diagnosis of hepatis steatosis (fatty liver)

However, it doesn’t indicate the stage/severity of non-alcoholic fatty liver disease

Question 12

What is a feature of non-alcoholic fatty liver disease on US scan?

Answer 12

Hyerpechogenicity

Question 13

Which two blood tests are used to assess non-alcoholic fatty liver disease?

Answer 13

Liver function tests

Enhanced liver fibrosis (ELF) blood test

Question 14

What LFT result indicates non-alcoholic fatty liver disease?

Answer 14

Increased ALT Levels

Increased AST Levels

ALT rise > AST rise

Question 15

When is the ELF blood test used to investigate non-alcoholic fatty liver disease?

Answer 15

It is the first line investigation used to assess non-alcoholic fatty liver disease

Question 16

What is the ELF blood test?

Answer 16

It measures three markers: HA, PIIINP and TIMP-1, which are then used in an algorithm to provide a result that indicates the severity of liver cirrhosis

Question 17

What ELF blood score indicates mild liver cirrhosis?

Answer 17

< 7.7

Question 18

What ELF blood score indicates moderate liver cirrhosis?

Answer 18

7.7 - 9.8

Question 19

What ELF blood score indicates severe liver cirrhosis?

Answer 19

> 9.8

Question 20

When is the NAFLD fibrosis score used to investigate non-alcoholic fatty liver disease?

Answer 20

is the second line investigation used to assess non-alcoholic fatty liver disease, when the ELF blood test is not available

Question 21

What is the NAFLD fibrosis score?

Answer 21

It measures markers, such as age, BMI, liver enzyme levels, platelet levels, albumin levels and diabetes, which are then used in an algorithm to provide a result that indicates the severity of liver cirrhosis

Question 22

When is the Fibroscan used to investigate non-alcoholic fatty liver disease?

Answer 22

It is the third line investigation used to assess non-alcoholic fatty liver disease

It is performed when the ELF blood score or NAFLD fibrosis score indicates fibrosis

Question 23

What is the Fibroscan?

Answer 23

It is a specialised ultrasound scan that can be used to classify the severity of liver cirrhosis

It involves sending high frequency sound waves into the liver and measuring the transmission back to the sound wave probe – a process known as transient elastography

Question 24

What is the function of the Fibroscan?

Answer 24

It enables a measure of liver elasticity, and therefore assessment of the degree of liver cirrhosis

Question 25

When is liver biopsy used to investigate non-alcoholic fatty liver disease?

Answer 25

It should be conducted in individuals who have advanced fibrosis

Question 26

When is conservative management of non-alcoholic fatty liver disease recommended?

Answer 26

It is the first line management option

Question 27

What are the four conservative management options of non-alcoholic fatty liver disease?

Answer 27

Weight Loss

Regular Exercise

Smoking Cessation

Alcohol Cessation

Question 28

What is the best first line management option of non-alcoholic fatty liver disease?

Answer 28

Weight loss

Question 29

What is the surgical management option of non-alcoholic fatty liver disease?

Answer 29

Liver transplant

Question 30

What is the liver transplant?

Answer 30

It involves surgical removal of the whole liver, with replacement of a donor liver

Question 31

What is the only curative management option of non-alcoholic fatty liver disease?

Answer 31

Liver transplant

Question 32

When are liver transplants used to manage non-alcoholic fatty liver disease?

Answer 32

It is only considered in those with severe liver cirrhosis