Fatty Liver

Question 1

what tests could you do for NAFLD?

Answer 1

BMI
BP
Liver
Spleen
Ascites
External eye exam
Derm exam
- general
- skin characteristics
- skin lesions
- hair and nails

Question 2

what are the possible other conditions they could give?

Answer 2

NASH: think portal hypertension (BP, Ascites, spleen palpation)
MAFLD: metabolic associated

Question 3

What BP would increase the probability of NAFLD?

Answer 3

Hypertension: over 130/80

“Patients BP is 110/70, this is within normal range for BP, this decreases the probability of NAFLD. hypertension (a BP over 130/80). would increase the probability.”

Question 4

What liver findings are relevant for liver palpation and percussion for NAFLD?

Answer 4

The patient has a Midclavicular liver span between 6cm to 12cm, they are in no pain or distress during palpation, and there are no nodules present. This would decrease the probability of NAFLD.

In NAFLD, there may be Hepatomegaly, nodules / firm sharp borders may be felt, and the patient may be in pain on palpation.

Hepatomegaly can occur in fatty liver disease due to fat accumulation within hepatocytes, which enlarges the liver. Inflammation and fibrosis in more advanced disease stages (e.g., NASH) can further contribute to liver enlargement.

Question 5

Findings for Spleen?

Answer 5

percussion: remains tympanitic on percussion

palpation: not palpation, no pain or tenderness

Splenomegaly: sound on percussion shifts to “dullness”, positive Castelle’s sign, spleen palpable.

This would decrease the probability of NAFLD, aIn fatty liver disease, splenomegaly can develops due to portal hypertension caused by fibrosis or cirrhosis”

Question 6

Findings for ascites? Do fluid wave test

Answer 6

“no fluid wave observed/felt on the opposite flank”
“this would decrease the probability of fatty liver, In fatty liver disease, ascites develops due to portal hypertension caused by fibrosis or cirrhosis”

Question 7

findings for external eye exam

Answer 7

“there is occular and eyelid symmetry, no edema, lesions, discolouration, eyelashes are intact and eyelids cover same amount of eyeball”

“The sclera is white and surrounds the iris and pupil. The conjunctiva is pink and free of inflammation’.

This decreases the probability of NAFLD as icteric/jaundice of the sclera indicates liver pathology

Question 8

General skin exam findings

Answer 8

“skin is well perfused and smooth, colour is consistent with ethnicity, temperature is consistent throughout”
- no spider angiomas
- no caput medusae
- no jaundice
- no palmer erythema

“The absence of signs like spider angiomas, caput medusae, jaundice, and palmar erythema reduces the likelihood of advanced fatty liver disease because these findings are typically associated with significant liver pathology”

Question 9

findings for hair and nails?

Answer 9

There may be reduction of body hair