Non-Alcoholic Fatty Liver Disease Flashcards
Explain NAFLD.
Commonest liver disorder in Western industrialised countries (20%)
There is increased fat deposits in hepatocytes called steatosis.
This can be seen on ultrasound.
NAFLD is diagnosed when the fat deposits inside the hepatocytes cannot be explained by any other cause, such as alcoholic liver disease.
Stages of NAFLD
1 - Non-alcoholic fatty liver disease
2 - Non-alcoholic Steatohepatitis (NASH)
3 - Fibrosis
4 - Cirrhosis
What is non-alcoholic steatohepatitis?
Essentially NAFLD with inflammation present.
LFTs (typically ALT) will be elevated.
Risk factors
Obesity
Poor diet and low activity levels
T2DM
High cholesterol
Middle aged onwards
Smoking
High BP
Complications of NAFLD and NASH.
Those of cirrhosis.
Risk factors for progression of NAFLD.
Older age
Obesity
DM
NASH
Treatment of NAFLD.
Control risk factors such as obesity.
Address CVS risk (which is also the most common cause of death in NAFLD)
Avoid alcohol
No drug is of proven benefit but vitamin E might improve histology in fibrosis.
Follow-up of NAFLD.
Monitor complications such as NASH, DM, cirrhosis.
If there is cirrhosis present, screen for HCC with ultrasound +/- AFP twice yearly.
Investigations
Non-invasive liver screen
USS liver
Hep B and C serology
Autoantibodies (ANA, SMA, AMA, LKM-1, ASMA)
Immunoglobulins for AIH and PBC
Caeruloplasmin
Alpha1-antitrypsin
Ferritin and Transferrin saturation
Investigations specifically in NAFLD.
Liver ultrasound to confirm hepatic steatosis.
1st line - Enhanced liver fibrosis (ELF) blood test (HA, PIIINP, TIMP-1)
2nd line - NAFLD fibrosis score if ELF blood test is not available
3rd line - Fibroscan
Management
Weight loss
Exercise
Stop smoking
Control of diabetes, blood pressure and cholesterol
Avoid alcohol
Refer if liver fibrosis to a liver specialist where they may treat with Vitamin E or pioglitazone
