Single Best Answer (SBA) · Steatotic Liver Disease and Chronic Hepatitis
A 52-year-old obese man (BMI 32) with type 2 diabetes and hyperlipidaemia is referred for persistently raised liver enzymes (AST 78, ALT 102). He drinks no alcohol and viral serologies are negative. Ultrasound shows a mildly enlarged, bright (increased echogenicity) liver. What is the most likely diagnosis?
Show answer and explanation
Answer: A. Metabolic-associated steatotic liver disease (MASLD)
Metabolic dysfunction-associated steatotic liver disease (MASLD)
This patient has the classic profile: obesity, type 2 diabetes, hyperlipidaemia, raised transaminases, a bright (steatotic) liver on ultrasound, negative viral serology and no alcohol. This is MASLD (the new term for non-alcoholic fatty liver disease, NAFLD).
New terminology
| Term | Meaning |
|---|---|
| SLD | Steatotic liver disease (umbrella) |
| MASLD | Hepatic steatosis + at least one cardiometabolic risk factor, no other cause |
| MASH (NASH) | Steatohepatitis - steatosis plus inflammation and hepatocyte injury |
| MetALD | MASLD with significant alcohol intake |
Cardiometabolic risk factors (need >=1)
- Raised BMI/waist circumference, dysglycaemia/type 2 diabetes, hypertension, raised triglycerides, low HDL.
The disease spectrum
Steatosis -> steatohepatitis (MASH/NASH) -> fibrosis -> cirrhosis. The key prognostic factor is the stage of fibrosis.
Diagnosis
Exclude other causes; assess fibrosis non-invasively (FIB-4, ELF score, transient elastography/FibroScan with CAP for fat and stiffness for fibrosis), reserving biopsy for uncertainty.
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