Non-Alcoholic Fatty Liver Disease

Question 1

Stages of Non-Alcoholic Fatty Liver Disease

Answer 1

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

Question 2

Risk factors for Non-alcoholic Fatty Liver Disease (7)

Answer 2

Same risk factors as for cardiovascular disease and diabetes

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

Question 3

What is Non-alcoholic Fatty Liver Disease?

Answer 3

Non alcholic fatty liver disease - “metabolic syndrome” Group of chronic health conditions relating to processing and storing energy

Increase risk of heart disease, stroke and diabetes
Estimated that up to 30% of adults have NAFLD
Characterised by fat deposited in liver cells
Fat deposits can interfere with the functioning of the liver cells

NAFLD does not cause problems initially, however it can progress to hepatitis and cirrhosis

Question 4

Investigating Abnormal Liver Function Tests (7)

Answer 4

Ultrasound Liver
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 5

Autoantibodies

Answer 5

Antinuclear antibodies (ANA)
Smooth muscle antibodies (SMA)
Antimitochondrial antibodies (AMA)
Antibodies to liver kidney microsome type-1 (LKM-1)

Question 6

Management of NAFLD (5)

Answer 6

Weight loss
Exercise
Stop smoking
Control of diabetes, blood pressure and cholesterol
Avoid alcohol

Question 7

What is the Ehanced Liver Fibrosis (ELF) test?

Answer 7

Blood test
First line recommended investigation for assessing fibrosis
measures three markers (HA, PIIINP and TIMP-1) and uses an algorithm to provide a result that indicates the fibrosis of the liver:

< 7.7 indicates none to mild fibrosis
≥ 7.7 to 9.8 indicates moderate fibrosis
≥ 9.8 indicates severe fibrosis

Question 8

What is NAFLD fibrosis score?

Answer 8

Second line recommended assessment for liver fibrosis where the ELF test is not available

Based on an algorithm of: 
Age
BMI
Liver enzymes
Platelets
Albumin
Diabetes

Helpful in ruling out fibrosis but not assessing the severity when present