CLINICAL LECTURE

DEMONSTRATION

Saroj Jayasinghe
Department of Clinical Medicine
Faculty of Medicine
University of Colombo
 CLD
32 year old who had done tests to travel
abroad
Says he is healthy
BMI 29 and waist 105 cm
Otherwise general examination normal
BP 130 / 80 mm Hg
Physical examination normal
 CLD
32 year old who had done tests to travel
abroad
Says he is healthy
BMI 29 and waist 105 cm
Otherwise general examination normal
BP 130 / 80 mm Hg
Physical examination normal
 FBC
WBC 9,500
N 7,200
UFR - normal
Cr, K, Na
AST (SGOT) 92 IU (5-40)
ALT (SGPT) 48 (5-40)
ALK PO4, gamma GT and Bilirubin normal
ECG normal
 Asymptomatic mild elevation of ALT and AST
 What are the questions you would ask him?
 What are the questions you would ask him?
Causes of mild elevation in liver enzymes
Post viral?
A mild hepatitis or slowly progressive cirrhosis
Alcohol
Non-alcoholic fatty liver diseases
Drugs (anti-TB, methyl dopa, amiodorone)
 What are the questions you would ask him?
Causes of mild elevation in liver enzymes
Post viral? No history of fever
A mild hepatitis or slowly progressive cirrhosis
Alcohol: occasional alcohol, normal GGT
Drugs: paracetamol occasionally
Non-alcoholic fatty liver disease
NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)
Largely asymptomatic
Fatigue
How will you confirm?
NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)
Largely asymptomatic
Fatigue
Support your diagnosis:
Associated metabolic features: obesity, T2DM
Imaging
Ruling out other causes of mild elevation: HBsAg, Hep C
antibody, ferritin, ANA, anti smooth muscle antibody,
serum copper, caeruloplasmin, urinary copper
Biopsy (confirms)
 IMAGING
Ultrasound
Other forms of imaging
Transient elastography
 BIOPSY
RARELY DONE and NOT routinely recommended

MAY do in the following situations (i.e. risk

factors for of fibrosis)
Older (>50)
Obese (BMI >30)
T2DM
AST/ALT >1
 NAFLD
Non-alcoholic steatohepatitis
Fibrosis and Cirrhosis
(Hepatoma)
 TREATMENT
No specific treatment
Treat components of metabolic syndrome
Life style modification
Obesity
T2DM: metformin, glitazones
Dyslipidaemis- fibrates
Hypertension angiotensin-2 receptor blockage
Specific treatment
Vitamin E (800 IU/d)
?Ursodeoxycholic acid
 SUMMARY
Causes of mild elevation in liver enzymes
Post viral
A mild hepatitis or slowly progressive cirrhosis
Alcohol
Drugs
Non-alcoholic fatty liver disease
NAFLD
No specific treatment
Treat components of metabolic syndrome
Life style modification
Specific treatment