Here are the initial lab results:
Here are the results of the Abdominal Ultrasound:
- Echogenic liver, compatible with nonspecific hepatic parenchymal disease, including but not limited to hepatic steatosis.
- Patent hepatic vessels.
Choose the 3 highest yield diagnostic tests below!
Transient Elastography
Correct! Vibration controlled transient elastography (VCTE) can be used to non-invasively identify patients at low or high risk for advanced fibrosis (bridging fibrosis or cirrhosis).
Check HBV DNA
Incorrect! The patient’s labs are consistent with prior vaccination against hepatitis B.
Calculate FIB-4 index
Correct! FIB-4 index (which utilizes platelet count, ALT, AST, age) is a clinically useful tool for identifying NAFLD patients with higher likelihood of having bridging fibrosis (stage 3) or cirrhosis (stage 4).
Liver Biopsy
Incorrect! Liver biopsy can be considered in patients with NAFLD who have other competing etiologies of liver disease that cannot be ruled out without a biopsy or those who are at increased risk of having steatohepatitis and/or advanced fibrosis however non-invasive assessment should be performed first.
MRCP
Incorrect! There is no suggestion of pancreaticobiliary abnormality and it would not add additional diagnostic information at this time.
Check Iron Studies
Correct! In patients with suspected NAFLD, persistently high serum ferritin, and increased iron saturation, especially in the context of homozygote or heterozygote C282Y HFE mutation, a liver biopsy should be considered. Note that mildly elevated ferritin is a common feature of NAFLD that does not necessarily indicate hepatic iron overload.
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Case 4 Index:
Introduction
Physical Exam
GI SIM 