Nonalcoholic Fatty Liver Disease Flashcards

1
Q

Nonalcoholic fatty liver disease (NAFLD) triad. …..?

A

NAFLD can range from fatty liver alone to a triad of fatty infiltration, inflammation, and fibrosis termed nonalcoholic steatohepatitis (NASH)

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2
Q

Type 1 NASH resembles ….?

A

Resembles adult histologic findings with steatosis and balloon degeneration of hepatocytes and/or periportal fibrosis

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3
Q

Type 2 NASH includes ….?

A

Steatosis and portal inflammation.

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4
Q

Is aminotransferase sensitive in NAFLD ….?

A

No

A normal serum ALT level is present in 21–23% of pediatric patients with NAFLD

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5
Q

Gold standard for diagnosis of NAFLD ….?

A

A liver biopsy may be required for a delimiting diagnosis. There are no reliable biomarkers available to serve as an alternative to liver biopsy.

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6
Q

Risk factors for NAFLD ….?

A
obesity, 
male gender, white or 
Hispanic ethnicity, 
hypertriglyceridemia, and 
insulin resistance
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7
Q

Obese and overweight children with other risk factors should be screened for NAFLD at what age …….?

A

> 3 yr of age should be screened for NAFLD by checking aminotransferase levels and liver ultrasound, even though neither is highly sensitive or specific.

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8
Q

What is Lysosomal acid lipase deficiency (LAL-D), ?

A

Autosomal recessive disorder due to mutations in LIPA may produce a hepatic steatosis like syndrome

In contrast to NAFLD, patients with LAL-D usually demonstrate microvesicular or mixed micro- and macrovesicular steatosis not macrovesicular changes

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9
Q

Proven therapeutic trials in NAFLD ….?

A

Gradual weight loss

Low glycemic index foods and substituting polyunsaturated fatty acids for saturated fats may help

Vitamin E and vitamin C provide no additional benefit to the efficacy of lifestyle intervention (diet and exercise) in improving steatosis or biochemical abnormalities in pediatric NAFLD

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10
Q

Role of vitamin E in NASH …..?

A

vitamin E has been shown to improve balloon degeneration in children with NASH.

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11
Q

Role of metformin in NASH …..?

A

Metformin has produced mixed results in the treatment of NAFLD.

Thiazolidinediones (pioglitazone, rosiglitazone) improve liver histology in adults with NASH but have not been studied in children

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12
Q

Role of probiotics in NASH …..?

A

In view of the potential role of the gut microbiome in contributing to the pathogenesis of NAFLD, the role of probiotics as an adjunct to lifestyle changes is under investigation.

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13
Q

What is Cysteamine bitartrate ?..

A

Cysteamine bitartrate (slow release), a potential precursor of glutathione, an antioxidant, may reduce liver enzyme levels, as well as serum leptin and adiponectin levels, and is also a potential candidate for the treatment of NAFLD

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14
Q

What is the role of Incretin in NAFLD ?

A

GLP-1 is a neuropeptide (incretin) that has an antihyperglycemic effect. A metaanalysis demonstrated decreased ALT and improved imaging findings, as well as histologic features in adults with NAFLD and diabetes treated with GLP-1 agonists

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