Metabolic dysfunction-associated steatotic liver disease (MASLD): The Daily PANCE Blueprint
A 52-year-old female with obesity, type 2 diabetes, and hypertriglyceridemia presents for routine follow-up. She is asymptomatic. Labs reveal ALT 88 U/L, AST 52 U/L, platelets 210,000/μL, and normal bilirubin. Hepatitis B and C serologies are negative. Which of the following is the most appropriate next step?
A. Liver biopsy
B. CT abdomen with contrast
C. Liver ultrasound
D. Start vitamin E 800 IU daily
E. MRI with proton density fat fraction
Answer and topic summary
The answer is C. Liver ultrasound
Fatty liver disease, now termed metabolic dysfunction–associated steatotic liver disease (MASLD), is the most common chronic liver disease worldwide, affecting up to 38% of adults. It is driven primarily by overnutrition and metabolic dysfunction, leading to insulin resistance, increased hepatic fat production, and ectopic fat accumulation. Major risk factors include obesity, type 2 diabetes, dyslipidemia, hypertension, sedentary lifestyle, diets high in saturated fats, and alcohol use. MASLD ranges from simple steatosis to steatohepatitis (MASH), fibrosis, and cirrhosis. Many patients are asymptomatic, though fatigue, weakness, and RUQ discomfort may occur. Liver ultrasound is a useful initial imaging test, while FibroScan helps assess fibrosis. Liver biopsy remains the gold standard for diagnosing MASH and staging fibrosis when noninvasive tests are inconclusive. Management centers on lifestyle interventions: weight loss, Mediterranean diet, regular exercise, minimizing or avoiding alcohol, and control of metabolic comorbidities. Early disease is often reversible, but untreated MASLD can progress to advanced liver disease and liver failure.
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Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ ⇒
