Non-Alcoholic Fatty Liver Disease

Question 1

What is NAFLD? (3 things)

Answer 1

1. Increased fat in hepatocytes (steatosis)
2. Fat is visualized (e.g on US)
3. Fat can’t be assoc w other causes (e.g alcohol)

Question 2

When should you consider that liver disease is NOT caused by alcohol? (male n female)

Answer 2

Male = drinks less than 18 units / wk
Female = drinks less than  9 units / wk

Question 3

What is NAFLD characterized by?

Answer 3

Fat deposited in liver cells

Question 4

What problems does NAFLD cause? (2 things)

Answer 4

1. Nothing initially

2. Progresses to hepatitis + cirrhosis

Question 5

What are the stages of NAFLD? (4 things)

Answer 5

1. NAFLD
2. Non-alcoholic Steatohepatitis (NASH)
3. Fibrosis
4. Cirrhosis

Question 6

What are the risk factors for NAFLD? (8 things)

Answer 6

1. Middle age +
2. Smoking
3. Obesity
4. Poor diet / low activity
5. Type 2 DM
6. HTN
7. High cholesterol
8. Metabolic Syndrome

Question 7

What does it mean when you got NAFLD with inflammation (high ALT in LFT)?

Answer 7

Non-Alcoholic Steatohepatitis (NASH)

Question 8

What processes lead to lipid accum in liver? (4 things)

Answer 8

1. Increased fat supply (high fat diet + adipose lipolysis)
2. Decreased fat export (reduced VLDL sec)
3. Decreased free F.A oxidation
4. Increased de novo lipogenesis

Question 9

What are the pathophysiological steps of NAFLD? (4 steps)

Answer 9

1. Processes –> lipid accum (bc risk factors)
2. Increased Triglyceride synth. + Increased Hepatic uptake of F.A
3. Free F.A + byproducts damage hepatocytes by oxidative stress –> lipotoxicity (cellular injury + death)
4. Injured + dying cell induce immune response (inflamm cytokines + cells) –> to repair + replace hepatocytes

Question 10

What are the CF of NAFLD? (4 things)

Answer 10

1. Often asymptomatic
2. Fatigue / malaise
3. RUQ discomfort
4. Hepatomegaly

Question 11

What are the incidental findings of NAFLD? (aka stuff youll see randomly when ur not even looking for NAFLD) (2 things)

Answer 11

1. Abn LFT

2. Hepatic stenosis @ US

Question 12

What are the CF when NAFLD progresses to Cirrhosis? (4 things)

Answer 12

1. Spider naevi
2. Palmar erythema (red palms)
3. Hepatosplenomegaly
4. Ascites

Question 13

What are the risk factors for progression of NAFLD to Cirrhosis? (4 things)

Answer 13

1. Age
2. Obesity
3. DM
4. NASH

Question 14

What is the best diagnostic test for NAFLD that is RARELY done?

Answer 14

Liver biopsy
(only done if diagnosis is unclear)

Question 15

What is the use of liver biopsy in NAFLD? (2 things)

Answer 15

1. Distinguishes NAFLD from NASH

2. Detects cirrhosis

Question 16

What is used to confirm the diagnosis of NAFLD?

Answer 16

Liver US

Question 17

What does a Liver US NOT show? (3 things)

Answer 17

1. Severity of NAFLD
2. Liver function
3. Fibrosis

Question 18

What is the FIRST line investigation to check for Fibrosis in NAFLD?

Answer 18

Enhanced Liver Fibrosis (ELF) blood test

Question 19

What is the SECOND line investigation to check for Fibrosis in NAFLD?

Answer 19

NAFLD Fibrosis Score

Question 20

What are the pros and cons of NAFLD Fibrosis Score?

Answer 20

Pro = Helps RULE OUT fibrosis
Con = Doesn’t show SEVERITY of fibrosis

Question 21

What is the THIRD line investigation to check for Fibrosis in NAFLD?

Answer 21

FibroScan US

Question 22

What is the use of FibroScan US in NAFLD, and when is it done?

Answer 22

Shows severity of Fibrosis

Done when ELF or NAFLD Fibrosis Score indicate Fibrosis

Question 23

What is the management for NAFLD? (6 things)

Answer 23

1. Weight loss (maybe bariatric surgery if obese)
2. Exercise
3. X Smoking
4. Avoid alcohol
5. Control diabetes / BP / cholesterol
6. If fibrosis –> refer to Liver Specialist

Question 24

What will the Liver Specialist treat a NAFLD pt with Fibrosis with? (2 things)

Answer 24

1. Vit E

2. Pioglitazone

Question 25

What complications should a NAFLD pt be monitored for in follow ups? (3 things)

Answer 25

1. NASH
2. Cirrhosis
3. DM