Non-Alcoholic Fatty Liver Disease

Question 1

What is non-alcoholic fatty liver disease?

Answer 1

It is characterised by fat deposited in the liver cells which can interfere with the functioning of the liver cells. NAFLD does not cause problems initially, but it to progress to hepatitis and cirrhosis.

Question 2

What percentage of adults have NAFLD?

Answer 2

Up to 30% of adults have NAFLD

Question 3

What are the stages of NAFLD?

Answer 3

1. Non-alcoholic Fatty Liver Disease
2. Non-alcoholic Steatohepatitis (NASH)
3. Fibrosis
4. Cirrhosis

Question 4

What are the risk factors for cardiovascular disease and diabetes?

Answer 4

Obesity
Poor diet and low activity levels
Type 2 diabetes
High cholesterol
Middle age onwards
Smoking
High blood pressure

Question 5

What is involved in the non-invasive screen for NAFLD?

Answer 5

• Ultrasound Liver (haptic steatosis as increased echogenity)
• Hepatitis B and C serology
• Autoantibodies (autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis)
• Immunoglobulins (autoimmune hepatitis and primary biliary cirrhosis)
• Caeruloplasmin (Wilsons disease)
• Alpha 1 Anti-trypsin levels (alpha 1 anti-trypsin deficiency)
  Ferritin and Transferrin Saturation (hereditary haemochromatosis)

Question 6

What is the first line investigation for non-alcoholic fatty liver disease?

Answer 6

Enhanced liver fibrosis (ELF), but is not currently available in many areas.

10/51 or above -> advanced fibrois

Question 7

What is the NAFLD?

Answer 7

NAFLD Fibrosis Score (NFS) is another option for assessing liver fibrosis in NAFLD. It is based on an algorithm of age, BMI, liver enzymes (AST and ALT), platelet count, albumin and diabetes.

Question 8

What is FIb-4?

Answer 8

Fibrosis 4 (FIB-4) score is another option for assessing liver fibrosis in NAFLD. It is based on an algorithm of age, liver enzymes (AST and ALT) and platelet count.

Question 9

What does the AST:ALT ration have to do with proving diagnosis NAFLD?

Answer 9

A ratio greater than 0.8 in NAFLD suggests advanced fibrosis.

An AST:ALT ratio greater than 1.5 (meaning a disproportionately high AST) indicates alcohol-related liver disease rather than NAFLD.

Question 10

What is the gold standard test for diagnosing NAFLD?

Answer 10

Liver biopsy is the gold standard test.

The diagnosis requires the presence of ultrasound findings of a fatty liver, risk factors and excluding other causes of liver disease with a careful alcohol history and full non-invasive liver screen.

Question 11

What is involved in the management of NAFLD?

Answer 11

Minimizing those risk factors
Refer patients with a scoring test with indicate liver fibrosis
Specialist management may include vitamin E, pioglitazone, bariatric surgery and liver transplantation.