5MinuteConsult Journal Club

Nonalcoholic Fatty Liver Disease: Commonly Missed and Deadly

Reference

https://doi.org/10.1161/ATV.0000000000000153

Study Summary

The American Heart Association issues the following statement about Non-alcoholic Fatty Liver Disease: “Nonalcoholic fatty liver disease (NAFLD) is an increasingly common condition that is believed to affect >25% of adults worldwide. Unless specific testing is done to identify NAFLD, the condition is typically silent until advanced and potentially irreversible liver impairment occurs. For this reason, the majority of patients with NAFLD are unaware of having this serious condition. Hepatic complications from NAFLD include nonalcoholic steatohepatitis, hepatic cirrhosis, and hepatocellular carcinoma. In addition to these serious complications, NAFLD is a risk factor for atherosclerotic cardiovascular disease, which is the principal cause of death in patients with NAFLD.”

To identify NAFLD in patients with NAFLD:

On Exam: Palpate and percuss liver span; if liver edge is palpable with deep inspiration, begin evaluation OR

On Labs: Even if they are within the normal limits, if a trend of increasing ALT and AST is seen, or AST/ALT is greater than 1.0, begin evaluation.

Evaluation: A right upper quadrant ultrasound. If echogenicity is seen, obtain the following: serology for hepatitis A, B, and C, celiac serology (IgA anti-tTG) α1-antitrypsin, iron, copper, anti-smooth muscle antibody, ANA, serum gammaglobulin, ferritin. Also, obtain some measure of liver elasticity (like a FibroScan) and evaluate risk using tools like NAFLD fibrosis score, FIB-4 index, APRI score.

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