Hepatic steatosis

Last reviewed: 27 Aug 2022
Last updated: 10 Aug 2022

Summary

Definition

History and exam

Key diagnostic factors

  • absence of significant alcohol use
  • mild abnormality in liver function tests
  • truncal obesity
More key diagnostic factors

Other diagnostic factors

  • fatigue and malaise
  • right upper quadrant abdominal discomfort
  • hepatosplenomegaly
  • signs of chronic liver disease
Other diagnostic factors

Risk factors

  • obesity
  • insulin resistance or diabetes
  • dyslipidemia
  • hypertension
  • metabolic syndrome
  • rapid weight loss
  • medications
  • total parenteral nutrition (TPN)
  • diseases associated with hepatic steatosis
More risk factors

Diagnostic investigations

1st investigations to order

  • serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
  • total bilirubin
  • alkaline phosphatase
  • gamma glutamyl transferase
  • CBC
  • metabolic panel
  • lipid panel
  • prothrombin time and INR
  • serum albumin
  • autoimmune liver disease screen
  • iron studies
  • hepatitis B surface antigen, surface antibody, and core antibody
  • hepatitis C virus antibody
  • alpha-1 antitrypsin level and phenotype
  • liver ultrasound
More 1st investigations to order

Investigations to consider

  • fasting insulin
  • homeostatic model assessment (HOMA) calculation
  • abdominal MRI
  • elastography
  • liver biopsy
  • ceruloplasmin
  • HFE gene mutation testing
  • anti-M2 mitochondrial antibody
More investigations to consider

Emerging tests

  • cytokeratin-18 fragments

Treatment algorithm

ONGOING

without end-stage liver disease

end-stage liver disease

Contributors

Authors

Shahid M. Malik, MD
Shahid M. Malik

Clinical Assistant Professor of Medicine

Division of Gastroenterology, Hepatology and Nutrition

Department of Medicine

Program Director, Transplant Hepatology Fellowship Program

Starzl Transplantation Institute

University of Pittsburgh Medical Center

Pittsburgh

PA

Disclosures

SMM declares that he has no competing interests.

Rachel Zhuang, MD

Physician

General Internal Medicine

University of Pittsburgh Medical Center

Pittsburgh

PA

Disclosures

RZ declares that she has no competing interests.

Kapil B. Chopra, MD, FACP, FAASLD, AGAF
Kapil B. Chopra

Professor of Medicine

Medical Director of Comprehensive Liver Program and Liver Pancreas Institute

University of Pittsburgh School of Medicine

University of Pittsburgh Medical Center

Pittsburgh

PA

Disclosures

KBC declares that he has no competing interests.

Peer reviewers

Philip Newsome, PhD, FRCPE

Senior Lecturer in Hepatology & Honorary Consultant Physician

Liver Research Group

Institute of Biomedical Research

The Medical School

University of Birmingham

Birmingham

UK

Disclosures

PN declares that he has no competing interests.

Stephen A. Harrison, MD, LTC, MC

Chief of Hepatology

Department of Medicine

Gastroenterology & Hepatology Service

Brooke Army Medical Center

Fort Sam Houston

Associate Professor of Medicine

University of Texas Health Science Center

Houston

TX

Disclosures

SAH is an author of a reference cited in this topic.

Robert D. Goldin, MBCHB, MD, FRCPath

Reader in Liver and GI Pathology

Imperial College at St. Mary's

London

UK

Disclosures

RDG declares that he has no competing interests.

  • Hepatic steatosis images
  • Differentials

    • Alcoholic liver disease
    • Cryptogenic cirrhosis
    • Autoimmune hepatitis
    More Differentials
  • Guidelines

    • Quality standards for the management of non-alcoholic fatty liver disease (NAFLD): consensus recommendations from the BASL and BSG NAFLD Special Interest Group
    • The diagnosis and management of nonalcoholic fatty liver disease
    More Guidelines
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