Non-alcoholic fatty liver disease other diagnostic studies

Jump to navigation Jump to search

Non-Alcoholic Fatty Liver Disease Microchapters


Patient Information


Historical Perspective




Differentiating Non-Alcoholic Fatty Liver Disease from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


History and Symptoms

Physical Examination

Laboratory Findings


X Ray




Other Imaging Findings

Other Diagnostic Studies


Medical Therapy


Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case studies

Case #1

Non-alcoholic fatty liver disease other diagnostic studies On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides


American Roentgen Ray Society Images of Non-alcoholic fatty liver disease other diagnostic studies

All Images
Echo & Ultrasound
CT Images

Ongoing Trials at Clinical

US National Guidelines Clearinghouse

NICE Guidance

FDA on Non-alcoholic fatty liver disease other diagnostic studies

CDC on Non-alcoholic fatty liver disease other diagnostic studies

Non-alcoholic fatty liver disease other diagnostic studies in the news

Blogs on Non-alcoholic fatty liver disease other diagnostic studies

Directions to Hospitals Treating Non-alcoholic fatty liver disease

Risk calculators and risk factors for Non-alcoholic fatty liver disease other diagnostic studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]


Liver biopsy may be helpful in the diagnosis of non-alcoholic fatty liver disease. Findings on biopsy include macrovesicular steatosis, inflammation, ballooning degeneration, zone 3 perivenular/periportal/perisinusoidal fibrosis and, finally, mallory bodies.

Other Diagnostic Studies

  • Liver biopsy is considered as a gold-standard for diagnosing, grading, and staging NAFLD.
  • Invasive test
  • Associated with significant bleeding risk in patients with clotting abnormalities due to hepatic disease.


Complications of liver biopsy are rare but include


Classically, biopsy reveals:[1][2]


Histo-pathological classification

Depending on degree of steatosis, necroinflammatory activity, and degree of fibrosis non-alcoholic liver disease can be classified as follows:


NAFLD activity score is employed for grading steatohepatitis of NASH. NAS represents the sum of scores for steatosis, lobular inflammation, and ballooning.[4]

Component Range Score
Steatosis <5% 0
5-33% 1
34-66% 2
>66% 3
Lobular Inflammation None 0
<2 focci 1
2-4 2
>4 3
Hepatocyte Balloning None 0
Few ballooned cells 1
Many ballooned cells 2
Interpretation 0-2 Non-diagnostic
3-4 Borderline
5-8 Diagnostic


Based on the degree of fibrosis on biospy NASH can be classified into 4 stages.

Stage 1

Zone 3 fibrosis
Perisinusoidal fibrosis
Portal/ periportal fibrosis

Stage 2 Perisinusoidal and portal/periportal fibrosis
Stage 3 Bridging fibrosis
Stage 4 Cirrhosis


  1. Angula P. Nonalcoholic Fatty Liver Disease. NEJM. 2002 346(16):1221-31
  2. Brunt EM, Janney CG, Di Bisceglie AM et al. Nonalcoholic steatohepatitis: A proposal for grading and staging the histological lesions. Am. J. Gastroenterol. 1999; 94(9):2467-2474
  3. Skelly et al. Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. J Hepatol 2001;35:195-9
  4. Vizuete J, Camero A, Malakouti M, Garapati K, Gutierrez J (2017). "Perspectives on Nonalcoholic Fatty Liver Disease: An Overview of Present and Future Therapies". J Clin Transl Hepatol. 5 (1): 67–75. doi:10.14218/JCTH.2016.00061. PMC 5411359. PMID 28507929.

Template:WS Template:WH