Hepatitis (nafld) Flashcards
What is non-alcoholic fatty liver disease (NAFLD)?
NAFLD is the most common cause of liver disease in the developed world, largely caused by obesity, and describes a spectrum of disease ranging from steatosis to liver cirrhosis.
What are the stages of non-alcoholic fatty liver disease?
The stages include steatosis (fat in the liver), steatohepatitis (fat with inflammation), and progressive disease that may cause fibrosis and liver cirrhosis.
What is the key mechanism leading to steatosis in NAFLD?
Insulin resistance is thought to be the key mechanism leading to steatosis.
What is non-alcoholic steatohepatitis (NASH)?
NASH describes liver changes similar to alcoholic hepatitis in the absence of alcohol abuse and affects around 3-4% of the general population.
What are some associated factors of NAFLD?
Associated factors include obesity, type 2 diabetes mellitus, hyperlipidaemia, jejunoileal bypass, and sudden weight loss/starvation.
What are the common features of NAFLD?
Common features include being usually asymptomatic, hepatomegaly, ALT typically greater than AST, and increased echogenicity on ultrasound.
What did the NICE guidelines on NAFLD state in 2016?
NICE guidelines state there is no evidence to support screening for NAFLD in adults, and management is based on incidental findings of asymptomatic fatty changes on liver ultrasound.
What is the enhanced liver fibrosis (ELF) blood test?
The ELF blood test is a combination of hyaluronic acid, procollagen III, and tissue inhibitor of metalloproteinase 1, resulting in an ELF score to check for advanced fibrosis.
What alternatives to the ELF blood test can be used to assess fibrosis severity?
Non-invasive tests like the FIB4 score or NAFLD fibrosis score, used in combination with a FibroScan, can assess fibrosis severity.
What should be done for patients likely to have advanced fibrosis?
Patients likely to have advanced fibrosis should be referred to a liver specialist for a liver biopsy to stage the disease more accurately.
What is the mainstay of treatment for NAFLD?
The mainstay of treatment is lifestyle changes, particularly weight loss, and monitoring.
What ongoing research is being conducted for NAFLD management?
Ongoing research is focused on the role of gastric banding and insulin-sensitising drugs like metformin and pioglitazone.
