Nonalcoholic Fatty Liver Disease (NAFLD)
History & Physical
- Most are asymptomatic
- May have vague abdominal pain or h/o constipation
- High fat diet with little exercise
- Most are overweight or obese
- Acanthosis nigricans is common
- Anicteric
- Mild to moderate hepatomegaly
Laboratory findings
- Mild to moderate elevation of AST/ALT
- Mildly elevated alkaline phosphatase
- Normal bilirubin, albumin, and PT
- Ultrasound shows generalized increased echogenecity and/or focal areas of
decreased echogenecity
Differential diagnosis:
- Chronic viral hepatitis
- Auto-immune liver disease
- Alpha-1-antitrpsin deficiency
- Wilson’s disease
- Drug or toxin exposure
- Consider liver biopsy if persistent elevation (>6 months) of AST/ALT that
has not responded to weight reduction or discontinuation of medications
Treatment options
- Life style changes with diet and exercise
- Pharmacologic therapy (ursodeoxycholic acid (Actigall), vitamin E, insulin
sensitizing agents)
CHLA Board Review 2005