Non Alcoholic Fatty Liver disease/ NASH Flashcards
What is steatosis?
Fatty liver
What is steatohepatitis?
Fatty liver associated with inflammation
How is steatosis divided?
Alcohol-related fatty liver disease.
Non-alcoholic fatty liver disease (NAFLD).
What is non-alcoholic steatohepatitis?
NAFLD associated with inflammation
List 4 risk factors for NASH
T2DM
Obesity
Dyslipidemia
Metabolic syndrome: impaired glucose tolerance, central obesity, dyslipidaemia, HTN
What is the pathophysiological cause of steatosis?
Accumulation of triglycerides + other lipids in hepatocytes due to defective fatty acid metabolism
Give 2 epidemiological facts about NASH
2–3% of the population have NASH
Average age: 40–50y
How does NASH usually present?
Usually ASYMPTOMATIC in early stages- an incidental finding
On direct questioning, what 4 symptoms may present in NASH?
RUQ pain
Fatigue
Unexplained weight loss
Weakness
List 3 signs that may be found on examination in NASH
Hepatomegaly
Splenomegaly +/- portal HTN in cirrhosis.
Signs of chronic liver disease in patients with cirrhosis (ascites, oedema, spider naevi).
List 3 investigations for NASH
LFTs: elevated AST + ALT
Liver US: hyper-echogenic, bright image. May show steatosis
Liver Biopsy: confirms diagnosis
What management approach is taken for NASH? What 7 features does this involve?
Conservative: controlling risk factors: BP Diabetes Cholesterol Weight loss Stop smoking Exercise regularly Reduce alcohol consumption (although NOT caused by excessive alcohol, drinking can make it worse)
What complications may arise due to NASH?
CIRRHOSIS- Ascites, Oesophageal varices, Hepatic encephalopathy
Hepatocellular carcinoma
End-stage liver failure
What is the prognosis for NASH?
Up to 20% with NASH develop cirrhosis within 10 years
