Non-Alcoholic Fatty Liver Disease


Step 1: View clinicals

A 45-year-old man is referred for further evaluation after a routine health screening revealed several abnormal laboratory test results. He is currently asymptomatic. There is no history of recent weight gain. His medical history is only significant for elevated triglyceride levels (~250 mg/dL) detected two years ago. He was asked to make lifestyle modifications but defaulted on follow-up after just one month. He does not smoke, and only drinks socially, generally not more than 1 to 2 units of alcohol each month. He currently leads a sedentary lifestyle. His laboratory results are as follows: AST: 55 IU/L (8-48) ALT: 70 IU/L (7-55) ALP, Bilirubin, INR: Within normal limits Fasting plasma glucose: 120 mg/dL (70-110) Triglycerides: 175 mg/dL (<150) Total cholesterol, LDL, HDL: within normal limits Iron studies: within normal limits CRP, ESR: within normal limits

Step 2: Order all relevant investigations

Ultrasound abdomen

There is mild hepatomegaly, with a liver length of 17 cm in the midclavicular line. The liver shows a hyperechoic homogeneous echotexture with occasional hyperechoic focal areas suggestive of fatty infiltration.

Viral hepatitis screen

Negative for hepatitis B and C.

Serum ceruloplasmin levels

278 mg/L (200-400)

Liver biopsy

The biopsy reveals macrovesicular steatosis with a predominantly perivenular distribution.

Step 3: Select appropriate management

Exercise and weight reduction
Start fenofibrate
Liver transplantation

Score: ★★☆