Review article
A Practical Approach to Diagnosing Non-Alcoholic Fatty Liver Disease
Ivica Grgurević
Abstract
Diagnosing non-alcoholic fatty liver disease (NAFLD) begins with analysing patient’s clinical features. The typical risk profile
includes an overweight patient with comorbidities such as type 2 diabetes mellitus, arterial hypertension and/or hyperlipidaemia, excluding harmful alcohol consumption. Ultrasonography is the most widely used diagnostic tool for detecting fatty liver, which has higher echogenicity, i.e. is lighter in colour, compared to renal cortex. However, ultrasound cannot detect mild steatosis where < 20 – 30% of hepatocytes have been infiltrated by fat. Elastographic methods are used for grading steatosis and staging fibrosis. Liver fibrosis stage is the most significant prognostic indicator. On the other hand, the relevance of inflammatory activity is questionable and the degree of steatosis has no significant impact on the outcome of the disease. Steatosis
and fibrosis can be evaluated using non-invasive biochemical tests, ranging from simple routine laboratory tests to more complex tests that include circulating macromolecules and components of extracellular matrix. Non-invasive methods provide reliable results for the exclusion of cirrhosis; however, their positive predictive value is relatively modest, as they often over-estimate the fibrosis stage and provide no information on inflammatory activity. Liver biopsy provides a more objective diagnosis of the histological features and, as a result, a more reliable prognosis. The workup of NAFLD patients should start at the primary healthcare level, with simple biochemical tests such as FIB-4, which excludes significant fibrosis. Elevated results need to
be additionally confirmed by another test, most preferably elastography. If this test excludes significant fibrosis, the patient remains under the care of a primary care physician, and if it detects severe fibrosis/cirrhosis, the patient is referred to specialist treatment. This pathway has resulted in an 80 % decrease in referrals to a specialist and a 5-fold improvement in the detection of significant fibrosis/cirrhosis.
Keywords
Non-alcoholic fatty liver; obesity; liver cirrhosis; steatosis; fibrosis; metabolic syndrome; non-invasive methods; elastography
Hrčak ID:
232196
URI
Publication date:
15.1.2020.
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