Non-Alcoholic Fatty Liver Disease Flashcards
What is non-alcoholic fatty liver disease (NAFLD)?
It is defined as a group of conditions in which there is fat deposition in liver cells
These fat deposits can interfere with the functioning of the liver cells
What is the pathophysiology of non-alcoholic fatty liver disease?
Insulin resistance, which leads to steatosis
What are the four stages of non-alcoholic fatty liver disease?
Non-Alcoholic Fatty Liver Disease (NAFLD)
Non-Alcoholic Steatohepatitis (NASH)
Liver Fibrosis
Liver Cirrhosis
What is non-alcoholic steatohepatitis (NASH)?
It is defined as the deposition of fat within the liver, which results in inflammation
What are the ten risk factors of non-alcoholic fatty liver disease?
Older Age > 50 Years Old
Obesity
Smoking
Type Two Diabetes Mellitus
Hypothyroidism
Hypertension
Hypercholesterolaemia
Metabolic Syndrome
Jejunoileal Bypass
Sudden Weight Loss/Starvation
What is metabolic syndrome?
It is a combination of diabetes, hypertension and obesity
In general how does non-alcoholic fatty liver disease present?
Asymptomatically
However, it becomes symptomatic one it progresses to the NASH, fibrosis and cirrhosis stages
What are the seven clinical features of non-alcoholic fatty liver disease?
Right Upper Quadrant Pain
Jaundice
Pruritis
Oedema
Hepatomegaly
Unexplained Weight Loss
Type Two Diabetes Mellitus Features
Do we screen for non-alcoholic fatty liver disease?
No
In most cases non-alcoholic fatty liver disease is diagnosed through incidental findings on liver ultrasound scans
What are the five investigations used to diagnose non-alcoholic fatty liver disease?
Ultrasound Scan
Blood Tests
NAFLD Fibrosis Score
Fibroscan
Liver Biopsy
How are ultrasound scans used to investigate non-alcoholic fatty liver disease?
It is used to confirm the diagnosis of hepatis steatosis (fatty liver)
However, it doesn’t indicate the stage/severity of non-alcoholic fatty liver disease
What is a feature of non-alcoholic fatty liver disease on US scan?
Hyerpechogenicity
Which two blood tests are used to assess non-alcoholic fatty liver disease?
Liver function tests
Enhanced liver fibrosis (ELF) blood test
What LFT result indicates non-alcoholic fatty liver disease?
Increased ALT Levels
Increased AST Levels
ALT rise > AST rise
When is the ELF blood test used to investigate non-alcoholic fatty liver disease?
It is the first line investigation used to assess non-alcoholic fatty liver disease
What is the ELF blood test?
It measures three markers: HA, PIIINP and TIMP-1, which are then used in an algorithm to provide a result that indicates the severity of liver cirrhosis
What ELF blood score indicates mild liver cirrhosis?
< 7.7
What ELF blood score indicates moderate liver cirrhosis?
7.7 - 9.8
What ELF blood score indicates severe liver cirrhosis?
> 9.8
When is the NAFLD fibrosis score used to investigate non-alcoholic fatty liver disease?
is the second line investigation used to assess non-alcoholic fatty liver disease, when the ELF blood test is not available
What is the NAFLD fibrosis score?
It measures markers, such as age, BMI, liver enzyme levels, platelet levels, albumin levels and diabetes, which are then used in an algorithm to provide a result that indicates the severity of liver cirrhosis
When is the Fibroscan used to investigate non-alcoholic fatty liver disease?
It is the third line investigation used to assess non-alcoholic fatty liver disease
It is performed when the ELF blood score or NAFLD fibrosis score indicates fibrosis
What is the Fibroscan?
It is a specialised ultrasound scan that can be used to classify the severity of liver cirrhosis
It involves sending high frequency sound waves into the liver and measuring the transmission back to the sound wave probe – a process known as transient elastography
What is the function of the Fibroscan?
It enables a measure of liver elasticity, and therefore assessment of the degree of liver cirrhosis
When is liver biopsy used to investigate non-alcoholic fatty liver disease?
It should be conducted in individuals who have advanced fibrosis
When is conservative management of non-alcoholic fatty liver disease recommended?
It is the first line management option
What are the four conservative management options of non-alcoholic fatty liver disease?
Weight Loss
Regular Exercise
Smoking Cessation
Alcohol Cessation
What is the best first line management option of non-alcoholic fatty liver disease?
Weight loss
What is the surgical management option of non-alcoholic fatty liver disease?
Liver transplant
What is the liver transplant?
It involves surgical removal of the whole liver, with replacement of a donor liver
What is the only curative management option of non-alcoholic fatty liver disease?
Liver transplant
When are liver transplants used to manage non-alcoholic fatty liver disease?
It is only considered in those with severe liver cirrhosis
