hepatic and biliary disorders
Metabolic Dysfunction–Associated Liver Disease (MASLD)
Diagnosis of MASLD
History (presence of risk factors, absence of excessive alcohol intake) Serologic tests that rule out hepatitis B and C Ultrasound evidence of steatosis or MR elastography with fat fraction Liver Biopsy None The diagnosis of MASH should be suspected in patients with Metabolic Syndrome (typically obesity, type 2 diabetes mellitus or a high fasting plasma glucose level, hypertension, and dyslipidemia) and in patients with unexplained laboratory abnormalities suggesting liver disease. Differentiating simple steatosis from MASH can be difficult and elevated liver enzymes are not a sensitive predictor for identifying MASH. The presence of metabolic syndrome as well as elevated ferritin increases the likelihood that a patient has MASH rather than simple steatosis. Further, clinical scoring systems such as the FIB4 score, MASLD fibrosis score calculator or laboratory MASH FibroSure® can identify patients at risk for fibrosis and thus those more likely to have MASH and be at risk for progression to 20 g/day) is needed, and Serology should show absence of hepatitis B and C (ie, hepatitis B surface antigen and hepatitis C virus antibody should be negative). Liver biopsy reveals damage similar to that seen in alcoholic hepatitis, usually including large fat droplets (macrovesicular fatty infiltration) as well as pericellular or "chicken wire" fibrosis. Indications for biopsy include unexplained signs of Imaging Tests of the Liver and Gallbladder , including ultrasonography, CT, and particularly MRI, may identify hepatic steatosis. Noninvasive measures of fibrosis such as transient elastography (a test that uses both ultrasound and low-frequency elastic waves), 1.Cassinotto C, Boursier J, de Ledinghen V, et al: Liver stiffness in nonalcoholic fatty liver disease: A comparison of supersonic shear imaging, FibroScan, and ARFI with liver biopsy.Hepatology63(6):1817-1827, 2016. doi: 10.1002/hep.28394 2.Lee MS, Bae JM, Joo SK, et al: Prospective comparison among transient elastography, supersonic shear imaging and ARFI for predicting fibrosis in nonalcoholic fatty liver disease.PLoS One12(11)e:0188321, 2017. doi: 10.1371/journal.pone.0188321. eCollection 2017.Erratum in:PLoS One3(6):e0200055, 2018. doi: 10.1371/journal.pone.0200055. eCollection 2018. 