Non-Alcoholic Fatty Liver Disease

Question 1

What is the common cause of non-alcoholic fatty liver disease?

Answer 1

Metabolic syndrome - hypertension, diabetes mellitus, obesity, hyperlipidaemia.

Question 2

What is the pathophysiology of non-alcoholic fatty liver disease how is it visualised?

Answer 2

1. Increased fat in hepatocytes (steatosis)

2. USS

Question 3

What is the term for non-alcoholic fatty liver disease where inflammation is also present?

Answer 3

Non-alcoholic steatohepatitis (NASH)

Question 4

What is the difference in LFTs between non-alcoholic fatty liver disease and non-alcoholic steatohepatitis?

Answer 4

Typically raised a LT more than AST in non-alcoholic steatohepatitis.

Question 5

How is a diagnosis of non-alcoholic fatty liver disease confirmed?

Answer 5

Biopsy - >5% fat is abnormal

Question 6

What are the risk factors for progression from a healthy liver to a fibrotic liver in non-alcoholic fatty liver disease?

Answer 6

Old age, obesity, diabetes mellitus, non-alcoholic steatohepatitis.

Question 7

What is the treatment for non-alcoholic fatty liver disease?

Answer 7

1. Control symbolic and cardiovascular risk factors (bariatric surgery if needed)
2. Avoid alcohol
3. If cirrhotic, for HCC with abdominal USS and serum AFP twice-yearly.

Question 8

What is the difference between alcoholic liver disease and non-alcoholic fatty liver disease in these parameters?

1. BMI
2. HbA1c
3. AST
4. AST:ALT ratio

Answer 8

1. ALD - variable, NAFLD - raised
2. ALD - typically normal, NAFLD - raised
3. ALD - raised more than ALT, NAFLD - normal
4. ALD - >2, NAFLD - <0.8 (ALT>AST)