NAFLD

Question 1

What is Non-Alcoholic Fatty Liver Disease?

Answer 1

• A metabolic syndrome

- Fat deposits in hepatocytes, interfering with their function

Question 2

How many adults are estimated to have NAFLD?

Answer 2

30%

Question 3

What are metabolic syndromes?

Answer 3

Chronic health conditions that increase the risk of heart disease, stroke and diabetes

Question 4

Describe the stepwise progression of NAFLD.

Answer 4

1- NAFLD

2- Non-alcoholic steatohepatitis (NASH)

3- Fibrosis

4- Cirrhosis

Question 5

What is NASH?

Answer 5

Hepatitis caused by initial NAFLD, unclear why some people don’t go on to develop this from the initial NAFLD

Question 6

When do symptoms of NAFLD tend to begin?

Answer 6

Once fibrosis begins

Question 7

What are the risk factors for NAFLD?

Answer 7

Same as CVD and diabetes:

• Age
• Cholesterol, DM, Obesity
• HTN, smoking..

Question 8

How are deranged LFTs with an unclear cause investigated?

Answer 8

Non-invasive liver screen

Question 9

What is in a non-invasive liver screen?

Answer 9

• USS
• Hep B and C serology
• Autoantibodies (AI Hep, PBC, PSC)
• Caeruloplasmin (Wilson’s)
• Alpha-1-antitrypsin
• Ferritin and transferrin saturation (haemochromatosis)

Question 10

What autoantibodies are in the liver screen?

Answer 10

ANA (Nucleus)
SMA (Smooth Muscle)
AMA (Mitochondria)
LKM-1 (Liver Kidney Microsome Type 1)

Question 11

What does an USS show in NAFLD?

Answer 11

Hepatic steatosis (Fatty Liver)

Question 12

What is an ELF Test?

Answer 12

A specific test for fibrosis cause by NAFLD:

• Uses three markers to grade the fibrosis from mild (<7.7) to severe (9.8+)

Question 13

What are the first, second and third line investigations for NAFLD?

Answer 13

1 ELF

2 NAFLD Fibrosis Score

3 FibroScan

Question 14

What is an NAFLD fibrosis score?

Answer 14

Used when ELF unavailable:

• Algorithm of age, BMI, liver enzymes, platelets, albumin and diabetes
• Rules out fibrosis but doesn’t assess NAFLD severity

Question 15

When is fibroscan used?

Answer 15

When the ELF test of NAFLD fibrosis score indicate there is fibrosis present.

Question 16

How is NAFLD managed?

Answer 16

• Weight loss and exercise
• Stop smoking and avoid alcohol
• Control diabetes, BP and cholesterol
• Refer any fibrosis patients to liver specialists

Question 17

What may a liver specialist prescribe in fibrotic NAFLD?

Answer 17

• Vitamin E

Or

• Pioglotazone