FATTY LIVER DISEASE (AI)

Fatty liver disease, also known as hepatic steatosis, is a condition where excess fat builds up in
the liver. As a nurse, understanding the critical aspects of fatty liver disease involves knowing
its types, risk factors, pathophysiology, clinical presentation, management, and nursing
considerations.
1. TYPES OF FATTY LIVER DISEASE
• NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD): Fat accumulation in the
liver not caused by alcohol. Subdivided into:
• SIMPLE STEATOSIS: Fat accumulation without significant inflammation.
• Non-Alcoholic STEATOHEPATITIS (NASH): Fat accumulation with inflammation
and liver cell damage, potentially leading to fibrosis or cirrhosis.
• ALCOHOLIC FATTY LIVER DISEASE (AFLD): Caused by excessive alcohol
consumption.
2. RISK FACTORS
NAFLD:
• Obesity
• Type 2 diabetes mellitus
• Dyslipidemia (high triglycerides, low HDL)
• Metabolic syndrome
• Sedentary lifestyle
AFLD:
• Excessive alcohol consumption
• Poor diet and malnutrition
• Genetic predisposition
3. PATHOPHYSIOLOGY
• Accumulation of triglycerides in liver cells (steatosis) due to:
• Increased fat synthesis or delivery (from the bloodstream).
• Impaired fat breakdown or export by the liver.
• Inflammatory changes (in NASH) lead to liver cell injury, fibrosis, and eventual
cirrhosis in advanced cases.
4. CLINICAL PRESENTATION
• Often asymptomatic, especially in early stages.
• Symptoms (if present):
• Fatigue
• Right upper quadrant discomfort
• Hepatomegaly (enlarged liver)
• Advanced stages (cirrhosis):
• Jaundice
• Ascites
 • Edema
• Encephalopathy
5. DIAGNOSTIC TOOLS
• Laboratory Tests:
• Elevated liver enzymes (ALT, AST) in NASH and AFLD.
• Lipid profile and fasting glucose.
• Imaging:
• Ultrasound: Hyperechoic liver.
• MRI or CT scan for detailed imaging.
• Liver Biopsy: Gold standard for distinguishing simple steatosis from NASH.
• Non-invasive Scores: Fibrosis-4 (FIB-4), NAFLD fibrosis score.
6. MANAGEMENT
• Lifestyle Modifications:
• Weight loss: Target 5-10% body weight reduction.
• Balanced diet: Low fat, low sugar, Mediterranean-style.
• Regular physical activity.
• Pharmacologic Therapy:
• No specific FDA-approved medications for NAFLD/NASH.
• Treat comorbidities (e.g., diabetes, hyperlipidemia).
• Alcohol Cessation: Key for AFLD management.
• Advanced Disease:
• Manage complications of cirrhosis.
• Liver transplantation in end-stage cases.
7. NURSING CONSIDERATIONS
PATIENT EDUCATION:
• Emphasize the importance of lifestyle changes.
• Educate on the role of comorbidity control.
• Support alcohol cessation for AFLD patients.
MONITORING:
• Track liver function tests and symptoms of progression (e.g., jaundice, ascites).
• Monitor adherence to lifestyle interventions.
PSYCHOSOCIAL SUPPORT:
• Address emotional and psychological impacts of chronic liver disease.
• Provide resources for weight management or addiction counseling.
CARE COORDINATION:
• Collaborate with dietitians, hepatologists, and primary care providers.
• Understanding these core aspects equips nurses with the necessary knowledge to
educate patients, monitor progression, and provide holistic care.
 AI-GENERATED PRACTICE NCLEX QUESTIONS
1. What is the primary cause of Non-Alcoholic Fatty Liver Disease (NAFLD)?
A. Viral hepatitis
B. Alcohol abuse
C. Metabolic syndrome
D. Autoimmune conditions
Answer: C
Rationale: NAFLD is strongly associated with metabolic syndrome, which includes
obesity, insulin resistance, dyslipidemia, and hypertension.

2. What distinguishes Non-Alcoholic Steatohepatitis (NASH) from simple steatosis?

A. Presence of fibrosis
B. Accumulation of triglycerides in the liver
C. Normal liver enzymes
D. Absence of inflammation

Answer: A
Rationale: NASH involves fat accumulation, inflammation, and liver cell damage, which
can lead to fibrosis, unlike simple steatosis.

