Wk1 Fatty Liver Disease Flashcards
What is the characteristics of NAFLD?
- hepatic steatosis on imaging or histology
- exclusion of secondary causes
what is the prevalence of NAFLD?
20-30%
what is the most common causes of liver disease in Canada?
NAFLD
What is the prevalence of NASH?
3-5%
NAFLD is more common in which population?
obese/overweight adults
what is the prevalence of NAFLD in children?
3-10%
In patients with nonalcoholic fatty liver disease (NAFLD) in North America, what percentage have obesity?
40%
In patients with nonalcoholic fatty liver disease (NAFLD) in North America, what percentage have diabetes?
> 20%
In patients with nonalcoholic fatty liver disease (NAFLD) in North America, what percentage have dyslipidemia/hypertriglyceridemia ?
> 20%
What is NAFLD associated with?
Insulin resistance and metabolic syndrome
How do you diagnose ‘metabolic syndrome’?
3 out of 5:
- BP (>130/>85)
- FBG (5.6)
- HDL (<50F, <40M)
- TG (1.7)
- WC (35F, 40M)
or on medications
What are the maternal risk factor for NAFLD?
maternal obesity & high maternal early-pregnancy glucose concentration
What are the maternal protective factors for NAFLD?
breastfeeding >6 months which can reduce NAFLD risk in offspring and mother
What are some risk exposures risk factor for NAFLD?
drugs and toxins
What are some dietary and nutritional factors that can cause NAFLD?
- excessive dietary fructose
- malnutrition
- starvation & refeeding syndrome
- total parenteral nutrition
What is the percentage of patient with NAFLD progress to NASH?
20%
What is the percentage of patient with NASH progress to cirrhosis?
20%
less than 4% of patient with NAFLD progress to cirrhosis.
What is the risk factors for advanced hepatic fibrosis and cirrhosis?
Advanced age
Obesity
DM
What is the strongest predictor of progression of NAFLD?
The degree of inflammation on the first biopsy
What are some complications of NAFLD?
- Cardiovascular disease
- Hepatocellular carcinoma (1-2% of annual risk)
- End-stage liver disease and liver failure (45% over 10yrs)
What are some possible presentations of early stage NAFLD though most are asymptomatic?
- Fatigue
- Malaise
- RUQ mild abdominal discomfort
what lab testing is used to evaluate liver function?
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
What lab testing is used to examine metabolic risk factors?
- lipid levels
- fasting glucose or HbA1C
- fasting glucose and fasting insulin for insulin resistance (HOMA/QUICKI)
Which imaging is test of choice for NAFLD?
ultrasonography
What is liver biopsy indicated?
Assessing more advanced conditions like NASH and firbosis
Which noninvasive clinical risk scoring system can be used to screen high-risk groups for NAFLD such as those with metabolic syndrome or T2DM?
Fatty liver index (FLI)
NAFLD in metabolic syndrome score (NAFLD-MS score)
What is the gold standard for diagnosing NAFLD?
Liver biopsy and histology
How can NASH diagnosis be established?
Only with liver biopsy
Which testing is used in NAFLD patients who have had a liver biopsy?
NAFLD activity score
Should score of NAFLD activity score be used to definitively diagnosis NASH?
No. It correlated with steatohepatitis diagnosis.
Who need liver biopsy?
Those are at high risk for having NASH and advanced fibrosis based on noninvasive testing.
An indeterminate result from noninvasive test
Based on noninvasive testing, patient has low risk of fibrosis. Should liver biopsy be ordered?
No
Which test to estimate the amount of scarring in the liver?
NAFLD Fibrosis score
Which test to estimate the amount of liver fibrosis and need for a liver biopsy?
Fibrosis-4
Which test is used to measure liver stiffness and stage of liver fibrosis?
Ultrasound elastography
Which condition is the second most common reason for liver transplant in North America?
NAFLD
How often does NASH with cirrhosis require surveillance for hepatocellular carcinoma with a liver ultrasound?
Every six months.
