Diagnostic challenges of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

Abstract

http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/11-4-reading-cleveland a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/11-4-interview-vanwagner the interview with the author

Nonalcoholic Fatty Liver Disease: Evidence-Based Management and Early Recognition of Nonalcoholic Steatohepatitis

“…In addition to considering a patient's metabolic risk factors, there are 2 common clinical scenarios that typically increase a provider's suspicion for NAFLD: 1) the patient presents with abnormal imaging results with evidence of increased echogenicity or hepatic steatosis or 2) the patient has abnormal liver enzymes, particularly aminotransferases (aspartate transaminase [AST] or alanine transaminase [ALT]). 7 If an NP encounters a patient with chronically elevated aminotransferases, other potential causes of elevated liver enzymes must be considered. If a patient has a single abnormal laboratory test, the test can be repeated for confirmation.…”

“…1 If NAFLD is suspected in a patient with abnormal liver tests, an abdominal ultrasound is recommended as the initial cost-effective imaging modality used to evaluate the liver parenchyma for chronic changes, assess hepatic vasculature, and confirm hepatic steatosis ( Figure 3). 7 Abdominal ultrasound and computed tomographic scans detect steatosis in patients with moderate to massive steatosis and are less specific in detecting NAFLD in a patient with mild steatosis. 7 Magnetic resonance imaging has been found to have a greater specificity in detecting steatosis but is not recommended as an initial imaging modality for the evaluation of NAFLD and remains costly.…”

“…7 Abdominal ultrasound and computed tomographic scans detect steatosis in patients with moderate to massive steatosis and are less specific in detecting NAFLD in a patient with mild steatosis. 7 Magnetic resonance imaging has been found to have a greater specificity in detecting steatosis but is not recommended as an initial imaging modality for the evaluation of NAFLD and remains costly. 7 Ultrasound, computed tomographic scanning, and general magnetic resonance imaging may reveal steatosis but are limited in accurately detecting hepatic fibrosis.…”

“…7 Magnetic resonance imaging has been found to have a greater specificity in detecting steatosis but is not recommended as an initial imaging modality for the evaluation of NAFLD and remains costly. 7 Ultrasound, computed tomographic scanning, and general magnetic resonance imaging may reveal steatosis but are limited in accurately detecting hepatic fibrosis. 7 It is also important to note during the initial workup that although serum aminotransferases (AST and ALT) have often been used by providers to evaluate for NASH, they cannot be used alone to diagnosis NASH or the stage of a patient's liver disease.…”

SCCA-IgM as a Potential Biomarker of Non-Alcoholic Fatty Liver Disease in Patients with Obesity, Prediabetes and Diabetes Undergoing Sleeve Gastrectomy

“…Nevertheless, liver biochemistries can be in the normal range in patients with NAFLD [6, 7], and US or transient elastography, even if potentially more sensitive, are not considered reliable tools. Many serum markers and scores of fibrosis, such as the NAFLD fibrosis score (NFS), fibrosis 4 calculator (FIB-4), enhanced liver fibrosis (ELF), and FibroTest® [8-10], have proven acceptable diagnostic accuracy. In particular, the ALT/AST ratio is an index of severe liver damage and it is related to the degree of fibrosis [11].…”