NAFLD and alcoholic fatty liver

Question 1

What is the most common cause of abnormal LFTs in the UK?

Answer 1

Non-alcoholic fatty liver disease

Question 2

Features of NAFLD?

Answer 2

• Usually asymptomatic
• May cause non-specific symptoms (e.g. fatigue, malaise, abdominal discomfort)
• Risk factors present (metabolic syndrome)
• Deranged LFTs for >3 months

Question 3

Initial management of NAFLD?

Answer 3

Conservative (e.g. weight loss)

Question 4

What is the medical and surgical management of NAFLD?

Answer 4

• Medical: refer to specialist for vitamin E or pioglitazone if fibrosis
• Surgical: consider transplant in advanced disease

Question 5

Investigation for NAFLD?

Answer 5

• Non-invasive liver screen
• Liver USS
• Enhanced liver fibrosis blood test to assess for fibrosis

Question 6

Progression of alcoholic fatty liver disease?

Answer 6

1) Alcohol related fatty liver
2) Alcoholic hepatitis
3) Cirrhosis

Question 7

What are the stigmata of chronic liver disease?

Answer 7

• Reduced liver function: jaundice and bruising
• Portal hypertension: caput medusa, rectal haemorrhoids, varices, hepatomegaly, ascites
• Chronic liver disease: spider naevi, palmar erythema, asterixis, gynaecomastia

Question 8

Bloods findings in alcoholic fatty liver disease?

Answer 8

• Elevated PT
• Raised MCV
• Rise in AST:ALT>2:1
• Raised GGT

Question 9

What is the AST:ALT elevation pattern seen in AFLD?

Answer 9

2:1

Question 10

Gold standard investigation for alcoholic fatty liver?

Answer 10

Liver biopsy

Question 11

Management of alcoholic fatty liver disease?

Answer 11

• Alcohol cessation + thiamine supplement
• Steroids
• Treat complications of cirrhosis
• Liver transplant in severe disease (must be abstinent of 3 months)

Question 12

What is used to determine benefit of steroid use in acute episodes of alcoholic hepatitis?

Answer 12

Maddrey’s fulminant (score >32)

Question 13

Obesity/T2DM with abnormal LFTs might suggest?

Answer 13

Non-alcoholic fatty liver disease

Question 14

What is Maddrey’s fulminant based on?

Answer 14

Bilirubin and PT

Question 15

What are the complications of alcoholic fatty liver disease?

Answer 15

• Increased risk of breast, throat, oral and liver cancer
• Alcoholic liver disease
• Liver cirrhosis (+ further complications of alcoholic hepatitis)
• Alcohol dependence +/- withdrawal (=/- Korsakoff’s syndrome +/- Wernicke’s encephalopathy)
• Pancreatitis
• Alcoholic cardiomyopathy
• Oesophageal varices