Fatty liver

Question 1

Features

Answer 1

This is an abnormal build-up of fat in hepatocytes (hepatic steatosis).

Question 2

There are 2 main types

Answer 2

as distinct from fatty liver of pregnancy or alcoholic disease.

Non-alcoholic fatty liver disease (NAFLD)

• common
• usually benign
• may progress to cirrhosis

Non-alcoholic steatohepatitis (NASH)

• uncommon
• inflammation
• potentially serious with cirrhosis
• and possibly hepatocellular carcinoma

Question 3

Causes

Answer 3

The big two

1. obesity
2. diabetes mellitus.

Other:

• crash diet
• dyslipidaemia
• starvation (protein ↓)
• hypertension
• drugs, e.g. steroids, tetracycline, methotrexate

Question 4

Clinical

Answer 4

Usually asymptomatic with abnormal LFTs,

maybe

• fatigue/malaise,
• hepatomegaly

Question 5

Investigations

Answer 5

LFTs (typically ↑ AST, ALT in NAFLD)

fibrosis score

fibroscan

Question 6

Management

Answer 6

Lifestyle modification

treat cause, e.g. diabetes, obesity (inc. bariatric surgery).

Surveillance for cirrhosis and cardiovascular disease.

Refer if :

• evidence of cirrhosis
• very abnormal LFTs
• ↑ ↑ levels ferritin.