NON-ALCOHOLIC FATTY LIVER DISEASE Flashcards
Clinical Features (6)
1- Most common cause of chronic liver disease in many developed countries
2- Detected usually by routine abdominal ultrasound +/- hepatomegaly
3- Risk factors are mainly those of metabolic syndrome, including obesity, type 2 DM, hypertension, and hyperlipidemia, steroids
4- Patients are asymptomatic, hepatomegaly may be present
5- Liver biochemistry may show mild elevation of aminotransferases (ALT>AST) and/or gamma-GT
6- Patients with NASH induced cirrhosis need US surveillance every 6 months due to increased risk of hepatocellular carcinoma
Pathogenesis (2)
1- Histological changes = alcoholic liver injury
2- Range from simple fatty changes to inflammation (NASH), fibrosis, and cirrhosis
Investigations (6)
1- Usually by US - steatosis
2- Liver biopsy to stage the disease is most accurate test (micro-vesicular fatty deposits). It may be needed but it is not done much
3- Elastography to evaluate degree of fibrosis - difficult in morbidly obese.
4- Must exclude more serious liver diseases
5- Patients with NAFLD may have an elevated serum ferritin concentration or transferrin saturation (serum ferritin greater > 1.5x the upper limit of normal is associated with NASH and advanced hepatic fibrosis)
6- In non-alcoholic fatty liver disease ALT > AST (differentiate from alcoholic fatty liver disease where AST to ALT ratio is >2)
Management (4)
- Lifestyle changes: weight loss “0.5-1kg/week”, physical activity, and modify cardiovascular risk factors
- Orlistat: enteric lipase inhibitor causing fat malabsorption, and it is used for 1 year only to avoid fat-soluble vitamins deficiency
- Pioglitazone/vitamin E: for biopsy proven NASH and failed lifestyle intervention
- Weight loss following bariatric surgery