Evaluation of Fatty Liver – Beyond sonography and SGPT

 

Evaluation of Fatty Liver – Beyond sonography and SGPT

How many of you have fatty liver on sonography?

How did you come to know that you have fatty Liver?

What tests did you carry out to evaluate fatty liver?

Fatty Liver is most diagnosed incidentally when patients get evaluated for abdominal discomfort or as a routine health checkup. Sometimes it gets diagnosed when altered liver tests are noticed. It affects nearly one quarter of our population.

Whenever there is fatty liver, the pragmatic next step is to start evaluating for metabolic syndrome like diabetes, hypertension, abnormal cholesterol levels, obesity, thyroid abnormalities, sleep apnea. The next step is to exclude other liver disease like viral hepatitis, autoimmune hepatitis, and metabolic liver disease. Once fatty liver is diagnosed, we need to evaluate the stage of fatty liver disease. There is a misconception that ultrasound gives you the stage of liver disease. It does not give stage of liver disease but just grade of fat in the liver. The sonography just mentions the degree of fat in the liver as grade 1, 2 or 3. It is insufficient to tell you the stage of liver disease. Also, SGPT or ALT is inadequate to give you the stage of liver disease. It may be falsely normal in more than 50 percent patients despite abnormal liver function.

Stage of Liver Disease

So how do you know what stage the liver disease is?

Normal Liver

       

Fatty Liver – Grade 1, Grade 2 or Grade 3

Steatohepatitis

Fibrosis Grade 1, Grade 2, Grade3

Cirrhosis (Stage 4 Fibrosis)

 

You have the following tests to diagnose the stage of liver disease (Available in India)

Once, you know the stage of liver disease, your liver doctor will start medicines based on presence or absence of other conditions and stage of liver disease. Lifestyle modification remains at the center of fatty liver management.You need to get one blood tests and one elastography test as advised by your liver specialist to know the stage of liver disease. We also need to know that Fibroscan is not the only test to tell ou about the stage of liver disease. You have all the above tests.

To know more, contact you hepatologist


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