Non - Alcoholic Fatty Liver Disease

Question 1

Description: NAFLD is an umbrella term encompassing which 3 entitles (stages)?

Answer 1

• Simple steatosis
• Non - alcoholic steatohepatitis
• Fibrosis and cirrhosis

Question 2

Aetiology/Risk Factors: State the risk factors of NAFLD

a) Associated with components of metabolic syndrome (4
(b) Other risk factors (3)

Answer 2

(a) Diabetes mellitus, Obesity, Hypertension and Hypertriglyceridemia
(b) Age, Genetics ( PNPLA3 gene) and ethnicity (e.g Hispanics)

Question 3

PATHOLOGY NOT IN THE LECTURE

Answer 3

PATHOLOGY NOT IN THE LECTURE

Question 4

SYMPTOMS NOT IN THE LECTURE

Answer 4

SYMPTOMS NOT IN THE LECTURE

Question 5

SIGNS NOT IN THE LECTURE

Answer 5

SIGNS NOT IN THE LECTURE

Question 6

Investigations: How do we diagnose NAFLD? (8)

Answer 6

• Biochemical tests (AST/ALT ratio - ratio should be <1 and ALT should be raised)
• Enhanced liver fibrosis panel (ELF) (blood test)
• Cytokeratin - 18
• Ultrasound
• Fibroscan
• MR/CT
• MR spectroscopy (quantifies the fat)
• Liver biopsy

Question 7

Treatment: How do we treat NAFLD?

Answer 7

• Weight loss (diet/exercise/bariatric surgery)
• Insulin sensitizers e.g. Metformin, Pioglitazone
• Glucagon-like peptide-1 (GLP-1) analogues e.g. Liraglutide
• Farnesoid X nuclear receptor ligand e.g. Obeticholic acid
• Vitamin E

Question 8

Complications: Describe the natural history of NAFLD.

Answer 8

NAFLD may proceed to steatosis which may lead to non - alcoholic steatohepatitis which may lead to fibrosis and even cirrhosis

This progression is coupled with increased cardiovascular risk

Question 9

Extra: Describe the NAFLD score

Answer 9

Age 
Diabetes (or impaired fasting glucose)
BMI
AST/ALT
Platelet count 
Albumin

Score of >= 3 = HIGH RISK