Non-Alcoholic Liver Disease Flashcards
T or F. Non-Alcoholic Fatty Liver Disease is becoming the most common liver disease
T. Due to obesity, diet, being pieces of shit basically
TEST QUESTION!!!
Describe Nonalcohlic fatty liver disease
This is an acquired liver disease in both children and adults that has arise primarily in correlation with obesity in the US over the past 30-40 yrs
What EtOH consumption rates would be defined as NAFLD?
less than 20g/day (probably closer to 10g/day in women)
What is the classic histo of NAFLD?
Macrovesicular hepatic steatosis
What are the two main categories under the diagnosis of NAFLD?
1) ISolated steatosis
2) Non-alcoholic steatohepatitis (NASH) which is marked by significant inflammation, and more likely to progress to fibrosis and cirrhosis
What is the main player in the development of such prevelant NAFLD?
BMI over 30
others: Type 2 Diabetes, Sleep Apnea, Hyperlipidemia, and Metabolic Syndrome
NAFLD is the most common!!
Can NAFLD steatosis only occur in obese pts?
No, while up to 70% of obese pts have signs of steatosis, 10-15% of normal BMI pts do as well
Can NAFLD-related NASH only occur in obese pts?
No, this is obivously worse than steatosis and thus less common, being seen in 15-20% of obese pts but still 3% in normal BMI pts
Why do some people with elevated BMIs show NAFLD and others do not?
It is highly correlated to the distribution of fat. Those with central obesity (in the stomach) and much more liekly to get it than those with peripheral obesity (i.e. arms, legs, back)
What races commonly get NAFLD?
Mexicans are the most common and AA are the least likely to get it
Which gender is most likely to get NAFLD?
Women
Does NAFLD occur in children?
Yes, 10% of children have NAFLD making it the leading cause of Pediatric liver disease
When does NAFLD most commonly occur in children?
Mean age at 12
What is the prognosis of progression on NAFLD in children? Will it go to fibrosis or cirrhosis?
In 100 children with NASH, 8% had advanced fibrosis and 3% had cirrhosis
What are some other causes of Nonalcoholic Fatty Liver Disease?
•Nutritional Abnormalities
-Total Parenteral Nutrition, Starvation, Refeeding
•Metabolic Diseases: Abetalipoproteinemia, Hypobetalipoproteinemia
- Occupational Chemical Exposure
- Drugs like Tamoxifen, Corticosteroids, Methotrexate
How could starvation lead to NAFLD?
Starvation leads to peripheral fat being shifted to the liver!! Not just the fatties
What kinds of surgeries have been assoicated with NAFLD?
Those promoting rapid weight loss such as:
Jejunoileal bypass (causes fat deposition in the liver)
Gastric bypass – less common
Are pts with NAFLD-related fatty liver likely to progress to NASH?
No, limited
Are pts with NAFLD-related NASH likely to progress to advanced fibrosis? cirrhosis?
•30-40% with advanced fibrosis
10-15% will advance to cirrhosis
T or F. NASH caused cirrhosis can lead to HCC
T.
How are TAGs from the GI normally handled?
•Normally triglycerides incorporated into chylomicrons
–Travel via lymphatics for storage in peripheral fat
What happens to peripheral fat in NAFLD?
Peripheral fat is hydrolyzed to free FAs and transported to the liver where they are oxidized by mitochondria promoting free radical formation and damage, thus:
steatosis is a result of disturbed balance between periphery and liver fat
What is another significant aspect about the pathology of NAFLD?
Insulin resistance leads to increased peripheral lipolysis leading to increased levels of FFAs that are depositied in the liver and subjected to mitochondrial fatty acid oxidation promoting free radical formation and liver damage.
Increased free FAs in the liver also promoted increased gucose output, increasing insulin levels which promote increased hepatic lipogenesis
