Liver diseases Flashcards
What is the most common disease in western country?
Non-alcoholic fatty liver disease
Which metabolic disorders are associated with Non-alcoholic fatty liver disease?
obesity, dyslipidaemia, diabetes, hypertension
How is Non-alcoholic fatty liver disease, often identified?
Via ultrasound showing
increased fat in hepatocytes (steatosis) visualized - that
cannot be attributed to other causes (such as alcohol)
What is the difference between Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH)?
Inflammation is also present with NASH plus ( raised LFT, typically raised ALT)
may be a rise in gamma GT
What is the progression of histological presentations of Non-alcoholic fatty liver disease?
Fatty changes
Fat and inflammation (NASH)
Fibrosis
Cirrhosis
What method is used for the staging of Non-alcoholic fatty liver disease?
Liver biopsy
Which imaging test is used to evaluate the degree of fibrosis in the liver?
Elastography
How is Non-alcoholic fatty liver disease managed? (5)
- Lifestyle advice - weight loss/ exercise/ address risk factors
- Orlistat, an enteric lipase inhibitor causing malabsorption of dietary fat. Used with a low-fat diet to reduce weight. Only use for 1 year
- Pioglitazone or vitamin E may be used for those with biopsy-proven NASH, in whom lifestyle intervention has failed
- Bariatric surgery
- Liver transplant
People with NASH are at risk of Hepatocellular carcinoma. How often should they be surveilled?
ultrasound surveillance should therefore be performed 6-monthly.
List and describe the 3 stages of alcoholic liver disease
Sage 1 - Fatty live
Metabolism of alcohol produces fat in the liver. There is no liver cell damage. The fat disappears on stopping alcohol.
stage 2 - alcoholic hepatitis
Fatty changes + infiltration of by polymorphonuclear leucocytes (inflammation) and hepatocyte necrosis, mainly in zone 3.
