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Nonalcoholic steatohepatitis fibrosis risk — ABIM Board MCQ

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ModerateGastroenterology/HepatologyNonalcoholic steatohepatitis fibrosis riskABIM Board

A 58-year-old with obesity and type 2 diabetes has hepatic steatosis, persistent mild aminotransferase elevation and FIB-4 of 1.8. Viral hepatitis and alcohol-related disease have been excluded. What is the next fibrosis assessment?

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Correct answer: D — Obtain transient elastography for secondary fibrosis assessment

The best answer is “Obtain transient elastography for secondary fibrosis assessment”. FIB-4 at least 1.3 does not rule out advanced fibrosis and should trigger secondary risk assessment, commonly vibration-controlled transient elastography, ELF or another validated modality. ERCP evaluates ducts, while amylase and radiography do not stage fibrosis. Long deferral would miss patients needing specialist assessment and cirrhosis-directed care.

Reference: AASLD Practice Guidance on NAFLD Clinical Assessment and Management: https://pubmed.ncbi.nlm.nih.gov/36727674/