Introduction Non-alcoholic fatty liver disease (NAFLD) is becoming a common cause for secondary care referral. While simple steatosis does not lead to liver related morbidity, non-alcoholic steatohepatitis (NASH) may lead to cirrhosis and hepatocellular carcinoma. Currently, non-invasive imaging including ultrasonography (USS) may reveal fatty infiltration. Many patients attend secondary care for USS, in whom NAFLD may be identified incidentally. While the true prevalence and burden of NAFLD in the community remains unclear, patients attending for USS in whom NAFLD is identified could provide the opportunity to reduce disease burden by monitoring for any complications. The aims of this study were to assess whether patients reported to have fatty liver on USS, irrespective of clinical indication, were adequately assessed by testing of liver function tests (LFTs) and if abnormal, subsequently referred to a specialist clinic.
Methods A single centre, retrospective analysis of all patients who underwent USS over a 5-month period (January–May 2011) at Chase Farm Hospital was performed. Patients who had LFTs within 8 weeks of USS were said to have had their LFTs checked appropriately. Data were obtained from radiology reports via PACS/EPR reporting systems.
Results 258 patients were investigated over the audit period. 69 (26.7%) patients (42 male, 27 female), median age 58 years (25–91 years) were reported to have fatty liver on ultrasound. 52 (75.3%) of these patients had their LFTs checked of which 37 (71.2%) were abnormal. 12 (17.3%) patients with fatty liver on ultrasound were formally seen in a specialist clinic. Over half of patients (27, 51.9%) with fatty liver and abnormal LFTs were never seen in a specialist clinic.
Conclusion A quarter of patients with USS diagnosis of fatty liver did not have their LFTs checked potentially missing an opportunity to monitor for complications of NAFLD. While only the tip of the iceberg of NAFLD patients are referred to secondary care, a large portion of the iceberg goes unnoticed even on surfacing. An increased awareness of NAFLD needs to relayed to all healthcare professionals including radiologists and general practitioners coming into contact with this “iceberg.”
Competing interests None declared.