Non-alcoholic fatty liver disease

Question 1

What is the definition of NAFLD?

Answer 1

Macrovesicular hepatic steatosis in those who do not consume alcohol in harmful amounts

Question 2

What are the risk factors for NAFLD?

Answer 2

Obesity, T2DM, hypertension, hypercholesterolaemia, metabolic syndrome, >50, smoke

Question 3

What is the presentation of NAFLD?

Answer 3

Fatigue, malaise, hepatosplenomegaly, truncal obesity, RUQ discomfort
Late disease - pruritis, jaundice, spider naevus, palmar erythema, nail changes, Dupuytrens contracture, bruising, petechiae

Question 4

What are the investigations for NAFLD?

Answer 4

Raised AST, ALT, ALP, bilirubin, GGT, INR

FBC (anaemia, thrombocytopenia)

Question 5

What is the management of NAFLD?

Answer 5

Weight loss, diabetes control, statins, vit E

End stage - transjugular intrahepatic portosystemic shunt, liver transplant

Question 6

What are the complications of NAFLD?

Answer 6

Cirrhosis, ascites, variceal haemorrhage, portosystemic encephalopathy, NASH (non-alcoholic steatohepatitis)