Non-alcoholic fatty liver disease (NAFLD)

Question 1

1) What is the first stage of NAFLD?
2) What is the second stage of NAFLD?
3) What is the third stage of NAFLD?
4) What is the fourth stage of NAFLD?

Answer 1

1) Steatosis
2) Steatohepatitis
3) Liver fibrosis
4) Liver cirrhosis

Question 2

1) What is the underlying pathology of NAFLD?
2) This pathology occurs in patients with what syndrome?

Answer 2

1) Fat deposition in hepatocytes
2) Patients with metabolic syndrome

Question 3

Name 3 risk factors for the development of NAFLD

Answer 3

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

Question 4

Name 3 tests that would be performed in a patient with abnormal liver function (3 tests that are a part of a liver failure screen), and what the tests are looking for

Answer 4

• Liver ultrasound
• Serology: Hepatitis B and C
• Autoantibodies: autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis
• Immunoglobulins: autoimmune hepatitis and primary biliary cirrhosis
• Ceruloplasmin: Wilson’s disease
• Alpha 1 anti-trypsin levels: alpha 1 anti-trypsin deficiency
• Ferritin and Transferrin Saturation: hereditary haemochromatosis

Question 5

1) What investigation can confirm a diagnosis of hepatic steatosis?
2) What is the first line investigation to assess fibrosis?
3) What is the second line investigation to assess fibrosis?
4) If these 2 investigations indicate fibrosis, what investigation is done next, and what is this?

Answer 5

1) Ultrasound
2) Enhanced Liver Fibrosis (ELF) blood test
3) NAFLD fibrosis score
4) Fibroscan - ultrasound that measures the stiffness of the liver and gives an indication of fibrosis

Question 6

1) Name 3 aspects of the management of NAFLD
2) What can be given that might improve fibrosis?

Answer 6

1) Weight loss, exercise, stop smoking, control of diabetes, blood pressure and cholesterol, avoid alcohol
2) Vitamin E

Question 7

What symptom is associated with an acute exacerbation of NAFLD?

Answer 7

Weight loss