Path Notes: Metabolic Liver Disease ****

Question 1

What is Non Alcoholic Fatty Liver Disease? What conditions belong to this group? What are the common pathological features they share?

Answer 1

NAFL is a group of conditions which have a fatty liver (hepatic steatosis) in common, but which occur in patients without a history of heavy alcohol intake.

NAFL conditions include:

1. Hepatic Steatosis
2. Non-Alcoholic Steatohepatitis (NASH)
3. Steatosis accompanied by minor, nonspecific inflammation

Typically characterised by:

1. Steatosis
2. Lack of inflammation, necrosis and scarring

Question 2

What are some general features, regarding clinical course / presentation, or NASH?

Answer 2

NASH affects women and men equally.

It is most commonly associated with metabolic disorders: obesity, dyslipidaemia, hyperinsulinaemia, insulin resistance, type II diabetes

Question 3

What is the pathogenesis of NASH?

Answer 3

1. Hepatic fat accumulation: microvesicular and macrovesicular
2. Hepatic Oxidative Stress

Question 4

What are the microscopic features of NASH?

Answer 4

1. Steatosis
2. Muti-focal parenchymal inflammation (mainly neutrophils)
3. Sinusoidal fibrosis

Question 5

What are the clinical (e.g. LFT results) features of NASH?

Answer 5

1. Elevated ALT and GGT
2. AST/ALT ratio is usually <1 (tends to be 2-2.5 in alcoholics)
3. Hepatocyte injury progresses to cirrhosis in 10-20% of cases