Wk1 Fatty Liver Disease

Question 1

What is the characteristics of NAFLD?

Answer 1

1. hepatic steatosis on imaging or histology
2. exclusion of secondary causes

Question 2

what is the prevalence of NAFLD?

Answer 2

20-30%

Question 3

what is the most common causes of liver disease in Canada?

Answer 3

NAFLD

Question 4

What is the prevalence of NASH?

Answer 4

3-5%

Question 5

NAFLD is more common in which population?

Answer 5

obese/overweight adults

Question 6

what is the prevalence of NAFLD in children?

Answer 6

3-10%

Question 7

In patients with nonalcoholic fatty liver disease (NAFLD) in North America, what percentage have obesity?

Answer 7

40%

Question 8

In patients with nonalcoholic fatty liver disease (NAFLD) in North America, what percentage have diabetes?

Answer 8

> 20%

Question 9

In patients with nonalcoholic fatty liver disease (NAFLD) in North America, what percentage have dyslipidemia/hypertriglyceridemia ?

Answer 9

> 20%

Question 10

What is NAFLD associated with?

Answer 10

Insulin resistance and metabolic syndrome

Question 11

How do you diagnose ‘metabolic syndrome’?

Answer 11

3 out of 5:

• BP (>130/>85)
• FBG (5.6)
• HDL (<50F, <40M)
• TG (1.7)
• WC (35F, 40M)

or on medications

Question 12

What are the maternal risk factor for NAFLD?

Answer 12

maternal obesity & high maternal early-pregnancy glucose concentration

Question 13

What are the maternal protective factors for NAFLD?

Answer 13

breastfeeding >6 months which can reduce NAFLD risk in offspring and mother

Question 14

What are some risk exposures risk factor for NAFLD?

Answer 14

drugs and toxins

Question 15

What are some dietary and nutritional factors that can cause NAFLD?

Answer 15

• excessive dietary fructose
• malnutrition
• starvation & refeeding syndrome
• total parenteral nutrition

Question 16

What is the percentage of patient with NAFLD progress to NASH?

Answer 16

20%

Question 17

What is the percentage of patient with NASH progress to cirrhosis?

Answer 17

20%

less than 4% of patient with NAFLD progress to cirrhosis.

Question 18

What is the risk factors for advanced hepatic fibrosis and cirrhosis?

Answer 18

Advanced age
Obesity
DM

Question 19

What is the strongest predictor of progression of NAFLD?

Answer 19

The degree of inflammation on the first biopsy

Question 20

What are some complications of NAFLD?

Answer 20

• Cardiovascular disease
• Hepatocellular carcinoma (1-2% of annual risk)
• End-stage liver disease and liver failure (45% over 10yrs)

Question 21

What are some possible presentations of early stage NAFLD though most are asymptomatic?

Answer 21

• Fatigue
• Malaise
• RUQ mild abdominal discomfort

Question 22

what lab testing is used to evaluate liver function?

Answer 22

Mild elevated or normal ALT and AST

• AST/ALT <0.8 or ALT/AST>1 for early NAFLD
• AST/ALT>1.5 in alcohol associated liver disease
• AST>ALT in advanced fibrosis and cirrhosis

Possible elevation of ALP and GGT

Question 23

What lab testing is used to examine metabolic risk factors?

Answer 23

• lipid levels
• fasting glucose or HbA1C
• fasting glucose and fasting insulin for insulin resistance (HOMA/QUICKI)

Question 24

Which imaging is test of choice for NAFLD?

Answer 24

ultrasonography

Question 25

What is liver biopsy indicated?

Answer 25

Assessing more advanced conditions like NASH and firbosis

Question 26

Which noninvasive clinical risk scoring system can be used to screen high-risk groups for NAFLD such as those with metabolic syndrome or T2DM?

Answer 26

Fatty liver index (FLI) NAFLD in metabolic syndrome score (NAFLD-MS score)

Question 27

What is the gold standard for diagnosing NAFLD?

Answer 27

Liver biopsy and histology

Question 28

How can NASH diagnosis be established?

Answer 28

Only with liver biopsy

Question 29

Which testing is used in NAFLD patients who have had a liver biopsy?

Answer 29

NAFLD activity score

Question 30

Should score of NAFLD activity score be used to definitively diagnosis NASH?

Answer 30

No. It correlated with steatohepatitis diagnosis.

Question 31

Who need liver biopsy?

Answer 31

Those are at high risk for having NASH and advanced fibrosis based on noninvasive testing. An indeterminate result from noninvasive test

Question 32

Based on noninvasive testing, patient has low risk of fibrosis. Should liver biopsy be ordered?

Answer 32

No

Question 33

Which test to estimate the amount of scarring in the liver?

Answer 33

NAFLD Fibrosis score

Question 34

Which test to estimate the amount of liver fibrosis and need for a liver biopsy?

Answer 34

Fibrosis-4

Question 35

Which test is used to measure liver stiffness and stage of liver fibrosis?

Answer 35

Ultrasound elastography

Question 36

Which condition is the second most common reason for liver transplant in North America?

Answer 36

NAFLD

Question 37

How often does NASH with cirrhosis require surveillance for hepatocellular carcinoma with a liver ultrasound?

Answer 37

Every six months.