Hepatic steatosis with minimal alcohol; spectrum from simple steatosis to NASH to cirrhosis.
Risk factors
- • Obesity, T2DM, dyslipidaemia, MetS
History taking
- • Onset, duration, progression, severity
- • Aggravating / relieving factors
- • Past history, drugs, allergies, comorbidities
- • Family & social history relevant to presentation
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • LFT, lipid, HbA1c, USS abdomen
- • FIB-4 / NAFLD fibrosis score, FibroScan if intermediate–high risk
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Weight loss 7–10% reverses NASH
- • Treat metabolic comorbidities
- • Pioglitazone or vitamin E in selected biopsy-proven NASH
Lifestyle advice
- • Mediterranean diet, exercise, alcohol avoidance
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
Clinical pearls
- • FIB-4 <1.3 reasonably excludes advanced fibrosis
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
