Fatty liver on abdominal ultrasound

Key Messages:

• Incidental “Fatty Liver” findings found in abdominal ultrasound in children usually indicate Non-Alcoholic Fatty Liver Disease (NAFLD), commonly associated with obesity.

• NAFLD is on a spectrum of disease and may lead to serious conditions like cirrhosis and liver failure if not managed early.

What to Do:

• History & Examination:

Patients may complain of fatigue and persistent RUQ pain.

Change in cognitive ability including memory’s or language should raise index of suspicion for alternative diagnoses - eg Wilson’s disease

Assess obesity and hepatomegaly. Assess for signs of chronic liver disease

• Investigations: Check blood pressure

FBC, UEs, LFTs (split bili, ALT, AST, GGT), fasting lipid profile, HbA1c.

• Lifestyle Management: Advise on diet and physical activity. Refer to local health services like Suffolk’s Healthy Living Service for nutritional and weight management support. This should be expedited if raised AST/ALT

When to Refer:

• All Cases: Refer all children with fatty liver findings on ultrasound

• Expedited Referral: Expedited referral for abnormal findings or if BMI is not raised eg less than 91st centile

• Additional Tests (usually Secondary Care but to consider with expedited referral ): Coagulation screen, TFTs, coeliac serology, hepatitis serology, liver autoantibodies, Wilson’s disease testing (caeruloplasmin, serum copper) for uncertain diagnoses or red flags.