Non-alcoholic fatty liver disease Flashcards
what is the definition of NAFLD?
Non-alcoholic fatty liver disease (NAFLD) is a clinico-histopathological entity that includes a spectrum of conditions characterised histologically by macrovesicular hepatic steatosis in those who do not consume alcohol in amounts generally considered harmful to the liver
what is the epidemiology of NAFLD?
It is estimated that NAFLD affects 20% to 40% of the Western world, with the Asian and Pacific regions being less affected.
The majority of cases occur in people between the ages of 40-60 years, but NAFLD is becoming increasingly prevalent in the paediatric population.
what is the aetiology of NAFLD?
The association of hepatic steatosis with inflammatory changes and fibrosis in obese patients was first described over 50 years ago. The term non-alcoholic steatohepatitis was first used to describe a group of patients who developed liver failure following surgical jejunoileal bypass for obesity.
what are the risk factors for NAFLD?
Obesity Insulin resistance diabetes Dyslipidemia Hypertension Metabolic syndrome Rapid weight loss Hepatotoxic medications TPN
what is the pathophysiology of NAFLD?
Although the pathophysiology of primary NAFLD is not yet fully understood, the most widely held hypothesis implicates insulin resistance as the key mechanism leading to the accumulation of excessive triglyceride accumulation in the liver and subsequent development of hepatic steatosis. Once steatosis is present, some have proposed a second hit or additional oxidative injury, which is required to manifest the necro-inflammatory component seen in steatohepatitis.
what are the signs of NAFLD?
Risk factors
Hepatosplenomegaly
what are the symptoms of NAFLD?
Fatigue
Malaise
Truncal obesity
RUQ discomfort
what are the first line and gold standard investigations for NAFLD?
AST and ALT Total bilirubin Alkaline phosphatase Gamma glutamyl transferase FBC metabolic panel Lipid panel Prothrombin time Serum albumin ANA Iron studies
what are the differential diagnoses for NAFLD?
Alcoholic liver disease
Cryptogenic cirrhosis
Autoimmune hepatitis
how is NAFLD managed?
Diet and exercise Vitamin E Weight loss roux-en-Y gastric bypass Insulin sensitisers Lipid lowering therapy End stage: Liver transplant Transjuguar intrahepatic portosystemic shunt
how is NAFLD monitored?
Without advanced liver disease, there are no guidelines.
what are the complications of NAFLD?
Ascites, variceal haemorrhage, portosystemic encephalopathy, HCC, hepatorenal syndrome
what is the prognosis of NAFLD?
The overall prognosis in patients with bland steatosis (fatty liver without evidence of active inflammation) is considered to be good and a majority of patients will remain stable throughout their lifetime
Patients who have NASH progress to cirrhosis 9% to 20% of the time. Up to one third of these patients will die from complications from liver failure or require liver transplantation
