fatty liver dz

Question 1

what makes a liver “fatty”?

Answer 1

over 5% steatosis– more white space on histology

Question 2

Lack of balance between energy in & out → disposal capacity (fructose, sucrose, glucose) → formation and accumulation of intrahepatic fat

Answer 2

hepatic steatosis

Question 3

overarching term for >5% of liver with steatosis; absence of another causes (meds, starvation); little to no alcohol use; v common in DM2

Answer 3

NAFLD

Question 4

what makes NASH diferent from NAFL?

Answer 4

NASH has steatosis, hepatocyte ballooning, lobular inflammation, perisinusoidal fibrosis that could progress to cirrhosis; its more severe

NASH= non-alcoholic steatohepatitis

Question 5

4 stages of NAFLD disease progression. bold the step that is irreversibel

Answer 5

healthy liver →NAFLD → NASH → Cirrhosis

Question 6

bloated hepatocyte, large fat droplets & displaced nucleus

Answer 6

NAFLD

Question 7

inflamed dying hepatocyte, collagen fibers

Answer 7

NASH

Question 8

remnants of dead cells, scarring

Answer 8

cirrhosis

Question 9

5 conditions associated with NAFL & how?

Answer 9

obesity: associated w/ progression
T2DM: most impactful risk factor
HTN: higher incidence as NAFL progresses
dyslipidemia: statins could help
OSA: associated w/ more advanced NAFLD/NASH

Question 10

which distribution of body fat has a higher risk of IR, CVD & fibrosis regardless of BMI? which is protective against NAFL?

Answer 10

• android has higher risk (includes waist, belly button)
• gynoid is protective (starts by bikini line?)

Question 11

why is it important to diagnose? (2)

Answer 11

• increased overall mortality & CV death
• inreased risk of malignancy (GI, kidney, breast)

Question 12

relationship between BMI and NASH & NAFL

Answer 12

higher BMI more likely to have NASH
lower BMI more likely to have NAFL

Question 13

diagnosis of fatty liver (4)

Answer 13

• dx of exclusion; mostly asymptomatic
• elevated AST & ALT, glucose
• histology or US showing evidence of heatpic steatosis
• no other cause of hepatic fat accumulation

Question 14

4 drugs that could cause hepatic fat accumulation

Answer 14

steroids
methotrexate
amiodarone
tamoxifen

Question 15

6 d/o that could cause hepatic fat accumulation

Answer 15

Hep C
wilsons
lipodystrophy
starvation
parental nutrition
acute fatty liver

Question 16

primary assessment used to look for patients at risk for advanced fibrosis; age, AST, ALT, platelet count

Answer 16

FIB-4 calculator– helps estimate amount of scarring

Question 17

• secondary assessment that can be done in office or use US-based methods; fairly reliable for advanced fibrosis
• if advanced fibrosis (over 8) found, refer to GI/hepatology

Answer 17

vibration-controlled elastography (VCTE)

Question 18

also used in risk stratification to detect over 5.5% hepatic fat but has limited availability

Answer 18

MRI– MR spectroscopy or Elastography

Question 19

reference standard for risk stratification; reserved for diagnostic uncertainty but has limitations related to risk & cost

Answer 19

liver biopsy

Question 20

3 general treatment options for fatty liver

Answer 20

liver protective behavior
bariatric surgery
medications

Question 21

4 dietary changes to make

Answer 21

limit carbs
mediterranean diet
coffee
macronutrient composition

Question 22

3 medication options for fatty liver

Answer 22

• pioglitazone
• vitamin E 800 IU plant based
• GLP-1 and SGLT-2i

Question 23

medication that improves AST, ALT, fibrosis but causes weight gain

Answer 23

pioglitazone

Question 24

medication that should not be used if at increased risk for prostate cancer or bleeding

Answer 24

Vitamin E

Question 25

what do the GLP-1 med names end with? how about the SGLT-2i meds?

Answer 25

• GLP1 ends in “-glutide”
• SGLT-2i ends in “-gliflozin”