Gastro - Non-Alcoholic Fatty Liver Disease Flashcards
What is non-alcoholic fatty liver disease?
Excessive fat in hepatocytes, specifically triglycerides
Causes disfunction of hepatocytes
How does NAFLD present?
Asymptomatic
Can progress to hepatitis and liver cirrhosis
How many people have NAFLD?
25% of people
What are the stages of NAFLD?
- Non-alcoholic fatty liver disease
- Non-alcoholic steatohepatitis
- Fibrosis
- Cirrhosis
What are the risk factors of NAFLD?
Same risk factors as CVD and diabetes
Obesity
Poor diet
Sedentary lifestyle
Type 2 diabetes
High cholesterol
Hypertension
Smoking
What is NAFLD associated with?
Metabolic syndrome
Combination of hypertension, obesity and diabetes
Common and increases risk of CVD and other health problems
What investigations are used for NAFLD?
LFTs- raised ALT
Liver ultrasound - can confirm hepatic steatosis (increased echogenicity)
Enhanced liver fibrosis blood test - first-line investigation for assessing fibrosis in NAFLD
Measures HA, PIIINP, TIMP-1
10.51 or above- advanced fibrosis
under 10.51- unlikely advanced fibrosis
NAFLD Fibrosis score
Fibrosis 4
Transient elastography (FibroScan)
Liver biopsy
How is NAFLD diagnosed?
Requires ultrasound findings of a fatty liver
Risk factors
Exclude other causes of liver disease with careful alcohol history and full non-invasive liver screen
Liver biopsy
Gold standard test
How is NAFLD managed?
Weight loss
Healthy diet (Mediterranean diet)
Exercise
Avoid alcohol
Stop smoking
Control diabetes, blood pressure and cholesterol
Refer patients when scoring indicates liver fibrosis to specialist
What does specialist management of NAFLD involve?
Vitamin E
Pioglitazone
Bariatric surgery
Liver transplantation
