skip to main content

Metabolic dysfunction-associated steatotic liver disease — ESEGH MCQ

Instant feedback + full explanation. One question, done properly.

HardHepatologyMetabolic dysfunction-associated steatotic liver diseaseESEGH

A 52-year-old woman with type 2 diabetes and BMI 36 kg/m2 has persistently abnormal ALT around 82 IU/L. She drinks 6 units of alcohol weekly and viral, autoimmune and iron studies are unremarkable. Ultrasound shows hepatic steatosis. FIB-4 is 3.4. What is the most important next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Refer for second-line fibrosis assessment or hepatology review

A high FIB-4 in metabolic dysfunction-associated steatotic liver disease suggests increased risk of advanced fibrosis and warrants second-line assessment such as ELF testing, transient elastography or hepatology review. Reassurance is inappropriate because fibrosis stage drives prognosis. Steroids and UDCA are not routine treatments for MASLD. The pearl is that risk stratification matters more than the absolute ALT in fatty liver disease.

Reference: NICE NAFLD Guideline NG49; BSG Abnormal Liver Blood Tests Guidance