Non Alcoholic Fatty Liver Disease

Question 1

What is NAFLD?

Answer 1

Non-alcoholic fatty liver disease (NAFLD) is characterised by excessive fat in the liver cells, specifically triglycerides. These fat deposits interfere with the functioning of the liver cells.

Question 2

What can NAFLD progress to? (2)

Answer 2

Hepatitis
Cirrhosis

Question 3

What are the 4 stages of progression 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 of NAFLD? (7)

Answer 4

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

Question 5

What is metabolic syndrome?

Answer 5

Combination of hypertension, obesity and diabetes

Question 6

What does metabolic syndrome increase your risk of? (2)

Answer 6

CVD
NAFLD
Loads of other health problems

Question 7

What LFTs indicate NAFLD?

Answer 7

Raised ALT

Question 8

What investigation can confirm a diagnosis of hepatic steatosis?

Answer 8

Liver ultrasound
Shoes increased echogenicity

Question 9

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

Answer 9

Enhanced liver fibrosis (ELF) blood test

Question 10

What indicates advanced fibrosis in the ELF blood test?

Answer 10

10.51 or above

Question 11

What 3 markers are measured in the ELF blood test?

Answer 11

HA
PIIINP
TIMP-1

Question 12

What is the NAFLD fibrosis score?

Answer 12

A second line option for assessing liver fibrosis in NAFLD

Question 13

What is the fibrosis 4 score?

Answer 13

A second line option for assessing liver fibrosis in NAFLD

Question 14

The ELF blood test indicates advanced fibrosis in a patient with NAFLD. What investigation is done next?

Answer 14

Transient elastography (fibroscan)
Determines the degree of fibrosis

Question 15

What does a AST:ALT ratio between 0.8-1.5 mean?

Answer 15

Suggests advanced fibrosis in NAFLD

Question 16

What is the gold standard test for diagnosing NAFLD?

Answer 16

Liver biopsy

Question 17

What is the management of NAFLD? (8)

Answer 17

• Weight loss
• Healthy diet (Mediterranean diet is recommended)
• Exercise
• Avoid/limit alcohol intake
• Stop smoking
• Control of diabetes, blood pressure and cholesterol
• Refer patients where scoring tests indicate liver fibrosis to a liver specialist
• Specialist management may include vitamin E, pioglitazone, bariatric surgery andliver transplantation