Our Summary

This research paper discusses Non-alcoholic fatty liver disease (NAFLD), a range of liver conditions that occur without alcohol consumption. They range from a simple fat buildup in the liver (Non-alcoholic Fatty Liver or NAFL), to a more complex condition that includes liver injury and inflammation (non-alcoholic steatohepatitis; NASH). The paper suggests that there might be conditions that fall in between these two extremes.

Diagnosing these conditions is usually done by examining a small sample of liver tissue (a biopsy), as there aren’t any non-invasive tests that are accurate enough. If at least 5% of the cells in the liver sample have fat in them, and the patient has the right combination of symptoms, they can be diagnosed with NAFLD. If inflammation and specific types of liver cell damage are present in the sample, then it’s usually diagnosed as NASH.

One of the most important parts of the diagnosis is figuring out the stage of fibrosis, or scarring in the liver. This is a better indicator of how serious the disease is than the inflammation and cell damage.

The paper mentions that there are scoring systems for NAFLD that try to quantify the disease, but they aren’t very practical and have limitations. Instead, the authors recommend using the SAF (Steatosis, Activity, Fibrosis) score, which separately assesses the amount of fat in the liver, the level of activity (inflammation and cell damage), and the stage of fibrosis.

FAQs

  1. What is the role of liver biopsy in the diagnosis of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH)?
  2. What are the limitations of semi-quantitative histological scoring systems for NAFLD?
  3. How does the SAF (Steatosis, Activity, Fibrosis) score help in assessing the grade and stage of NAFLD and NASH?

Doctor’s Tip

One helpful tip a doctor might tell a patient about liver biopsy is to make sure to follow any pre-biopsy instructions given by the healthcare provider, such as fasting before the procedure. It is also important to inform the healthcare provider about any allergies, medications, or medical conditions before the biopsy. After the procedure, it is important to follow post-biopsy care instructions, such as avoiding strenuous activities and taking any prescribed medications as directed. It is also important to follow up with the healthcare provider for the results and further management of the condition.

Suitable For

Patients who are typically recommended for a liver biopsy include those with suspected non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) in order to accurately diagnose and stage the disease. This may include patients with abnormal liver function tests, imaging findings suggestive of fatty liver, or risk factors such as obesity, diabetes, or metabolic syndrome. Additionally, patients who may benefit from a liver biopsy include those with unclear or conflicting non-invasive test results, those with advanced liver disease or cirrhosis, and those being considered for clinical trials or specific treatments for NAFLD/NASH.

Timeline

Before liver biopsy:

  1. The patient may present with symptoms such as fatigue, abdominal pain, or jaundice.
  2. The patient’s medical history, physical examination, and laboratory tests may suggest the presence of liver disease.
  3. Non-invasive tests such as imaging studies or blood tests may be performed to assess the severity of liver disease and determine the need for a liver biopsy.

During liver biopsy:

  1. The patient is informed about the procedure and gives consent.
  2. The patient is prepared for the biopsy, which may involve fasting and stopping certain medications.
  3. The biopsy is performed using a needle to extract a small sample of liver tissue for examination.
  4. The patient may experience some discomfort or pain during the procedure.

After liver biopsy:

  1. The patient is monitored for a period of time to check for any complications such as bleeding or infection.
  2. The liver tissue sample is sent to a pathology lab for analysis.
  3. The results of the biopsy, including the presence of steatosis, inflammation, and fibrosis, are used to diagnose and stage the liver disease.
  4. The patient may receive further treatment or follow-up based on the biopsy results.

What to Ask Your Doctor

  1. What is the purpose of a liver biopsy in diagnosing non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH)?

  2. How is a liver biopsy performed and what can I expect during the procedure?

  3. What are the potential risks and complications associated with a liver biopsy?

  4. How long will it take to receive the results of the liver biopsy?

  5. What information will the liver biopsy provide about the severity of my NAFLD or NASH?

  6. How will the results of the liver biopsy impact my treatment plan?

  7. Are there any alternative diagnostic tests or imaging studies that could be used instead of a liver biopsy?

  8. How often will I need to undergo liver biopsies to monitor my condition?

  9. How should I prepare for a liver biopsy in terms of fasting or medication adjustments?

  10. Are there any specific post-biopsy care instructions I should follow?

Reference

Authors: Bedossa P. Journal: Liver Int. 2017 Jan;37 Suppl 1:85-89. doi: 10.1111/liv.13301. PMID: 28052629