Nonalcoholic Fatty Liver Disease

Implications for Clinical Practice and Health Promotion

Bethany Croke, FNP-BC; Deborah Sampson, FNP-BC

Disclosures

Journal for Nurse Practitioners. 2012;8(1):45-50. 

In This Article

Presentation

Patients are typically asymptomatic, and abnormalities are found upon a routine liver enzyme test or an abdominal ultrasound for an unrelated illness. Early symptoms (Table 1), when they do occur, are typically nonspecific, such as fatigue and vague right upper quadrant pain. Some patients with progressed disease (ie, NASH or cirrhosis) may present with signs of serious liver damage, such as jaundice, anorexia, pruritis, and ascites. Upon physical exam 30%-100% of patients will be obese and 50% will have hepatomegaly.[1] Less common physical findings include spider nevi and palmar erythema.

Pediatric NAFLD presentation is also typically asymptomatic in its early stages.[14,15] Like adults, symptoms include fatigue, malaise, and vague right upper or epigastric pain. The classic presentation is a boy, 11–13 years old, who is overweight or obese. Furthermore, greater than 90% of children with NAFLD have central adiposity contributing to their obesity, and hepatomegaly is a common finding.[9] Acanthosis nigricans is also a common finding as a result of insulin resistance, and cardiovascular markers, such as hypertension and increased waist circumference, can coexist in children with NAFLD.[16]

In terms of laboratory findings, NAFLD is the most common cause of persistent ALT elevation in the absence of other chronic liver diseases. The ALT elevation is not excessive, usually 1 to 4 times the upper limit of normal. The AST may also be elevated, but the AST/ALT ratio is rarely > 2. Of important note, ALT levels do not correlate with the degree of steatosis or fibrosis. Other laboratory measures to consider are markers indicating decreased liver function in progressed disease, such as increased prothrombin time, decreased albumin levels, and increased serum bilirubin. Glucose levels and fasting lipid profiles may reveal comorbidities associated with NAFLD, such as diabetes and hypertriglyceridemia, respectively.

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