Gastroenterology Education and CPD for trainees and specialists

1. Which one of the following statements regarding non alcoholic fatty liver disease (NAFLD) is false?

1. Weight loss improves liver biochemistry
2. Liver biopsy should be considered in patients with diabetes or age >45yrs
3. Insulin resistance is almost universal
4. Cirrhosis develops in almost 40% of patients of NASH
5. Prevalence of NAFLD is up to 30% whereas prevalence of NASH is only up to 6%

Explanation :Data based on ultrasonographic studies and serum enzyme measurements indicate that the prevalence of NAFLD in the general U.S. population is approximately 30% and nearly 5 percent of children. There are no reliable data on the prevalence of NASH - the most severe form of NAFLD. However, a review of the literature suggests a prevalence of approximately 5 to 6%. Steatosis alone is reported to have a more benign clinical course, with cirrhosis developing in only 1 to 3% of patients. However in patients with NASH cirrhosis develops in 9 to 25%.

2. Which one of the following statements regarding non alcoholic fatty liver disease (NAFLD) is true?

1. Increases in visceral adipose tissue and intrahepatic fat correlate with insulin resistance
2. Resistance to the action of insulin results in enhanced peripheral lipolysis
3. This in turn results in a preferential shift from carbohydrate to FFA beta-oxidation
4. FFAs are inducers of several cytochrome p-450 microsomal lipoxygenases, capable of producing hepatotoxic free oxygen radical species
5. All above

3. 1.Which one of the following statements regarding non alcoholic fatty liver disease (NAFLD) is false?

1. Microvesicular steatosis is more dangerous than macrovesicular steatosis
2. Diabetic patients with age>45yrs are at increased risk for progressive fibrosis from NASH
3. Fibroscan reading of >7 kPa is suggestive of fibrosis
4. Insulin sensitizers like pioglitazone has been used in NASH
5. Metabolic syndrome X consists of obesity, hypertension and IHD.

Explanation :Metabolic syndrome X requires three of the five criteria Glucose >= 5.6mmol/Lor drug treatment for elevated blood glucose HDL cholesterol <1.0mmol/L in men and <1.3mmol/L in women or drug treatment for low HDL-C Triglyceride >= 1.7 mmol/L or drug treatment for elevated triglycerides Obesity Waist 102 cm (men) or 88 cm (women) Hypertension 130/85 mmHg or drug treatment for hypertension Fibroscan uses a ultrasonic transducer, to send a vibration of low frequency (50 Mhz) and amplitude is into the liver. The vibration wave induces an elastic shear wave that propagates through the organ. The velocity of this wave correlates directly with tissue stiffness- the stiffer the tissue the faster the wave.Results are expressed in kilopascals (kPa). Normal value is less than 7

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