MASLD — RACP Adult Medicine MCQ

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ModerateGastroenterologyMASLDRACP Adult Medicine

A 50-year-old obese man (BMI 38) with type 2 diabetes and dyslipidaemia has persistently elevated ALT (95 U/L, 3× over 12 months). Hepatitis B and C serology are negative. Autoimmune hepatitis markers are negative. Ferritin and ceruloplasmin are normal. He drinks <2 standard drinks/week. Liver ultrasound shows increased echogenicity (fatty liver). FibroScan shows liver stiffness of 12 kPa (suggesting significant fibrosis, F3). What is the most likely diagnosis?

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Correct answer: C — Metabolic dysfunction-associated steatotic liver disease (MASLD)

Persistent elevated ALT with fatty liver on ultrasound, metabolic risk factors (obesity, T2DM, dyslipidaemia), excluded other causes, and FibroScan showing significant fibrosis is MASLD (formerly NAFLD/NASH — renamed per Delphi consensus 2023). FibroScan >12 kPa suggests F3-4 fibrosis requiring liver biopsy consideration. Treatment: weight loss (7-10% body weight), exercise, manage metabolic comorbidities, and GLP-1 RA (semaglutide — shown to improve NASH histology). Resmetirom (thyroid hormone receptor agonist) is newly approved for NASH with fibrosis.

Reference: GESA – 2024 – MASLD; AASLD 2024; Delphi MASLD Nomenclature 2023