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Metabolic dysfunction-associated steatotic liver disease fibrosis risk — RACP Adult Medicine MCQ

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HardGastroenterology and hepatologyMetabolic dysfunction-associated steatotic liver disease fibrosis riskRACP Adult Medicine

A 54-year-old man with obesity and type 2 diabetes has persistently elevated ALT and ultrasound showing fatty liver. Platelets are 122 x10^9/L, albumin is 34 g/L and transient elastography suggests liver stiffness of 15 kPa. What is the most important prognostic factor?

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Correct answer: B — Stage of liver fibrosis

In fatty liver disease, fibrosis stage is the strongest predictor of liver-related outcomes and mortality. ALT may be normal in advanced disease and does not reliably stage risk. Ultrasound steatosis, dyspepsia and triglycerides are clinically relevant but not the key prognostic determinant.

Reference: GESA fatty liver disease guidance; RACGP Red Book