Investigations

A definitive diagnosis can only be achieved by liver biopsy and histopathological analysis. Efforts are being made to find non-invasive markers of disease which can distinguish the stages of fibrosis, fibrosis from NASH and NASH from simple steatosis. 1.Blood tests: o Full blood count. o Liver function tests:  Raised AST or ALT (up to 10 times increase).  AST and ALT may be normal in steatosis and steatohepatitis. o Alkaline phosphatase may be raised o Fasting lipid profile:  Hyperlipidaemia is usually present.  Triglycerides may be raised. Iron studies:  Ferritin may be raised in NASH.  Iron overload is more harmful when associated with NASH and screening for haemochromatosis is recommended if the ferritin is significantly elevated. Autoimmune studies:  Antinuclear antibodies (ANAs) and anti-smooth muscle antibody (ASMA) may be raised in NASH.  Cirrhosis may give positive results.  Autoimmune liver disease may be suggested by serum protein electrophoresis if appropriate. Viral studies are done to exclude viral hepatitis. Blood sugar: fasting levels may demonstrate impaired fasting glycaemia or diabetes characteristic of the metabolic syndrome.

o o

2.Diagnostic imaging. These techniques may be used to define extent and course of disease. Steatohepatitis is usually diffuse, whereas steatosis may be focal or diffuse. o Ultrasound:  Shows a hyperechogenic, bright image.  Ultrasound has some diagnostic accuracy in detecting steatosis. o Ultrasound is not good at distinguishing NASH and fibrosis within NAFLD o CT scanning may be helpful to monitor the course of the disease. o MRI scan can be used to exclude fatty infiltration and the course and extent of this and other liver. 4.Liver biopsy: o The only definitive test. o An NAFLD score can be performed. This scores for steatosis, inflammation, ballooning and fibrosis.