Non-alcoholic Fatty Liver Disease

Question 1

risk factors for cirrhosis/advanced liver disease related to fatty liver

Answer 1

• older age
• obestiy
• diabetes

Question 2

NAFLD pathophys

Answer 2

Metabolic syndrome –> abnormal production of hormones and cytokines –> proinflammatory response: esp decreased adiponectin, increased TNF-alpha

–> steatosis (NAFL) + cell death + inflammation (NASH) + insulin resistance

Question 3

lab tests in NAFLD

Answer 3

• AST, AST up to 3-5x elevated, may be normal
  
  • AST/ALT ratio <1 in most cases
• ferritin elevated in 50% cases
• neg tests for other liver diseases
• markers of metabolic syndrome

Question 4

how to establish severity of NAFLD?

Answer 4

Blood tests

• AST/ALT ratio higher in cirrhosis
• thrombocytopenia suggests cirrhosis
• increase in bili, decrease in albumin appear late

imaging: fibroscan

liver biopsy = gold standard, questionable utility

Question 5

tx in NAFLD

Answer 5

lifestyle modifications: diet and weight-loss

Vit E: but not in pts w/ cardiac disease

tx metabolic syndrome

• metformin or glitazone for DMII
• tx hyperlipidemia

consider bariatric surgery

Ursodeoxycholic acid