NAFLD is the most common liver disease in first world countries, with a prevalence of 20% to 30% in the general population; however, this increases to 70% with obesity and 90% with diabetes mellitus. NAFLD is a spectrum of fat deposition and hepatic inflammation followed by fibrosis due to metabolic insults. Simple hepatic steatosis can be seen in 70% to 75% of cases without cellular insult. Nonalcoholic steatohepatitis (NASH) can be found in 25% to 30% of cases with hepatocyte injury and inflammation due to lipid; these entities, simple hepatic steatosis and NASH, can coexist. Progressive insults with inflammation can result in fibrosis leading to cirrhosis and hepatocellular carcinoma [4,5]. US Abdomen Ultrasound (US) is useful as a first-line investigation tool for mild increase in liver enzymes. US has been used world-wide to screen for both alcohol-induced liver disease and NAFLD. US has the benefit of being noninvasive and is an accurate method to detect steatosis [6,7]. US can be successfully diagnose hepatic lipid content of >33% but can be unreliable with mild fatty infiltration, with an 84.8% sensitivity and a 93.6% specificity with US in moderate and sever hepatic fat deposition (defined as >30% by histology) [8,9]. Both sensitivity and specificity declined to 53.3% to 65% and 77% to 81.2%, respectively, when mild steatosis was included with moderate and severe degrees of steatosis. It is noteworthy that sonographic specificity further deteriorates with confounding factors such as inflammation or fibrosis within the liver parenchyma [8,10,11]. Estimation of hepatic steatosis on conventional US is subjective and challenged by inter- and intraobserver variability. Normal liver shows echogenicity similar to or just higher than normal renal cortex. Fatty infiltration Abnormal Liver Function Tests increases the echogenicity of the liver parenchyma.
Abnormal Liver Function Tests. NAFLD is the most common liver disease in first world countries, with a prevalence of 20% to 30% in the general population; however, this increases to 70% with obesity and 90% with diabetes mellitus. NAFLD is a spectrum of fat deposition and hepatic inflammation followed by fibrosis due to metabolic insults. Simple hepatic steatosis can be seen in 70% to 75% of cases without cellular insult. Nonalcoholic steatohepatitis (NASH) can be found in 25% to 30% of cases with hepatocyte injury and inflammation due to lipid; these entities, simple hepatic steatosis and NASH, can coexist. Progressive insults with inflammation can result in fibrosis leading to cirrhosis and hepatocellular carcinoma [4,5]. US Abdomen Ultrasound (US) is useful as a first-line investigation tool for mild increase in liver enzymes. US has been used world-wide to screen for both alcohol-induced liver disease and NAFLD. US has the benefit of being noninvasive and is an accurate method to detect steatosis [6,7]. US can be successfully diagnose hepatic lipid content of >33% but can be unreliable with mild fatty infiltration, with an 84.8% sensitivity and a 93.6% specificity with US in moderate and sever hepatic fat deposition (defined as >30% by histology) [8,9]. Both sensitivity and specificity declined to 53.3% to 65% and 77% to 81.2%, respectively, when mild steatosis was included with moderate and severe degrees of steatosis. It is noteworthy that sonographic specificity further deteriorates with confounding factors such as inflammation or fibrosis within the liver parenchyma [8,10,11]. Estimation of hepatic steatosis on conventional US is subjective and challenged by inter- and intraobserver variability. Normal liver shows echogenicity similar to or just higher than normal renal cortex. Fatty infiltration Abnormal Liver Function Tests increases the echogenicity of the liver parenchyma.