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CMS 200 > Wk1 Fatty Liver Disease > Flashcards

Wk1 Fatty Liver Disease Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

What is the characteristics of NAFLD?

A
  1. hepatic steatosis on imaging or histology
  2. exclusion of secondary causes
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2
Q

what is the prevalence of NAFLD?

A

20-30%

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3
Q

what is the most common causes of liver disease in Canada?

A

NAFLD

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4
Q

What is the prevalence of NASH?

A

3-5%

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5
Q

NAFLD is more common in which population?

A

obese/overweight adults

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6
Q

what is the prevalence of NAFLD in children?

A

3-10%

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7
Q

In patients with nonalcoholic fatty liver disease (NAFLD) in North America, what percentage have obesity?

A

40%

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8
Q

In patients with nonalcoholic fatty liver disease (NAFLD) in North America, what percentage have diabetes?

A

> 20%

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9
Q

In patients with nonalcoholic fatty liver disease (NAFLD) in North America, what percentage have dyslipidemia/hypertriglyceridemia ?

A

> 20%

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10
Q

What is NAFLD associated with?

A

Insulin resistance and metabolic syndrome

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11
Q

How do you diagnose ‘metabolic syndrome’?

A

3 out of 5:

  • BP (>130/>85)
  • FBG (5.6)
  • HDL (<50F, <40M)
  • TG (1.7)
  • WC (35F, 40M)

or on medications

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12
Q

What are the maternal risk factor for NAFLD?

A

maternal obesity & high maternal early-pregnancy glucose concentration

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13
Q

What are the maternal protective factors for NAFLD?

A

breastfeeding >6 months which can reduce NAFLD risk in offspring and mother

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14
Q

What are some risk exposures risk factor for NAFLD?

A

drugs and toxins

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15
Q

What are some dietary and nutritional factors that can cause NAFLD?

A
  • excessive dietary fructose
  • malnutrition
  • starvation & refeeding syndrome
  • total parenteral nutrition
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16
Q

What is the percentage of patient with NAFLD progress to NASH?

A

20%

17
Q

What is the percentage of patient with NASH progress to cirrhosis?

A

20%

less than 4% of patient with NAFLD progress to cirrhosis.

18
Q

What is the risk factors for advanced hepatic fibrosis and cirrhosis?

A

Advanced age
Obesity
DM

19
Q

What is the strongest predictor of progression of NAFLD?

A

The degree of inflammation on the first biopsy

20
Q

What are some complications of NAFLD?

A
  • Cardiovascular disease
  • Hepatocellular carcinoma (1-2% of annual risk)
  • End-stage liver disease and liver failure (45% over 10yrs)
21
Q

What are some possible presentations of early stage NAFLD though most are asymptomatic?

A
  • Fatigue
  • Malaise
  • RUQ mild abdominal discomfort
22
Q

what lab testing is used to evaluate liver function?

A

Mild elevated or normal ALT and AST

  • AST/ALT <0.8 or ALT/AST>1 for early NAFLD
  • AST/ALT>1.5 in alcohol associated liver disease
  • AST>ALT in advanced fibrosis and cirrhosis

Possible elevation of ALP and GGT

23
Q

What lab testing is used to examine metabolic risk factors?

A
  • lipid levels
  • fasting glucose or HbA1C
  • fasting glucose and fasting insulin for insulin resistance (HOMA/QUICKI)
24
Q

Which imaging is test of choice for NAFLD?

A

ultrasonography

25
Q

What is liver biopsy indicated?

A

Assessing more advanced conditions like NASH and firbosis

26
Q

Which noninvasive clinical risk scoring system can be used to screen high-risk groups for NAFLD such as those with metabolic syndrome or T2DM?

A

Fatty liver index (FLI)

NAFLD in metabolic syndrome score (NAFLD-MS score)

27
Q

What is the gold standard for diagnosing NAFLD?

A

Liver biopsy and histology

28
Q

How can NASH diagnosis be established?

A

Only with liver biopsy

29
Q

Which testing is used in NAFLD patients who have had a liver biopsy?

A

NAFLD activity score

30
Q

Should score of NAFLD activity score be used to definitively diagnosis NASH?

A

No. It correlated with steatohepatitis diagnosis.

31
Q

Who need liver biopsy?

A

Those are at high risk for having NASH and advanced fibrosis based on noninvasive testing.

An indeterminate result from noninvasive test

32
Q

Based on noninvasive testing, patient has low risk of fibrosis. Should liver biopsy be ordered?

A

No

33
Q

Which test to estimate the amount of scarring in the liver?

A

NAFLD Fibrosis score

34
Q

Which test to estimate the amount of liver fibrosis and need for a liver biopsy?

A

Fibrosis-4

35
Q

Which test is used to measure liver stiffness and stage of liver fibrosis?

A

Ultrasound elastography

36
Q

Which condition is the second most common reason for liver transplant in North America?

A

NAFLD

37
Q

How often does NASH with cirrhosis require surveillance for hepatocellular carcinoma with a liver ultrasound?

A

Every six months.

CMS 200 (6 decks)

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