3.11. Liver + Biliary Tree Disease - Non-Alcoholic Fatty Liver Disease Flashcards
Which group of conditions is Non-Alcoholic Fatty Liver Disease (NAFLD) associated with?
Metabolic Syndromes - e.g. Diabetes, Obestity, Hypertension, Hypertriglyceridaemia
What other factors effect Non-Alcoholic Fatty Liver Disease (NAFLD)?
- The frequency increases with age
- There is a genetic factor (e.g. the PNPLA3 gene)
- It is more prevalent in the Hispanic Community
What is the Pathology of Non-Alcoholic Fatty Liver Disease (NAFLD)?
The Hepatocytes become infiltrated with fat (Steatosis) associated with a disturbance in metabolism - but not associated with Alcohol intake.
What can this Steatosis lead to?
- Hepatomegaly - known as Non-Alcoholic Steatohepatitis (NASH)
- The inflammatory response, resulting in fibrosis of the liver
What can the Inflammatory Response, causing Fibrosis, lead to?
Liver Cirrhosis
What are the Clinical Signs of Non-Alcoholic Fatty Liver Disease (NAFLD)?
- Hepatomegaly
- Obesity
- Weight Loss
- Jaundice
Why is Obesity a Clinical Sign?
As this is the Major Risk Factor
Why might there be Weight Loss?
Due to the potential Malabsorption of Fat, due to the Malfunctioning Liver
What Type of Jaundice will be present?
Intrahepatic (Conjugative) Jaundice
What are the Symptoms of Non-Alcoholic Fatty Liver Disease (NAFLD)?
- Asymptomatic (in most cases)
- Pain
- Fatigue / Weakness
- Pruritus
What type of Pain might occur?
A dull, aching pain in the Right Hypochondriac Region
Why might Pain occur?
Due to the damage of hepatocytes and the associated Hepatomegaly
Why might Fatigue / Weakness be present?
Due to Malabsorption
Why might Pruritus?
Due to the Hyperbilirubinaemia associated with the Jaundice and Liver Failure
What investigations are neccessary in Non-Alcoholic Fatty Liver Disease (NAFLD)?
- Staging
- Liver Function Test (and Biochemistry)
- Enhanced Liver Fibrosis (ELF) Panel
- Abdominal Ultrasound / CT Scan
- Fibroscan
- MRI Spectroscopy
- Biopsy
When must Staging occur?
Before treatment begins
What is taken into account for the Staging?
Each of these being High Risk will score 1 point
- Age
- Diabetes
- BMI
- Aminotransferase Ratio (AST/ALT)
- Platelet Count
- Albumin Count
How many points must there be before the patient is deemed High Risk of developing Non-Alcoholic Fatty Liver Disease (NAFLD)?
3
What is the Age Component of the Scoring System?
Low Risk - Less than 45
High Risk - Older than 45
What is the Diabetes Component of the Scoring System?
Low Risk - Absent
High Risk - Present
What is the BMI Component of the Scoring System?
Low Risk - Less than 30
High Risk - Greater than 30
What is the Aminotransferase Ratio (AST/ALT)Component of the Scoring System?
Low Risk - Less than 1 (ASTALT)
What is the Platelet Count Component of the Scoring System?
Low Risk - Normal (>150)
High Risk - Low (<150)
What is the Albumin Count Component of the Scoring System?
Low Risk - Normal (>34)
High Risk - Low (<34)