3. What is the main mechanism causing fatty liver disease?

A. Impaired bile secretion
B. Excessive fat accumulation in liver cells
C. Decreased immune response
D. Elevated bilirubin production
Answer: B
Rationale: Fatty liver disease occurs when there is an imbalance between fat synthesis
and fat breakdown, leading to excess fat accumulation in hepatocytes.

4. Which of the following is a common risk factor for Alcoholic Fatty Liver Disease
(AFLD)?
A. Sedentary lifestyle
B. Excessive alcohol consumption
C. Low-fat diet
D. Viral hepatitis
Answer: B
Rationale: AFLD is directly caused by excessive alcohol intake, which impairs fat
metabolism in the liver.

5. Which process contributes to liver damage in AFLD?

A. Increased bile production
B. Alcohol-induced oxidative stress
C. Elevated protein metabolism
D. Immune suppression
Answer: B
Rationale: Alcohol metabolism generates toxic by-products like acetaldehyde, which
causes oxidative stress and liver cell injury.

6. A patient with NAFLD is asymptomatic. Which diagnostic test is most likely to

detect the condition?
A. Liver biopsy
B. Serum bilirubin
C. Abdominal ultrasound
D. Complete blood count
Answer: C
Rationale: Ultrasound can detect fat accumulation in the liver and is a common non-
invasive tool for diagnosing NAFLD.

7. Which lab value is typically elevated in NASH?

A. ALT and AST
B. Hemoglobin
C. Platelets
D. Sodium
Answer: A
Rationale: Elevated liver enzymes (ALT and AST) indicate liver cell damage, commonly
seen in NASH.

8. What is the primary reason NASH can progress to cirrhosis?

A. Persistent inflammation and fibrosis
B. Viral infection
C. Excessive bilirubin production
D. Iron overload
Answer: A
Rationale: Chronic inflammation in NASH leads to fibrosis, which can progress to
cirrhosis.

9. Which population is most at risk for developing NAFLD?

A. Underweight individuals
B. People with Type 2 diabetes
C. Children with cystic fibrosis
D. Patients with acute pancreatitis
Answer: B
Rationale: Type 2 diabetes is a significant risk factor for NAFLD due to associated insulin
resistance and metabolic syndrome.

10. Which condition is most strongly associated with the progression of NAFLD to
cirrhosis?
A. Obesity
B. Hepatitis B
C. Gallstones
D. Hemolytic anemia
Answer: A
Rationale: Obesity contributes to metabolic changes that drive the progression of NAFLD
to more severe forms, including cirrhosis.
11. What is a common early symptom of fatty liver disease?
A. Jaundice
B. Right upper quadrant discomfort
C. Hematemesis
D. Ascites
Answer: B
Rationale: Early symptoms include nonspecific signs like fatigue and right upper
quadrant discomfort.

12. Which of the following is an indicator of advanced liver disease?

A. Hepatomegaly
B. Jaundice
C. Elevated triglycerides
D. Weight gain
Answer: B
Rationale: Jaundice indicates significant liver dysfunction, often seen in advanced disease
stages like cirrhosis.

13. Which imaging modality is most sensitive for quantifying liver fat content?
A. Ultrasound
B. CT scan
C. MRI
D. X-ray
Answer: C
Rationale: MRI is highly sensitive for detecting and quantifying liver fat content.

14. A patient with AFLD is at risk of which complication?

A. Portal hypertension
B. Splenomegaly
C. Hepatic encephalopathy
D. All of the above
Answer: D
Rationale: AFLD, especially when it progresses to cirrhosis, can lead to portal
hypertension, splenomegaly, and hepatic encephalopathy.

15. What is the purpose of a liver biopsy in NASH?

A. Diagnose cirrhosis
B. Measure bilirubin levels
C. Assess inflammation and fibrosis
D. Determine viral load
Answer: C
Rationale: Liver biopsy is the gold standard for assessing the degree of inflammation and
fibrosis in NASH.

16. Which physical finding suggests hepatomegaly in fatty liver disease?

A. Palpable liver edge below the costal margin
B. Dullness over the epigastric region
C. Pain over the left upper quadrant
D. Visible jaundice
Answer: A
Rationale: A palpable liver edge below the costal margin is a common sign of
hepatomegaly.

