NASH, Nonalcoholic fatty liver disease Flashcards
non alcoholic fatty liver disease definition
hepatic steatosis on imaging or biopsy exclusion of significant alcohol use or exclusion of other causes of fatty liver
clinical features of non alcoholic fatty liver disease
mostly asymptomatic metabolic syndrome steatohepatitis (AST/ALT ratio<1) hyperechoic texture on ultrasound
Treatment of non alcoholic fatty liver disease
diet and exercise consider bariatric surgery if BMI >35
pt has abdominal discomfort and mild aminotransferase elevation and DM2, HTN, and HLD has:
non alcohol fatty liver disease (NAFLD) Need to exclude other causes. This marked by the presence of hepatic steatosis (can’t be due to secondary cause like ETOH)
what do we see on histology of NAFLD?
see alcohol induced liver injury on histology and cirrhosis is more likely to develop in those with inflammation present (non-alcoholic steatohepatitis) than those without it (fatty liver dx)
main causes of hepatocellular pattern of aminotransferase elevation are:
steatosis/steatohepatitis (either alcohol or metabolism related) medications (acetaminophen) or hep B or C infection and hemochromatosis.
in order to diagnose NAFLD one must also
rule out other causes of liver dx like viral hepatitis, hemochromatosis, drug induced hepatitis, as these are reversible
what is defined as excessive ETOH for man and woman:
>15-21 drinks per week and >10–14 per women if consider alcohol related also should see AST/ALT ratio >2 and see macrocytosis.
what are non hepatic disorders that can cause elevations in LFTs?
muscle injury, thyroid dx, adrenal insufficiency and celiac dx. Testing can be done once you rule out hepatic causes.
Evaluation of hepatosteatosis algorithm
non alcoholic fatty liver disease is composed of
Risk factors for NAFLD
metabolic syndrome (central obesity, DM2/insulin resistance, HLD, HTN)
most common liver dx in western culturs
