From the Guidelines
MAFLD (metabolic-associated fatty liver disease) typically does not manifest as right upper quadrant (RUQ) pain, and patients are usually asymptomatic in its early stages. While MAFLD itself doesn't typically cause RUQ pain, some patients may experience discomfort or a feeling of fullness in the upper right abdomen due to liver enlargement, as noted in a study published in the Journal of Hepatology in 2023 1. However, this is not a common or defining symptom of MAFLD.
If a patient with MAFLD reports RUQ pain, it's essential to investigate other potential causes, such as:
- Gallbladder disease (e.g., gallstones)
- Liver inflammation or fibrosis progression
- Other abdominal conditions unrelated to MAFLD
MAFLD is primarily diagnosed through blood tests, imaging studies (like ultrasound or MRI), and sometimes liver biopsy, as outlined in the EASL-EASD-EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD) published in Diabetologia in 2024 1. The focus of management is on lifestyle modifications, including weight loss, dietary changes, and increased physical activity, rather than treating pain symptoms.
The most recent and highest quality study, published in Diabetologia in 2024 1, supports the approach of lifestyle modifications and management of comorbidities, such as type 2 diabetes and obesity, as the primary treatment for MAFLD. If a patient with MAFLD experiences persistent RUQ pain, they should be evaluated for complications or coexisting conditions that may require specific treatment, as recommended in the clinical practice guidelines 1. Additionally, the use of non-invasive tests, such as the fibrosis-4 index (FIB-4), and imaging techniques, like transient elastography, can help identify individuals with advanced fibrosis and predict liver-related outcomes 1.
From the Research
Clinical Presentation of Metabolic Associated Fatty Liver Disease (MAFLD)
The clinical presentation of Metabolic Associated Fatty Liver Disease (MAFLD) manifesting as Right Upper Quadrant (RUQ) pain is not directly addressed in the provided studies. However, the studies discuss the evaluation and diagnosis of RUQ pain, which can be related to MAFLD.
Evaluation of RUQ Pain
- The evaluation of patients with RUQ pain requires a combination of history, physical examination, laboratory testing, and diagnostic imaging 2.
- Ultrasonography (US) is the primary imaging modality of choice for initial imaging assessment of RUQ pain 3, 4.
- US can identify a variety of ultrasonographically diagnosable disease processes, including conditions of hepatic, pancreatic, adrenal, renal, gastrointestinal, vascular, and thoracic origin, all of which may result in RUQ pain 4.
Diagnosis of MAFLD
- The diagnostic criteria for MAFLD are practical, simple, and superior to the existing NAFLD criteria for identifying patients at increased risk of developing progressive liver disease 5.
- MAFLD affects up to 25% of the global population and is likely to be underestimated due to the increasing prevalence of type 2 diabetes mellitus (T2DM) and obesity 5.
Imaging Modalities
- US is the most useful initial imaging technique for patients presenting with a positive Murphy sign 6.
- Computed tomography (CT) and magnetic resonance (MR) imaging can be used as additional imaging modalities to confirm the extent and nature of the complications of acute cholecystitis or other conditions causing RUQ pain 6, 3, 4.