Fatty Liver Disease for the NP Exam
Fatty Liver Disease for the Nurse Practitioner Licensing Exam
Overview
- Fatty liver disease includes Non-Alcoholic Fatty Liver Disease (NAFLD) and Alcoholic Liver Disease (ALD), both involving fat accumulation in liver cells.
- NAFLD occurs without significant alcohol consumption, while ALD is directly related to chronic alcohol use.
Non-Alcoholic Fatty Liver Disease (NAFLD)
Pathophysiology
- NAFLD is closely associated with metabolic syndrome (obesity, insulin resistance, type 2 diabetes, and dyslipidemia).
- It ranges from simple steatosis (fat accumulation without inflammation) to non-alcoholic steatohepatitis (NASH), which involves inflammation, hepatocyte damage, and fibrosis, potentially leading to cirrhosis.
Clinical Features
- Most patients are asymptomatic, with incidental findings of elevated liver enzymes or fat on imaging.
- Some may present with fatigue or right upper quadrant (RUQ) discomfort.
Diagnosis
- Imaging: Ultrasound often shows increased liver echogenicity (bright liver).
- Laboratory tests: Elevated ALT and AST, with an AST:ALT ratio <1.
- Liver biopsy: Gold standard for diagnosing NASH and assessing fibrosis.
Management
- Weight loss and lifestyle changes are the main treatments, with a target of 7–10% body weight reduction.
- Pioglitazone and Vitamin E can be used in select patients, particularly those with NASH.
Alcoholic Liver Disease (ALD)
Pathophysiology
- Chronic alcohol intake causes fat accumulation, inflammation, and fibrosis.
- ALD includes simple steatosis, alcoholic hepatitis, and cirrhosis.
Clinical Features
- Alcoholic hepatitis presents with jaundice, fever, RUQ pain, and tender hepatomegaly.
Management
- Alcohol cessation is critical to prevent disease progression.
- Corticosteroids are used for severe alcoholic hepatitis.
Key Points
- NAFLD is linked to metabolic syndrome and can progress to NASH, cirrhosis, and hepatocellular carcinoma.
- ALD is caused by chronic alcohol use and can progress from steatosis to alcoholic hepatitis and cirrhosis.
- Weight loss is key in treating NAFLD, while alcohol cessation is essential for ALD.
- AST:ALT ratio >2 is indicative of ALD, while NAFLD typically has an AST:ALT ratio <1.