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GI, liver, kidney > NAFLD > Flashcards

NAFLD Flashcards

1
Q

Definition of NAFLD

A

> 5% of hepatocytes steatotic - fatty infiltration of liver in absence of secondary cause
Liver manifestation obesity and metabolic syndrome

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1
Q

Staging of NAFLD

A

Hepatic steatosis only
Steatohepatitis +/- fibrosis - NASH
Cirrhosis

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2
Q

What is NASH

A

Steatohepatitis +/- fibrosis
Fat and hepatocellular injury and inflammation
can still regress from fibrosis

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3
Q

Prognosis of cirrhosis

A
  • 45% risk of decompensation in 10 years
  • 2% risk HCC/year
  • 20% mortality - 10 years
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4
Q

Pathogenesis of NAFLD

A
  • Visceral obesity → insulin resistnace
  • Increase lipolysis in peripheral tissues → more free fatty acids in blood in the liver
  • Lipogenesis - more fat produced in liver, also decreased export
  • Gut microbiota, oxidative stress and genetics, age, geneder, ethnicity → inflammation
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5
Q

Factors affecting NAFLD progression

A

T2DM
Weight gain
Poor DM contol
Metabolic syndrome
Inacitivity
Diet - high fat, sugar, fructose
Increasing age
Genetics - PNPLA3, TM5F6
Sleep apnoea

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6
Q

Factors slowing NASH progression

A

Weight loss
Exercise
Mediterranean diet
DM control
Coffee

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7
Q

WHo suspect NAFLD in

A
  • All overwieght/obese individuals
  • Older sedentary
  • T2DM/metabolic syndrome
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8
Q

How is NAFLD identified

A

Raised liver enxymes but ofetn normal
Imaging of steatosis
Imagine evidence of cirrhosis or liver cancer

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9
Q

What is criteria for NAFLD diagnosis

A

Raised ALT+/or GGT + steartosis on imaging
OR evidence of insuline resistance/central obesity/metabolic facotrs

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10
Q

How to rule out other differentials in NAFLD

A

No hisotry of alcogol excess
Pre-exisitng liver disease
Hepatotoxic drugs
Negative liver screen for other diseases eg virus
Liver biopsy if uncertain diagnosis

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11
Q

What does a raised ALT fall with

A

Advancing fibroris
Age

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12
Q

What is most common LFT abnormality in NAFLD

A

Raised GGT
Next - ALT, IgA, ferritin w normal TS

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13
Q

What aminotransferase increases with fibrosis

A

AST

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14
Q

Imaging for NAFLD

A

US
MRI - PDFF
MR spectrocsopy

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15
Q

What is CAP

A

Controlled attenuation parameter
Bedside measure of steatosis

16
Q

Staging of fribrosis

A

F0-1
F2-3
F4

17
Q

Managment of FO-1 fibrosis

A

Lifestyle advice, treat metabolic syndrome
Reassess FIB4/TE 3 years

18
Q

F2-3 manamgenet

A

Lifestyle + metabolic treat
NAFLD direct therapy

19
Q

F4 fibrosis managmenet

A

NAFLD direct therapy
HCC and varices screen
lifestyle + treat metabolic

20
Q

Tests for fibrosis

A

Scores -
FIB-4
NAFLD fibrosis score
ELF test
Fibrotest
ProC3

21
Q

What level means fibrosis on a transient elastograhy and suggests liver biopsy

A

> 8kPa

22
Q

Imaging for fibroris

A

Transient elastography
Acoustic force radiation imaging - ARFI
Mr ELASTOGRAPHY

23
Q

Clinical scores for fibroriss

A

AST:ALT ratio >0.8 = advanced fibroris
FIB-4 score

24
Q

What FIB-4 scores suggest transient elastography

A

> 1.3 if under 65
2 if over 65

25
Q

What is conisidered in FIB4

A
  • Age
  • AST
  • ALT
  • Platelet count
  • 0.3 = no fibrosis
26
Q

What FIB4 diagnoses fibrosis level

A

> 2.67 if under 65
3.25 if over 65

27
Q

Treatment for NAFLD

A

Weight loss - 10% goal
Exercise
Manage CVS risk

28
Q

Weight loss help in NAFLD

A

Orlistat
Clinic visits
Support schemes/programmes, diets etc
Bariatric surgery if BMI >40 or >35 + comorbidity (caution in cirrhosis)

29
Q

What medications are good for NAFLD that treat diabetes

A

Metformin - reduce HCC
Pioglitazone, liraglutide - reduce steatosis + slows fibrosis progression

30
Q

Pioglitazone side effects

A

weight gain, increased risk bladder cancer, reduced bone density

31
Q

Maangement of metabolic syndrome in NAFLD

A

Treat DM - metformin, pioglizine, liraglutide
HPTN - ARBs/ACEis (antifibrotic)
Dyslipidemia - statins
Sleep apnoea
Smoking cessation

32
Q

Treatment for F3 NASH non diabetic vs diabetic

A

Vit E if non diabetic
Assess ALT response after 6 monhts - should decline
Diabetic - GLP-1, piaglitzone or empaglaflozin

33
Q

What blood test can test for advanced fibrosis

A

Enhanced liver fibrosis - ELF blood test

34
Q

What does ELF blood test test

A

hyaluronic acid + procollagen III + tissue inhibitor of metalloproteinase 1.

35
Q

What investigations used together to for diagnosis of NAFLD

A

FIB-4 or NAFLD fibrosis
+ fibroscan (transient elastography)

GI, liver, kidney (50 decks)

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