Questions and Answers
What percentage of adults are thought to have Non-alcoholic fatty liver disease (NAFLD)?
30%
What is the main cause of fat deposition in the liver cells in NAFLD?
Decreased sensitivity of insulin receptors on the liver, leading to increased fat storage
What is the most common association of NAFLD?
Metabolic syndrome
What is the final stage of NAFLD, characterized by permanent scarring of the liver?
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What is the name of the disease characterized by a deficiency of alpha-1 antitrypsin (A1AT)?
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What is the term for the measurement of the amount of iron bound to transferrin in the blood?
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What is the typical liver panel composed of?
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What is indicated by an ALT > AST ratio?
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What is suggested by an AST > ALT ratio in a 2:1 ratio?
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What does an isolated rise in GGT indicate?
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What does a dark urine and normal stools indicate in terms of bilirubin levels?
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What is the next step in investigating abnormal LFTs without a clear cause?
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Study Notes
Immunoglobulins and Liver Diseases
- Immunoglobulins can be affected by Wilson's disease and A1AT levels, which can impact liver function
Non-Alcoholic Fatty Liver Disease (NAFLD)
- 30% of adults are thought to have NAFLD, making it the most common cause of abnormal LFTs in the UK
- Mainly affects those with metabolic syndrome
- Risk factors: obesity, poor diet, low activity levels, T2DM, high cholesterol, middle age onwards, smoking, HTN
- Cause: fat deposition in liver cells, potentially due to decreased sensitivity of insulin receptors
- Stages: steatosis (fatty liver), non-alcoholic steatohepatitis (steatosis + inflammation), fibrosis (production and deposition of fibrotic tissue), cirrhosis (chronic fibrosis causing permanent scarring)
Clinical Features of NAFLD
- Generally asymptomatic, but may cause non-specific symptoms: fatigue, general malaise, abdominal discomfort
Liver Function Tests (LFTs)
- Typical liver panel: total protein, albumin, ALP, ALT, bilirubin (+ AST + GGT)
- ALT and AST: rise in conjunction with hepatocellular injury
- ALT > AST: normal hepatocellular picture
- AST > ALT in 2:1 ratio: alcoholic liver disease
- ALP: increased in liver pathologies due to bile salt accumulation
- GGT: isolate rise = chronic alcohol excess; non-specific and also elevated in COPD, renal failure, post MI + hepatic malignancies
- Bilirubin: isolated rise = pre-hepatic jaundice; dark urine + normal stools = pre-hepatic jaundice; dark urine + pale stools = post-hepatic jaundice
- Investigating abnormal LFTs: perform non-invasive liver screen, including USS liver, Hepatitis B and C serology, Autoantibodies
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