Doctors use your medical history, a physical exam, and tests to diagnose Non-Alcoholic Fatty Liver Disease (NAFLD) including Non-Alcoholic Fatty Liver (NAFL) and Non-Alcoholic Steatohepatitis (NASH).
Medical history is the first step towards the diagnosis. In NAFLD patients, there can be a history of being overweight or obesity, insulin resistance or type 2 diabetes, high levels of triglycerides or abnormal levels of cholesterol in the blood, and some metabolic syndrome.
The physical exam would include an examination of your body weight and height to calculate your body mass index. The doctor looks for the signs of NAFL or NASH such as an enlarged liver, signs of cirrhosis, an enlarged spleen, ascites, and muscle loss, and signs of insulin resistance, such as darkened skin patches over your knuckles, elbows, and knees.
The blood tests in an NAFLD patient will show increased levels of liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Advanced liver fibrosis or scarring can be calculated by special scores like the FIB-4 or APRI.
Imaging tests can show fat in your liver. If you have cirrhosis, routine imaging tests may show nodules, or lumps, in your liver. Ultrasound and computed tomography (CT) will be used to create images of your liver. Magnetic resonance imaging (MRI) can be done to produce detailed images of organs and soft tissues. Elastography can help determine if you have advanced liver fibrosis by measuring the stiffness of your liver.
Lastly, a Liver biopsy can prove a diagnosis of NASH and show clearly how severe the disease is by examining the tissue under a microscope to look for signs of damage or disease.
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