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Metabolic dysfunction-associated steatotic liver disease
Other Resources UpToDate PubMed

Metabolic dysfunction-associated steatotic liver disease

Contributors: Michael W. Winter MD
Other Resources UpToDate PubMed

Synopsis

Metabolic dysfunction-associated steatotic liver disease (MASLD), also known as nonalcoholic fatty liver disease (NAFLD), is the most common liver disease around the world (prevalence of 25%), with 30% of the US population affected. MASLD is a chronic condition of fat accumulation in the liver without involvement of excessive alcohol consumption or use of steatogenic medications. MASLD represents a spectrum of disease, from steatotic liver disease (SLD) (steatosis without hepatocellular injury; also known as nonalcoholic fatty liver [NAFL]) to metabolic dysfunction-associated steatohepatitis (MASH) (steatosis with hepatic injury / inflammation; also known as nonalcoholic steatohepatitis [NASH]) to progressive fibrosis and liver cirrhosis. SLD encompasses MASLD and MetALD, a term describing people with MASLD who consume more than 140 g of alcohol per week for women and 210 g per week for men. MetALD accounts for the continuum of disease between MASLD and alcohol-related liver disease (ALD). With advancements in the treatment of viral hepatitis and a continual increase in obesity and metabolic syndrome in the United States, MASLD is becoming one of the most common causes of cirrhosis in the United States. With cirrhosis comes an increased risk of developing hepatocellular carcinoma.

Screening for MASLD is of the utmost importance in patients with underlying risk factors, primarily obesity and metabolic syndrome, as it is often asymptomatic. Some patients report vague symptoms such as fatigue or mild right upper quadrant abdominal pain. If MASLD progresses to cirrhosis, patients will often present with signs and symptoms of advanced liver disease: spider angiomata, gynecomastia, ascites, jaundice, and peripheral edema.

The primary risk factors for MASLD are central obesity, type 2 diabetes mellitus, and hyperlipidemia. Modification of these risk factors, mostly through weight loss and dietary and lifestyle changes, is the most effective preventive and treatment strategy.

Codes

ICD10CM:
K76.0 – Fatty (change of) liver, not elsewhere classified

SNOMEDCT:
1231824009 – Non-alcoholic fatty liver disease

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

MASLD is a diagnosis of exclusion, with no highly sensitive or specific test to confirm the diagnosis. Often, patients are referred for abnormal liver function tests, and a comprehensive workup must be done to have confidence that the laboratory abnormality and steatohepatitis are due to MASLD.

Alternative diagnoses to consider:
  • Alcoholic hepatitis
  • Chronic viral hepatitis (Hepatitis B virus infection and Hepatitis C virus infection most commonly)
  • Autoimmune hepatitis
  • Primary biliary cholangitis
  • Primary sclerosing cholangitis
  • Drug-induced hepatotoxicity (eg, antibiotics, methotrexate, amiodarone, corticosteroids)
  • Malignancy (particularly Liver cancer, biliary, metastatic)
  • Hemochromatosis
  • Wilson disease
  • Celiac disease
  • Alpha-1 antitrypsin deficiency
  • Bile duct stricture or obstruction
  • Congestive hepatopathy
  • Liver fluke (Fascioliasis, Clonorchiasis, Opisthorchis viverrini infection)

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:10/31/2017
Last Updated:11/30/2023
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Metabolic dysfunction-associated steatotic liver disease
A medical illustration showing key findings of Metabolic dysfunction-associated steatotic liver disease : Fatigue, Hepatomegaly, Alkaline phosphatase elevated, ALT elevated, AST elevated, Malaise, RUQ pain
Imaging Studies image of Metabolic dysfunction-associated steatotic liver disease - imageId=8358603. Click to open in gallery.  caption: '<span>Axial image from contrast enhanced CT scan of the abdomen demonstrating marked low attenuation of the liver, consistent with hepatic steatosis.</span>'
Axial image from contrast enhanced CT scan of the abdomen demonstrating marked low attenuation of the liver, consistent with hepatic steatosis.
Copyright © 2024 VisualDx®. All rights reserved.