Non-Alcoholic fatty liver disease Flashcards
What does Non-alcoholic fatty liver disease encompass
Steatosis without liver inflammation,
Who does NAFLD affect
All age groups - including children
How does the prevalence of NAFLD increase
With an increasing body weight
What is NASH
Non-alcoholic steatohepatitis
Most NAFLD is primary (idiopathic) true or false
True
What drugs can cause NAFLD
Amiodarone
Tamoxifen
synthetic oestrogens
glucocorticoids
What does the first “hit” of NAFLD consist of
Excessive triglyceride accumulation in the liver
Steatotic liver is then vulnerable to second hits. What do these result in
Inflammation and liver damage
Is NASH worse than alcoholic steatophepatitis
No. it is better - it progresses to cirrhosis less frequently and has a better long term survival
What are some of the risks of progression of NASH
Increasing age Obesity Pronounced weight loss Diabetes mellitus AST/ALT ratio >1 ALT more than 2 times the normal raised triglycerides
What are the symptoms of NAFLD
generally mild and non-specific (RUQ pain)
hepatomegaly
How is the diagnosis made for NAFLD
Incidentally - a detailed history of alcohol consumption should be obtained
Persistently elevated LFT with no alcohol history
Weight loss
What can differentiate simple fatty liver from NASH
Nothing
What is the hallmark of NAFLD
Macrovesicular steatosis in the absence of alcohol excess
Why should all patients have fasting sugars and lipids taken
Due to the association with the metabolic syndrome
What are the differences in ALT and AST in alcoholic liver disease and also NAFLD
ALT is greater than AST in NAFLD
AST is greater than ALT in ALD
What imaging is usually used
Ultrasound - hyperechoic liver
Liver biopsy: diagnosis
What has been developed as a way of predicting fibrosis
NAFLD Fibrosis Score
What is the management for NAFLD
Lifestyle modification: short term weight loss in combination with exercise leads to improvement in liver biochemical tests
Correction of cholesterol, triglycerides and blood sugar
When is pharmacological therapy considered
When there is no change in the condition after lifestyle modification
