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MASLD Nomenclature — RACP Adult Medicine MCQ

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HardGastroenterology & HepatologyMASLD NomenclatureRACP Adult Medicine

A 55-year-old with obesity and type 2 diabetes has hepatic steatosis and persistently raised ALT. FIB-4 falls in the indeterminate range. What is the next fibrosis-risk step?

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Correct answer: D — Use a second-line non-invasive test such as vibration-controlled transient elastography and refer according to the result

The best answer is “Use a second-line non-invasive test such as vibration-controlled transient elastography and refer according to the result”. In metabolic dysfunction-associated steatotic liver disease, a simple first-line score such as FIB-4 is followed by elastography or another validated second-line test when indeterminate or high. This identifies patients needing hepatology review while avoiding universal biopsy. ALT, steatosis and AFP cannot stage fibrosis on their own.

Reference: Gastroenterological Society of Australia: Clinical practice resources: https://gesa.org.au/Web/Resources/Clinical_Practice_Resources.aspx