Non-alcoholic fatty liver disease - chronic liver disease Flashcards
what is NAFLD?
Commonest disease in the world. It is a fatty liver or steatohepatitis in the absence of other cause (alcohol)
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
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
what syndrome is NAFLD associated with
the metabolic syndrome
what happens in NASH (histopathology) ?
Oxidative stress injury and other factors lead to lipid peroxidation in the presence of fatty infiltration and inflammation results
there is a __ hit paradign
2
what is the first hit?
excess fat accumulation
it is the ___ ___ ___ which cause the problem rather than triglycerides
it is the free fatty acids which cause the problem rather than triglycerides
what is the 2nd hit? 4
- intrahepatic oxidative stress and Lipid peroxidation
- Pro-inflammatory cytokine release (TNF alpha)
- Lipopolysaccharide get in from the gut
- Ischaemia - reperfusion injury
what are the risk factors? 6
obesity, hypertension, type 2 diabetes and hyperlipidaemia, wilsons disease, drugs
which drugs are a risk factor? 3
methotrexate, amiodarone, tetracycline
what are the symptoms?
Symptoms: most patients are asymptomatic, hepatomegaly may be present
how is a diagnosis made? 2
- increased LFT (typically ALT increased)
- Fatty liver on ultrasound
what are the complications of NAFLD? 2
- hepatic fibrosis ± hepatocellular cancer
simple steatosis is diagnosed by _____
ultrasound
what are the outcomes and risks of simple steatosis?
no liver outcomes but increased cardiovascular risks