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Materi Fatty Liver Rsu Hermina & PLN

Fatty liver, or fatty infiltration of the liver, occurs when more than 5% of the liver's weight is made up of fat. It has various causes including a high calorie diet high in carbohydrates and fructose, a sedentary lifestyle, and alcohol consumption. If left untreated, fatty liver can progress to non-alcoholic steatohepatitis (NASH) and potentially cirrhosis or liver cancer. Treatment focuses on lifestyle modifications like weight loss through calorie restriction and increased physical activity, as well as potentially medications like vitamin E or pioglitazone. While no drugs are specifically approved for NASH, these options may help resolve fatty liver disease in some patients.

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66 views15 pages

Materi Fatty Liver Rsu Hermina & PLN

Fatty liver, or fatty infiltration of the liver, occurs when more than 5% of the liver's weight is made up of fat. It has various causes including a high calorie diet high in carbohydrates and fructose, a sedentary lifestyle, and alcohol consumption. If left untreated, fatty liver can progress to non-alcoholic steatohepatitis (NASH) and potentially cirrhosis or liver cancer. Treatment focuses on lifestyle modifications like weight loss through calorie restriction and increased physical activity, as well as potentially medications like vitamin E or pioglitazone. While no drugs are specifically approved for NASH, these options may help resolve fatty liver disease in some patients.

Uploaded by

ifa virdiyas
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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All about

Fatty LIVER
Presenter
dr. Chofi Qolbi NA, SpPD
Internist
Find me
@RSU Hermina Ciruas
instagram :
@chofiqolbi
Apa Itu liver dan Apa Fungsinya?

Menghasilkan Protein (albumin)


dan proses sintesis kolesterol

Menghasilkan cairan empedu


dan berbagai enzim

Membersihkan darah dari racun


(amonia, zat berbahaya lain)

Menyimpan energi

menghancurkan sel darah merah


Definisi Fatty Liver ?
kandungan lemak di hati melebihi 5%
dari seluruh berat hati
Apa Saja Penyebab Fatty Liver?

High Calorie Intake (


Genetic
Carbohidrate and Fruktosa)

also present in 7% of normal-weight


Sedentary Life style
(lean) individuals

Alcohol
Apa yang bisa terjadi pada
perlemakan hati/ fatty liver
Natural history of NAFLD over 8–13 years

Steatosis 8%

NASH 
12−40% F1−F2
fibrosis
13%
5−10% Advanced
14% F3
fibrosis
0−50%
Death/
LTx Cirrhosis
25%

25−50% 7%

HCC
Diagnostic Flow Chart
Metabolic risk factors present

Ultrasound (steatosis biomarkers)*/


liver enzymes†

Steatosis present Steatosis absent

Normal Abnormal Normal


liver enzymes liver enzymes‡ liver enzymes

Serum fibrosis
markers§

Medium/
Low risk‖
high risk‖

Follow-up/ Follow-up/
Specialist referral
2 years 3–5 years

Identify other chronic liver diseases


Liver enzymes,
In-depth assessment of disease severity Ultrasound/
fibrosis
Decision to perform liver biopsy liver enzymes
biomarkers
Initiate monitoring/therapy
Bagaimana Pengobatannya ?

Energy restriction Fructose intake


• Avoid fructose-containing
• Calorie restriction (500−1,000/day)
food and drink
• 7−10% weight loss target
• Long-term maintenance approach
Daily alcohol intake
Coffee consumption • Strictly below 30 g men
• No liver-related limitations Comprehensive and 20 g women
lifestyle approach

Macronutrient composition Physical activity


• Low-to-moderate fat • 150−200 min/week moderate intensity
• Moderate-to-high carbohydrate in 3−5 sessions
• Low-carbohydrate ketogenic diets or • Resistance training to promote
high protein musculoskeletal fitness and improve
metabolic factors

EASL–EASD–EASO CPG NAFLD. J Hepatol 2016;64:1388–402


Terapi obat obatan?

No drugs are approved for NASH


No specific therapy can be
recommended
Any drug treatment is off label
Treatment: pharmacotherapy
• Insulin sensitizers
• Little evidence of histological efficacy with metformin
• PPAR agonist pioglitazone better than placebo
• Improved all histological features except fibrosis
• Achieved resolution of NASH more often
• Antioxidants
• Vitamin E may improve steatosis, inflammation and ballooning and resolve NASH in some patients
• Concerns about long-term safety exist

Recommendations Grade of evidence Grade of recommendation

While no firm recommendations can be made, pioglitazone* or vitamin E† or their


B 2
combination could be used for NASH
The optimal duration of therapy is unknown; in patients with increased ALT at baseline,
treatment should be stopped if there is no reduction in aminotransferases after 6 months C 2
of therapy‡

*Most efficacy data, but off-label outside T2DM; †Better safety and tolerability than pioglitazone in the short-term;
‡No recommendations can be made in patients with normal baseline ALT

EASL–EASD–EASO CPG NAFLD. J Hepatol 2016;64:1388–402


Treatment: pharmacotherapy
• Lipid-lowering agents
• Statins have not been adequately tested in NASH

Recommendations Grade of evidence Grade of recommendation

Statins may be confidently used to reduce LDL cholesterol and prevent cardiovascular
risk, with no benefits or harm to liver disease.
B 1
Similarly, n-3 polyunsaturated fatty acids reduce both plasma and liver lipids, but there are
no data to support their use specifically for NASH

EASL–EASD–EASO CPG NAFLD. J Hepatol 2016;64:1388–402


Terapi PEMBEDAHAN
TERIMAKASIH

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