Nonalcoholic Fatty Liver Disease NAFLD. This post will cover the points you need to know for your board exams as well as for teaching residents on the daily rounds. Please don't use the information here to treat your patients.
The most common cause of increased liver enzymes is NAFLD or what is commonly known as fatty liver disease. It might progress to NASH which is nonalcoholic steatohepatitis due to inflammation and necrosis of the liver that may progress into fibrosis and cirrhosis of the liver.
Risk factors for NAFLD include:
- Obesity
- Diabetes mellitus
- Dyslipidemia
- Bariatric patient on TPN with high fat/protein content
- Medications: Amiodarone, methotrexate, corticosteroids, tetracyclines, calcium channel blockers, estrogen and valproate
Patients usually have elevated transaminases. Other nonspecific autoimmune and blood markers like ferritin might be also increased (not to confuse with other diagnosis).
NAFLD might be seen with different imaging modalities, but ultrasound is the cheapest. NASH will need liver biopsy to be confirmed.
Management includes weight loss, controlling glucose and lipid levels, stopping the offending medication and probably vitamin E to decrease the inflammation in non-diabetic patients. Vitamin E is not recommended for diabetics or those with serious liver scarring.
A good book for physicians on the topic is the Need-to-Know book.
A book that patients found helpful is The definitive guide for patients with fatty liver disease.
The information in this post is not for patients and shouldn't be used in treating patients. Please refer to your doctor for medical advice.