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Nonalcoholic fatty liver disease
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Nonalcoholic fatty liver disease

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Contributors: Michael W. Winter MD
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Synopsis

Nonalcoholic fatty liver disease : Fatigue, Hepatomegaly, Alkaline phosphatase elevated, ALT elevated, AST elevated, Malaise, RUQ pain
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease around the world (prevalence of 25%), with 30% of the US population affected. NAFLD is a chronic condition of fat accumulation in the liver without involvement of excessive alcohol consumption or use of steatogenic medications. NAFLD represents a spectrum of disease, from nonalcoholic fatty liver (NAFL; steatosis without hepatocellular injury) to nonalcoholic steatohepatitis (NASH; steatosis with hepatic injury / inflammation) to progressive fibrosis and liver cirrhosis. With advancements in the treatment of viral hepatitis and a continual increase in obesity and metabolic syndrome in the United States, NAFLD 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 NAFLD 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 NAFLD 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 NAFLD 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:
197315008 – Non-alcoholic fatty liver

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

NAFLD 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 NAFLD.

Alternative diagnoses to consider:

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:04/05/2021
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Nonalcoholic fatty liver disease
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A medical illustration showing key findings of Nonalcoholic fatty liver disease : Fatigue, Hepatomegaly, Alkaline phosphatase elevated, ALT elevated, AST elevated, Malaise, RUQ pain
Imaging Studies image of Nonalcoholic fatty 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.

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