Non-alcoholic fatty liver disease Flashcards
What is Non-Alcoholic Fatty Liver Disease (NAFLD)?
NAFLD is characterized by excessive fat deposits (specifically triglycerides) in the liver cells, which interfere with liver cell function. It can progress from being asymptomatic to more severe stages like hepatitis and cirrhosis.
What are the stages of Non-Alcoholic Fatty Liver Disease (NAFLD)?
NAFLD consists of the following stages:
* Non-Alcoholic Fatty Liver (NAFL)
* Non-Alcoholic Steatohepatitis (NASH)
* Fibrosis
* Cirrhosis
What is the estimated prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD)?
Around 25% of adults are estimated to have NAFLD.
What are the risk factors for Non-Alcoholic Fatty Liver Disease (NAFLD)?
Risk factors for NAFLD include:
* Middle age and older
* Obesity
* Poor diet and low activity levels
* Type 2 diabetes
* High cholesterol
* High blood pressure
* Smoking
* Metabolic syndrome (hypertension, obesity, and diabetes)
How is metabolic syndrome related to NAFLD?
Metabolic syndrome, a combination of hypertension, obesity, and diabetes, significantly increases the risk of developing NAFLD and other cardiovascular diseases.
What are the initial investigations for Non-Alcoholic Fatty Liver Disease (NAFLD)?
Initial investigations for NAFLD include:
* Raised Alanine Aminotransferase (ALT) on liver function blood tests
* Liver Ultrasound: Confirms fatty liver (hepatic steatosis) but doesn’t indicate severity or fibrosis.
What is the Enhanced Liver Fibrosis (ELF) test used for in NAFLD?
The ELF test is a first-line investigation for assessing fibrosis in NAFLD, using three biomarkers (HA, PIIINP, and TIMP-1) to predict the presence of advanced fibrosis.
What does a result of 10.51 or above in the ELF test indicate?
A result of 10.51 or above indicates advanced fibrosis.
What is the NAFLD Fibrosis Score (NFS)?
The NFS is an algorithm used to assess liver fibrosis in NAFLD, considering factors such as age, BMI, liver enzymes (AST and ALT), platelet count, albumin, and diabetes status.
What is the FIB-4 score used for in NAFLD?
The FIB-4 score is used to assess liver fibrosis in NAFLD based on age, liver enzymes (AST and ALT), and platelet count.
What is the role of Transient Elastography (FibroScan) in NAFLD?
FibroScan measures liver stiffness using high-frequency sound waves to determine the degree of fibrosis and assess for liver cirrhosis.
When is a liver biopsy required in NAFLD?
A liver biopsy may be required to confirm the diagnosis of NAFLD, particularly when there is uncertainty or the need to exclude other liver diseases.
How does the AST:ALT ratio help in diagnosing NAFLD?
The AST:ALT ratio is used to assess the severity of liver fibrosis, with a normal ratio being less than 1.
What does an AST:ALT ratio >0.8 in NAFLD suggest?
An AST:ALT ratio >0.8 suggests advanced fibrosis.
What are the key components for diagnosing Non-Alcoholic Fatty Liver Disease (NAFLD)?
Key components for diagnosing NAFLD include:
* Ultrasound findings of fatty liver
* Presence of risk factors (e.g., obesity, type 2 diabetes)
* Exclusion of other causes of liver disease
* Liver biopsy is the gold standard.
What are the management strategies for Non-Alcoholic Fatty Liver Disease (NAFLD)?
Management strategies for NAFLD include:
* Weight loss
* Healthy diet (Mediterranean diet recommended)
* Exercise
* Avoid/limit alcohol
* Stop smoking
* Control diabetes, blood pressure, and cholesterol
* Refer patients with liver fibrosis to a liver specialist.
What are some specialist management options for Non-Alcoholic Fatty Liver Disease (NAFLD)?
Specialist management options for NAFLD include:
* Vitamin E
* Pioglitazone
* Bariatric surgery (for patients with severe obesity)
* Liver transplantation (in cases of advanced cirrhosis)
