CMS200 - Wk 1

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Questions and Answers

Which risk factor is NOT associated with the development of NAFLD?

Insulin resistance

Hypertension (correct)

Diabetes

Obesity

What is a common laboratory abnormality in patients with NAFLD?

Decreased triglycerides

Normal liver function tests

Elevated aminotransferase levels (correct)

Low creatinine levels

Which of the following is a suggested alternative name for NAFLD?

Non-alcoholic hepatic encephalopathy

Cholesterol liver disease

Metabolic-associated fatty liver disease (correct)

Non-alcoholic liver syndrome

Which imaging study is commonly used to evaluate steatosis in NAFLD?

Ultrasonography Signup and view all the answers

What is a potential severe complication of advanced NAFLD?

Hepatocellular carcinoma Signup and view all the answers

Which condition is characterized by fat accumulation in the liver without hepatocellular injury or fibrosis?

Non-alcoholic fatty liver (NAFL) Signup and view all the answers

What is a significant risk factor for the development of NAFLD?

Sedentary lifestyle Signup and view all the answers

In terms of demographics, which group has the highest prevalence of NAFLD?

Hispanics Signup and view all the answers

Which of the following terms refers to permanent liver damage characterized by scar tissue replacing liver cells?

Cirrhosis Signup and view all the answers

What percentage of the adult population in Canada is affected by NAFLD?

20-30% Signup and view all the answers

What is a significant risk factor for the progression of NAFLD to cirrhosis?

Obesity Signup and view all the answers

Which statement about the histopathology of NAFLD is true?

Nonalcoholic steatohepatitis (NASH) is associated with a more rapid progression compared to simple steatosis. Signup and view all the answers

What is the annual risk percentage of developing hepatocellular carcinoma in patients with NAFLD?

1-2% Signup and view all the answers

Which of the following is NOT a complication of NAFLD?

Acute kidney injury Signup and view all the answers

What is the strongest predictor of progression of NAFLD according to histological findings?

Degree of inflammation on the first liver biopsy Signup and view all the answers

Which factor is associated with mortality risk in patients with end-stage liver cirrhosis and hepatocellular carcinoma?

Cardiovascular risk factors Signup and view all the answers

Which condition can NAFLD coexist with?

Alcoholic liver disease Signup and view all the answers

What percentage of patients may develop end-stage liver disease and liver failure over 10 years if they have NAFLD?

45% Signup and view all the answers

Which of the following predicts cardiovascular events and chronic kidney disease in conjunction with NAFLD?

Type 2 diabetes mellitus Signup and view all the answers

Which of the following best describes the early stages of NAFLD?

They can present silently with simple steatosis. Signup and view all the answers

Study Notes

NAFLD Overview

An umbrella term for a spectrum of conditions characterized by excessive fat accumulation in the liver, excluding secondary causes.
Most common cause of liver disease in Canada, affecting ~20% of Canadians and ~37% of adult Americans.

Key Concepts

Steatosis: Abnormal retention of fat within an organ.
Hepatic Steatosis: Fat accumulation in the liver.
Hepatitis: Inflammation of the liver.
Steatohepatitis: Fat accumulation and inflammation of the liver.
Fibrosis: Scarring.
Cirrhosis: Permanent liver damage where scar tissue replaces liver cells.

NAFLD Progression

Simple Steatosis (or Non-alcoholic fatty liver (NAFL)): 5% or greater hepatic steatosis without hepatocellular injury or fibrosis.
Non-alcoholic steatohepatitis (NASH): 5% or greater hepatic steatosis with hepatocellular injury and inflammation, with or without fibrosis.
NASH with hepatocellular carcinoma: Can progress from NASH.

Epidemiology

Prevalence: 20-30% in western countries.
NASH Prevalence: 3-5%.
More common in obese/overweight adults, but can affect non-obese individuals.
Average age at diagnosis: 50 years.
Increasing prevalence in children due to rising childhood obesity: 3-10% in children.
Ethnic disparities: Hispanics > Caucasians > African Americans.
Sex disparities in Caucasians: Men > Women; No sex differences observed in Hispanics and African-Americans.

