NAFLD Flashcards
what is the most common liver abn in kids 2-19
more common in girls or boys
nonalcoholic fatty liver disease NAFLD
more common in boys
what is NAFLD
what is the more benign and the more severe version
are they both reversible
A condition in which excess fat accumulates in the liver of people who drink little or no alcohol.
benign is steatosis (just fat infiltrating liver cells without inflm)–likely reversible
nonalcoholic stateohepatitis involves inflm of liver and hepatocellular damage that can lead to cirrhosis–irreversible
what are potential complications of NAFLD
cirrhosis of liver, atheroclerosis and other cardiovascular issues, maybe inc risk of DM II or other metb issues
could progress to death or need transplant
how do you get definitive Dx of NAFLD
liver biopsy
what are the risk factors for NAFLD
mainly overnutrition and sedentary lifestyle
Obesity–especially visceral adiposity
High Blood Cholesterol
Type Two Diabetes
Malnutrition–excess fructose in soft drinks
Rapid Weight Gain or loss
Medication: steroids, exposure to toxins and
chemicals
patho of NAFLD
unclear
overnutrition and sedentary lifestyle and poor diet eg fructose leads to insulin resistance, metb syndrome, change in lipogenesis and obstr sleep apnea
they may have mitochondrial dysfx
genes might be involved
cytokines involved
major mnfts of NAFLD
in gen it is asymptomatic
faituge
wt loss
malaise
pain in upper R abd
kid is often obese making liver palpation difficult but if you could you would feel mild-mod hepatomegaly
-many kids have acanthosis nigricans
what is acanthosis nigricans
what does it often signify
Acanthosis nigricans is a brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds, such as the posterior and lateral folds of the neck, the armpits, groin, navel, forehead, and other areas.
often in those w prediabetes or insulin issues. and the overwt or those w dark skin
dx of NAFLD
is liver biopsy used freq
as biopsy is invasive, $$, there are complications so other tests are done first
what blood testsdo they run first for NAFLD and which are sensitive and specific
what is the most common finding
-most common is mild-mod elevation of serum ALT
-mild GGT
insulin resistance tests (hyperinsulinemia might be firt indication)
-hypertriglyceridemia and lipid profile
uric acid
-CK 18 a biomarker
no test is really sensitive or specific
imaging for NAFLD Dx
which of the following is not used and why
US, CT, MRI
US and MRI mostly
CT uses radiation. no good for kids!
if a kid is obese what tests would they likely run to check for NAFLD
liver transaminases and US.. if this indicates theres poss NAFLD then check for insulin resistance then run other tests and if highly suspicious then biopsy
tx of NAFLD
lifestyle to dec risk factors as theres no direct Tx
- wt loss (not rapid eg >few lbs a wk)
- change diet to high fruit and veg and low fat low GI
- dec screen time
- inc exercise to 150mins a wk or 75 vigorous exercise. more is better of course
- avoid tylenol and ETOH other hepatotoxins
- manage other issues eg DM II etc
- antioxidant vitamins might be useful..eg vit E…unclear
liver transplant if severe
