21. Nonalcoholic fatty liver disease

Question 1

what is the definition of NAFLD?

Answer 1

chronic liver condition where there is 5 percent more fat accumulation in the liver off individuals who consume less than 20-30g alcohol per day

Question 2

what is the risk factor for NAFLD?

Answer 2

excess calorie intake

rich in saturated fat and fructose

reduced physical activity

genetic mutation of PNPLA3

Question 3

what are the stages of non alcoholic fatsy liver disease

Answer 3

= NAFL
steatosis
no or minimal inflammation and fibrosis
not progressive

NASH =
steatosis with inflammation and fibrosis , progressive type = which will lead to cirrhosisi

BALLONING DEGENRATION of hepatocytes and necrosis

lymphocytes m neutrophils and kupffer cells

cirrhosis

Question 4

what are the approaches we MUST to take with someone having nafld?

Answer 4

see if they have metabolic syndrome MetS

diabetes type 2

random glucose test
glucose value is equal more than 11.1mmol/l

normal = 4.4 - 7.8 mmol/l

fasting of 8 hours glucose test
normal less than 5.6 mmol/l
impaired glucose tolerance = 5.6-6.9 mmol/l
diagnosing diabetes = >7mmol/l

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oral glucose tolerance test 
= normal food and no excessive activities for 3 days 
= fating 10-14 hours before test 
not allowed to smoke or stand up 
and taken 75G OF GLUOSE

blood taken 2 hours after
normal <7.8 mmol/l
impaired glucose tolerance 7.8-11.1 mmol/l
diabetes more than 11.1 mmol/l

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Hb1ac 
= values of the glucose levels in the previous 6-8 weeks 
normal 5-6 percent 
pre diabetes = 7 percent 
diabets 8 percent or more

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hypertriglyceridemia ,

low HDL-C

increased waist circumference

high blood pressure

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insulin resistance IN LIVER , ADIPOSE TISSE AND MUSCLE TISSUE

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see
HOMA-IR for patients without type 2 diabetes
used to test insulin resistance

HOMA-IR :
fasting glucose mol/l + insulin (mU/ml) / 22.5

above 1.9 = insulin resistant (healthy below 1.4)

Question 5

ho d we diagnose NAFLD?

Answer 5

slight increase in liver aminotransferases but
AST/ALT ratio is below 1

when alt is significantly higher than ast = non alcoholic fatty liver

increase in gamma GT

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abdominal ultrasound

FIB-4 test 
based on 
age , 
ALT , 
AST 
 platelet count 
FIB-4 >3.25 positive prrediction 65 percent and over for advanced fibrosis 

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US fibroscan

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fibrotest 
2 macroglobulin
haptoglobulin
apoliporportine a1
bilirubin
Gamma GT
patinets age
gender
acoustic radiation force impulse

<0.27=f0 
<0.31 = f1 
<0.58 = f2 
<0.72 = f3 
<1 = f4

acoustic radiotic force impulse

Question 6

what is the treatment for NAFLD?

Answer 6

low fat , low carb , low glycemic index food
increase dietary fibre
= veg , unrefined cereal s , legumes , olive oil , fish , nut
less than 750 kcal /day
= mediterranean diet
monounsaturated fats

no alcohol intake

physical activity

statin use encouraged +vit e

bariatric surgery = in extreme obesity

Question 7

nafld symptoms ?

Answer 7

nafld
asymptomatic
hepatomegaly = ruq pan

NASH steatohepatitis
weight loss
hepatomegaly
jaundice

Question 8

treatment for diabetes type 2 ?

Answer 8

2ND GEN SULFONYLUREAS
= increase insulin secretion

BIGUANIDE
metformin / glucophage

MEGLITINIDES - analogous of sulfonylureas = act similar
glinides
eg repaglinde

DIPEPTIDYL PEPTIDASE 4 INHIBITORS
increase incretin levels - block glucagon and increase insulin release
gliptin
eg alogliptins

SODIUM GLUCOSE CO TRANSPORTER 2 inhibitor
reduction of resoprtion of glucose from tubules
agliflozins
eg canagliflozin

PPAR gama agonists =
glitazones 
pioglitazone
used to treate symptoms of metabolic syndrome 
= uptake of fatty acids and oxidation 
decrease ldl 
increase cdl 

fibrates
PPAR alpha agonists
promotes uptake, utilization, and catabolism of fatty acids