The definitive diagnosis of NAFLD requires evidence of Is Ultrasound needed to diagnose NAFLD? excess fat in the liver, which may be seen on USS testing, or by liver biopsy. However, NICE does not recommend ultrasound routinely for patients who have evidence of the metabolic syndrome (T2DM, obesity, CVD, hypertension), and liver screening is otherwise normal, as there is a high probability of NAFLD. The appearances of steatosis on U/S are operator-dependent and a normal ultrasound does not rule out NAFLD. The decision whether to perform USS can be decided on an individual case basis where there is concern about alternative diagnoses. Statins:- continue, unless liver enzymes double within 3m of starting (incl. in people with abnormal baseline LFTs) ELF blood tests:- recent NICE guidelines suggested the use of ELF (Enhanced liver fibrosis score) to judge the risk of fibrosis/cirrhosis. This test is not currently available in our trust; it is also more expensive and the NAFLD score is proven to be a good first line test (see review articles below for more info) Authors: Dr Rob Palmer GPwSI Gastro, CCG Gastro lead – Dr Iain Ewing Consultant Hepatologist, HUH – References 1. Non-alcoholic fatty liver disease (NAFLD): assessment and management NICE guideline [NG49] Published date: July 2016 2. International Journal of Endocrinology, Volume 2015 (2015), Review Article: Noninvasive Assessment of Fibrosis in Patients with Nonalcoholic Fatty Liver Disease; et al 3. Managing Abnormal Liver Tests in Primary Care - Summary guideline August 2015; Barts and The London CEG 4. NICE Clinical Knowledge Summaries - NAFLD: https://cks.nice.org.uk/non-alcoholic-fatty-liver-disease-nafld
Is Ultrasound needed to diagnose NAFLD? The definitive diagnosis of NAFLD requires evidence of excess fat in the liver, which may be seen on USS testing, or by liver biopsy. However, NICE does not recommend ultrasound routinely for patients who have evidence of the metabolic syndrome (T2DM, obesity, CVD, hypertension), and liver screening is otherwise normal, as there is a high probability of NAFLD. The appearances of steatosis on U/S are operator-dependent and a normal ultrasound does not rule out NAFLD. The decision whether to perform USS can be decided on an individual case basis where there is concern about alternative diagnoses. Statins:- continue, unless liver enzymes double within 3m of starting (incl. in people with abnormal baseline LFTs) ELF blood tests:- recent NICE guidelines suggested the use of ELF (Enhanced liver fibrosis score) to judge the risk of fibrosis/cirrhosis. This test is not currently available in our trust; it is also more expensive and the NAFLD score is proven to be a good first line test (see review articles below for more info) Authors: Dr Rob Palmer – GPwSI Gastro, CCG Gastro lead Dr Iain Ewing – Consultant Hepatologist, HUH References 1. Non-alcoholic fatty liver disease (NAFLD): assessment and management NICE guideline [NG49] Published date: July 2016 2. International Journal of Endocrinology, Volume 2015 (2015), Review Article: Noninvasive Assessment of Fibrosis in Patients with Nonalcoholic Fatty Liver Disease; et al 3. Managing Abnormal Liver Tests in Primary Care - Summary guideline August 2015; Barts and The London CEG 4. NICE Clinical Knowledge Summaries - NAFLD: https://cks.nice.org.uk/non-alcoholic-fatty-liver-disease-nafld
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