17. Which symptom differentiates NASH from simple steatosis?

A. Fatigue
B. Weight gain
C. Persistent right upper quadrant pain
D. Unexplained fever
Answer: C
Rationale: Persistent pain in the right upper quadrant can indicate liver inflammation,
more common in NASH.

18. What is an expected finding in advanced AFLD?

 A. Elevated platelet count
B. Hypoalbuminemia
C. Increased creatinine clearance
D. Normal ALT levels
Answer: B
Rationale: Hypoalbuminemia occurs due to decreased liver synthesis in advanced disease.

19. What does an elevated NAFLD fibrosis score suggest?

A. Risk of simple steatosis
B. Advanced fibrosis or cirrhosis
C. Hepatitis co-infection
D. Biliary obstruction
Answer: B
Rationale: The NAFLD fibrosis score predicts the likelihood of advanced fibrosis or
cirrhosis.

20. What is a classic finding on ultrasound in fatty liver disease?

A. Hyperechoic liver
B. Calcifications
C. Hepatic nodules
D. Portal vein thrombosis
Answer: A
Rationale: Fatty liver disease typically appears as a hyperechoic (bright) liver on
ultrasound.

21. What is the first-line treatment for NAFLD?

A. Corticosteroids
B. Weight loss and lifestyle changes
C. Antiviral therapy
D. Liver transplantation
Answer: B
Rationale: Weight loss and lifestyle changes are the mainstay treatments for NAFLD.

22. What is the recommended weight loss goal for a patient with NAFLD?
A. 1–2% of body weight
B. 3–5% of body weight
C. 5–10% of body weight
D. 15% of body weight
Answer: C
Rationale: A weight loss of 5–10% has been shown to improve liver steatosis and
inflammation.

23. Which medication may be used to treat insulin resistance in NAFLD?

A. Metformin
B. Statins
C. Beta-blockers
D. ACE inhibitors
Answer: A
Rationale: Metformin helps improve insulin sensitivity, a key issue in NAFLD.

24. What is a priority nursing intervention for a patient with AFLD?

A. Promote alcohol cessation
B. Encourage a high-fat diet
C. Administer iron supplements
D. Reduce protein intake
Answer: A
Rationale: Alcohol cessation is critical to prevent further liver damage in AFLD.

25. Which dietary recommendation is appropriate for NAFLD?

A. High-protein diet
B. Mediterranean diet
C. High-carbohydrate diet
D. Low-fiber diet
Answer: B
Rationale: The Mediterranean diet is rich in healthy fats and antioxidants, beneficial for
NAFLD.

26. What nursing action is essential for monitoring NAFLD progression?

A. Regular weight checks
B. Monitoring for ascites
C. Checking stool for blood
D. Measuring serum calcium
Answer: A
Rationale: Regular weight checks help monitor the effectiveness of lifestyle interventions
in NAFLD.

27. What should the nurse teach a patient about exercise for NAFLD?
A. Exercise is not necessary if weight loss occurs
B. Aim for at least 150 minutes per week of moderate activity
C. High-intensity exercise is mandatory
D. Avoid exercise due to risk of injury
Answer: B
Rationale: Moderate exercise improves liver health and reduces fat accumulation in
NAFLD.

28. What is the main nursing goal in managing a patient with advanced cirrhosis
from fatty liver?
A. Reducing ascites with diuretics
B. Preventing esophageal varices
C. Avoiding further liver damage
D. Administering antibiotics
Answer: C
Rationale: Preventing further liver damage is the main goal in advanced disease.
29. A patient with AFLD asks if liver damage is reversible. How should the nurse
respond?
A. "Liver damage is always permanent."
B. "Stopping alcohol intake can reverse early-stage damage."
C. "Diet changes alone can reverse all liver damage."
D. "Medications will completely restore liver function."
Answer: B
Rationale: Early-stage fatty liver damage can often be reversed with alcohol cessation.

30. Which complication is most likely in untreated AFLD?

A. Cirrhosis
B. Diabetes mellitus
C. Gallbladder disease
D. Acute pancreatitis
Answer: A
Rationale: Chronic alcohol abuse and untreated AFLD often progress to cirrhosis.