Strategy for the diagnosis of nonalcoholic fatty liver disease

Abstract

Nonalcoholic fatty liver disease is currently considered as the most common disease of the liver and internal organs. Its close connection with diabetes mellitus, obesity, atherosclerosis, arterial hypertension, chronic kidney disease, rectal cancer, polycystic ovaries, psoriasis, etc. Nonalcoholic fatty liver disease includes various chronic clinical and morphological changes of liver parenchyma: steatosis, steatohepatitis, fibrosis, liver cirrhosis and hepatocellular carcinoma. According to the large-scale epidemiological studies, the prevalence of the nonalcoholic fatty liver disease in Russia currently stands at 37,1%. In the strategy of diagnosis of this disease, it is necessary to exclude alcoholic liver disease, chronic viral hepatitis, metabolic diseases, autoimmune liver diseases, taking medications, the effect of alimentary factor, etc. the methods used to exclude alcoholic liver damage with the help of international validated questionnaires are given in Detail. The most characteristic shifts in laboratory parameters of biochemical blood analysis, as well as the calculated diagnostic indices, such as the index of fatty liver, the index of nonalcoholic fatty liver disease, the index of liver steatosis, steatotest, the index of fibrosis of nonalcoholic fatty liver disease, FibroMax and others are shown. The instrumental methods of diagnosis of nonalcoholic fatty liver disease are described in detail: ultrasound, computed tomography, morphological examination of liver biopsies, determination of the parameter of controlled attenuation of the ultrasonic wave in the liver tissue using fibroscan. For the purpose of non- invasive determination of fibrosis degree different variants of elastography are used: transient, acoustic pulse wave, magnetic resonance. The most sensitive and specific methods of diagnosis of non-alcoholic fatty liver disease are selective magnetic resonance imaging with quantitative determination of fat and proton magnetic resonance spectroscopy. These techniques are practically not used in normal clinical practice due to the complexity and high cost of the equipment.

Keywords

diagnosis of nonalcoholic fatty liver disease / fatty hepatosis / steatohepatitis / diagnosis of alcoholic liver disease / alcohol consumption assessment / laboratory and instrumental diagnosis of nonalcoholic fatty liver disease / liver biopsy / liver elastography

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