Non-alcoholic fatty liver disease - chronic liver disease Flashcards

1
Q

what is NAFLD?

A

Commonest disease in the world. It is a fatty liver or steatohepatitis in the absence of other cause (alcohol)

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2
Q

This disease means that there is increased fat in the hepatocytes. This has the potential to progress from ____ _____ to non-alcoholic ______ which is ______ and damage of liver cells

A

This disease means that there is increased fat in the hepatocytes. This has the potential to progress from simple steatosis (fat in hepatocytes) to non-alcoholic steatohepatitis which is inflammation and damage of liver cells

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3
Q

what syndrome is NAFLD associated with

A

the metabolic syndrome

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4
Q

what happens in NASH (histopathology) ?

A

Oxidative stress injury and other factors lead to lipid peroxidation in the presence of fatty infiltration and inflammation results

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5
Q

there is a __ hit paradign

A

2

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6
Q

what is the first hit?

A

excess fat accumulation

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7
Q

it is the ___ ___ ___ which cause the problem rather than triglycerides

A

it is the free fatty acids which cause the problem rather than triglycerides

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8
Q

what is the 2nd hit? 4

A
  • intrahepatic oxidative stress and Lipid peroxidation
  • Pro-inflammatory cytokine release (TNF alpha)
  • Lipopolysaccharide get in from the gut
  • Ischaemia - reperfusion injury
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9
Q

what are the risk factors? 6

A

obesity, hypertension, type 2 diabetes and hyperlipidaemia, wilsons disease, drugs

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10
Q

which drugs are a risk factor? 3

A

methotrexate, amiodarone, tetracycline

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11
Q

what are the symptoms?

A

Symptoms: most patients are asymptomatic, hepatomegaly may be present

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12
Q

how is a diagnosis made? 2

A
  • increased LFT (typically ALT increased)

- Fatty liver on ultrasound

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13
Q

what are the complications of NAFLD? 2

A
  • hepatic fibrosis ± hepatocellular cancer
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14
Q

simple steatosis is diagnosed by _____

A

ultrasound

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15
Q

what are the outcomes and risks of simple steatosis?

A

no liver outcomes but increased cardiovascular risks

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16
Q

what is the treatment for simple steatosis AND NASH

A

weight loss and exercise

17
Q

how is NASH diagnosis made?

A

present at liver biopsy

18
Q

what are the outcomes of NASH?

A

can progress to cirrhosis