Suspected Fatty Liver Disease (NAFLD or ALD) – Leeds

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1 Background Information / Scope of Pathway

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2 Information Resources for Patients and Carers

Quick info:
The British Liver Trust website contains information on a wide range of liver disease and risk factors, and is a resource highly recommended by Leeds hepatologists.
The following are links to various resources.
British Liver Trust - Alcohol
British Liver Trust - NAFLD
British Liver Trust - Hepatitis B
British Liver Trust - Hepatitis C

Other recommended resources for patients and carers, produced by organisations certified by The Information Standard:

For details on how these resources are identified, please see Map of Medicine's document on Information Resources for Patients and Carers.

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3 Development and updates to this pathway

Pathway Developed May 2021 by citywide clinical team, led by Dr Richard Parker, consultant Hepatologist LTHT
Expiry: 31st May 2024

4 Referral Information

5 Raised ALT negative liver screen

6 Fatty Liver on Ultrasound

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7 Non-Alcoholic Fatty Liver Disease

Consider NAFLD if patients have one or more of:

  • Overweight or obese
  • Diabetes
  • Hypertension
  • Dyslipdaemia

Do not do liver screen if LFTs are normal.

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8 Alcoholic Fatty Liver Disease

Consider alcohol related disease if people drink more than 14 units/week.

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9 FIB-4 (AST, ALT, Age, Platelet count)

https://www.mdcalc.com/fibrosis-4-fib-4-index-liver-fibrosis#evidence

Consider screening for cirrhosis in people who drink above:
                Men: 50 units/week
                Women: 35 units/week*

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15 Primary Care Management

Low risk of significant fibrosis can be safely managed in primary care. Treat risk factors. Repeat fibrosis testing (FIB-4) in 3 years*

Most people with fatty liver disease will not have significant hepatic fibrosis and are therefore at low risk of liver related morbidity or mortality. These patients can be safely managed in primary care. Importantly fatty liver diseases are not a contraindication to primary or secondary prophylaxis or other common comorbidities such as cardiovascular disease or diabetes.
A minority of patients will have significant fibrosis and require specialist input. If fibrosis cannot be ruled out in primary care using non-invasive testing, referral to hepatology should be considered.
*NICE guideline NG50

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16 Significant fibrosis not ruled out – refer for Fibroscan

Only patients shown to have significant fibrosis on scan require referral to specialist hepatology services.

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18. Patients with evidence of significant fibrosis will be offered Specialist Hepatology appointment

All fibroscan findings with evidence of significant fibrosis will be reviewed by the hepatology team and offered an appointment.