Risk Factors and Causes

Principal Causes:
- Obesity (40% of patients with NAFLD)
- Diabetes mellitus (>20% of patients with NAFLD)
- Dyslipidemia/hypertriglyceridemia (>20% of patients with NAFLD)
Association with: Insulin resistance and metabolic syndrome.

Metabolic Syndrome

Important questions to ask patients during history taking:
- Family history of obesity or diabetes.
- Lifestyle habits, including diet, exercise, and alcohol consumption.
- Medications used.
- Presence of any existing conditions like high blood pressure, high cholesterol, and cardiovascular disease.

NAFLD Timing and Clinical Course

Slowly progressive disease: Silent liver disease when there is only steatosis.
Early Stages (simple steatosis or NAFL) are reversible.
Progression: NAFL → 20% develop NASH → 20% progress to cirrhosis → possible liver failure and liver cancer.
Risk Factors for Advanced Hepatic Fibrosis and Cirrhosis:
- Advanced age
- Obesity
- Diabetes mellitus
Strongest predictor of progression: The degree of inflammation on the first liver biopsy.

NAFLD Complications

Cardiovascular Disease
Hepatocellular carcinoma: Annual risk 1-2%.
End-stage liver disease and liver failure: Develops over 10 years in 45% of patients.
Coexistence with other chronic liver conditions
Cardiovascular risk factors contribute to mortality in those with end-stage liver cirrhosis and hepatocellular carcinoma.

Other Predicted Risks of NAFLD

Cardiovascular events
Chronic kidney disease
Colorectal cancers
Type 2 diabetes mellitus

NAFLD Signs and Symptoms

Most patients are asymptomatic.
Possible Presentations in early stages:
- Fatigue
- Malaise
- Mild abdominal discomfort (right upper quadrant)
Possible Presentations in advanced stages:
- Nausea
- Vomiting
- Jaundice
- Pruritis
- Memory impairment
- Easy bleeding
- Loss of appetite
- Hepatomegaly (in 75% of patients)
- Spider angiomas
- Signs of portal hypertension: edema, ascites, caput medusae
- Palmar erythema
- Gynecomastia - Dupuytren contracture - Petechiae

Detecting Hepatomegaly

Physical exam findings:
- Midclavicular liver span on percussion ≥ 10 cm: Sensitivity: 61-92%, Specificity: 30-43%
- Palpable liver edge: Sensitivity: 39-71%, Specificity: 56-85%

Diagnosing Hepatocellular Disease in Patients with Jaundice

Physical exam findings:
- Spider angiomas: Sensitivity: 35-47%, Specificity: 88-97%
- Palmar erythema: Sensitivity: 49%, Specificity: 95%
- Dilated abdominal veins: Sensitivity: 42%, Specificity: 98%
- Ascites: Sensitivity: 44%, Specificity: 90%
- Palpable spleen: Sensitivity: 29-47%, Specificity: 83-90%
- Palpable gallbladder: Sensitivity: 0%, Specificity: 69%
- Palpable liver: Sensitivity: 71-83%, Specificity: 15-17%
- Liver tenderness: Sensitivity: 37-38%, Specificity: 70-78%

Diagnosing Cirrhosis in Patients with Chronic Liver Disease

Physical exam findings:
- Spider angiomas: Sensitivity: 33-84%, Specificity: 48-98%
- Palmar erythema: Sensitivity: 12-70%, Specificity: 49-98%
- Gynecomastia: Sensitivity: 18-58%, Specificity: 92-97%
- Reduction of body or pubic hair: Sensitivity: 24-51%, Specificity: 94-97%
- Jaundice: Sensitivity: 16-44%, Specificity: 83-99%
- Dilated abdominal wall veins: Sensitivity: 9-51%, Specificity: 79-100%

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Description

Test your knowledge on non-alcoholic fatty liver disease (NAFLD) and its various components. This quiz will cover key concepts like steatosis, hepatitis, and the progression from simple steatosis to cirrhosis. Understand the implications and prevalence of this condition, particularly in North America.