Non-alcoholic fatty liver disease

Question 1

What are the four stages of non alcoholic fatty liver disease?

Answer 1

Fat alone
Fat and inflammation
Fat and inflammation, balooning degeneration, Mallory bodies
Fibrosis

Question 2

How does NAFLD present?

Answer 2

It is often asymptomatic and presents with deranged LFTs. Usually caused by obesity

Question 3

What is the pathogenesis behind NAFLD?

Answer 3

Liver takes up excess fatty acids. Excess fat in hepatocytes causes increased cellular stress and leads to production of inflammatory cytokines such as TNF alpha. These cause apoptosis and cellular injury

Question 4

What is adiponectin and how does this change in NAFLD?

Answer 4

Adiponectin is a protein produced by omental fat that stimulates glucose utilisation and free fatty acid synthesis. There are lower levels of adiponectin in obese patients so this contributes to NAFLD

Question 5

How is NAFLD assessed?

Answer 5

By liver biopsy or by ultrasound fibroscanning to esimate the liver fibrosis

Question 6

What is the management of NAFLD?

Answer 6

Primarily through weight loss and improved diet

Thiazolidinediones should also be considered, they reduce lipolysis and free fatty acids

Question 7

What is GLP-1 used for?

Answer 7

Glucagon like peptide (GLP-1) can also be given, in the form of exenatide, which can increase insulin release and delay gastric emptying, this reduces appetite in NAFLD