Gastroenterology 3 - Non-Alcoholic Fatty Liver Disease

Question 1

4 stages from NAFLD to cirrhosis

Answer 1

NAFLD
Non-alcoholic steatohepatitis
Fibrosis
Cirrohosis

Question 2

risk factors for non-alcoholic fatty liver disease

Answer 2

same as any metabolic syndrome

i.e.

obesity, diet, exercise, diabetes, cholesterol, age, smoking, BP

Question 3

describe the 7 components of a liver screen if liver enzymes are deranged

Answer 3

liver ultrasound
hepatitis viral serology
autoAbs (AI hepatitis, PBC, PSC)
immunoglobulins (AI, PBC)
caeruloplasmin 
alpha 1 antitrypsin
ferritin, transferrin sats

Question 4

what is the first line assessment for assessing liver fibrosis in the context of NAFLD?

Answer 4

enhanced liver fibrosis blood test

measures 3 markers to generate a score

estimates severity

second line combines age, BMI, liver enzymes, platelets, albumin, diabetes - only rules out or in, not severity

Question 5

how do you manage NAFLD?

Answer 5

weight loss
exercise
don't smoke
no alcohol
optimise diabetes, BP, cholesterol

Question 6

what treatments may be offered if liver fibrosis is identified? (non alcoholic)

Answer 6

vitamin E,

pioglitazone