Non-alcoholic fatty liver disease screening
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Non-Alcoholic Fatty Liver Disease Microchapters |
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Differentiating Non-Alcoholic Fatty Liver Disease from other Diseases |
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Diagnosis |
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Treatment |
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Case studies |
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Non-alcoholic fatty liver disease screening On the Web |
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American Roentgen Ray Society Images of Non-alcoholic fatty liver disease screening |
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Directions to Hospitals Treating Non-alcoholic fatty liver disease |
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Risk calculators and risk factors for Non-alcoholic fatty liver disease screening |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
There is insufficient evidence to recommend routine screening for NAFLD in general population. However, screening is recommended in high-risk population groups(obesity, insulin resistance and patients with metabolic syndrome) as more than 50 million Americans have been estimated to have metabolic syndrome and about 80% of them have NAFD.
Screening
- There is insufficient evidence to recommend routine screening for NAFLD. But it can be argued that at least for high-risk profiles like obesity, insulin resistance and patients with metabolic syndrome should be screened for NAFLD. [1] [2] [3] [4]
- Most of the time NAFLD is accidental finding on routine ultrasound.
- NAFLD usually has no symptoms. So diagnosing the problem often starts after a blood test finds higher-than-normal levels of liver enzymes. A standard blood test could reveal these results.
- However, at present, there are significant gaps in our knowledge regarding the diagnosis, natural history, and treatment of NAFLD.Sometimes patients with normal liver enzyme levels have NAFLD and NASH and maybe not enough for screening alone but with ultrasound which is sensitive can serve as a screening test.
| Incidental finding of Fatty liver on ultrasound | |||||||||||||||||||||||||||||||||||
| Check for persistently raised LFTs | |||||||||||||||||||||||||||||||||||
| Ask the patient for significant alcohol intake | |||||||||||||||||||||||||||||||||||
| NO | YES | ||||||||||||||||||||||||||||||||||
| Diagnose NAFLD | Consider other alcoholic related diseases | ||||||||||||||||||||||||||||||||||
Monitor severity of the disease
| Offer Enhanced Liver Fibrosis Test (ELF) | |||||||||||||||||||||||
| (>10.51) ELF Positive | (<10.51) ELF Negative | ||||||||||||||||||||||
| Indicating advanced fibrosis and risk of progression to cirrhosis | Typically Benign -- Advanced fibrosis unlikely | ||||||||||||||||||||||
| Refer the patient to Heptologist | |||||||||||||||||||||||
- On negative ELF test offer retest for every 3 years for adults and 2 years for children.
References
- ↑ Koot BGP, Nobili V (2017). "Screening for non-alcoholic fatty liver disease in children: do guidelines provide enough guidance?". Obes Rev. 18 (9): 1050–1060. doi:10.1111/obr.12556. PMID 28544608.
- ↑ Kummer S, Klee D, Kircheis G, Friedt M, Schaper J, Häussinger D; et al. (2017). "Screening for non-alcoholic fatty liver disease in children and adolescents with type 1 diabetes mellitus: a cross-sectional analysis". Eur J Pediatr. 176 (4): 529–536. doi:10.1007/s00431-017-2876-1. PMID 28213828.
- ↑ Glen J, Floros L, Day C, Pryke R, Guideline Development Group (2016). "Non-alcoholic fatty liver disease (NAFLD): summary of NICE guidance". BMJ. 354: i4428. doi:10.1136/bmj.i4428. PMID 27605111.
- ↑ "The Diagnosis and Management of Non-alcoholic Fatty Liver Disease: Practice Guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology - Gastroenterology".