Scribd
Upload
101 views5 pages

11.fatty Liver Disease

This document discusses fatty liver disease (FLD), including its risk factors, natural history, assessment, and lifestyle interventions. It identifies obesity, type 2 diabetes, dyslipidemia, and metabolic syndrome as established risk factors for non-alcoholic fatty liver disease (NAFLD). Weight loss through calorie reduction and exercise is an important lifestyle intervention, with at least 5% weight loss needed to improve liver inflammation and fibrosis. Screening tests and possibly liver biopsy are used to diagnose and monitor FLD depending on risk factors and liver enzyme levels.

Uploaded by

Subhi Mishra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
101 views5 pages

11.fatty Liver Disease

This document discusses fatty liver disease (FLD), including its risk factors, natural history, assessment, and lifestyle interventions. It identifies obesity, type 2 diabetes, dyslipidemia, and metabolic syndrome as established risk factors for non-alcoholic fatty liver disease (NAFLD). Weight loss through calorie reduction and exercise is an important lifestyle intervention, with at least 5% weight loss needed to improve liver inflammation and fibrosis. Screening tests and possibly liver biopsy are used to diagnose and monitor FLD depending on risk factors and liver enzyme levels.

Uploaded by

Subhi Mishra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
You are on page 1/ 5

Fatty Liver Disease

Objectives
Identify risk factors for fatty liver disease

Order appropriate screening tests

Diagnose and treat


fatty liver disease

Initiate appropriate referrals

Terminology
ALD: Alcoholic Liver Disease
Significant alcohol consumption*
> 21 drinks/week for males
> 14 drinks/weeks for females
NAFLD: Non-Alcoholic Fatty Liver Disease
steatosis without hepatocyte
injury
NASH: Non-Alcoholic Steatohepatitis
steatosis with inflammation,
hepatocyte injury
with or without fibrosis
By 2020

Natural History of FLD


fatty liver
steatohepatitis
steatohepatitis + fibrosis
steatohepatitis + cirrhosis
cryptogenic cirrhosis
NAFLD: risk factors
• Middle age • Auto-immune disease
• Female gender • Malnutrition
• Over-weight or obese • Abetalipoproteinemia
• Viral hepatitis • Overgrowth of bacteria in small
• Iron overload intestines
• Medications • TPN
• Rapid weight loss • Acute fatty liver of pregnancy
• Starvation/refeeding • HELLP syndrome
syndrome • Hispanic ethnicity
• Reye’s syndrome • Hereditary

Risk factors: Established association


• Obesity
• Type 2 DM: insulin resistance (IR)
• Dyslipidemia
• Metabolic syndrome (MS)

Risk factors: Emerging association


• Polycystic ovary syndrome
• Hypothyroidism
• Obstructive sleep apnea
• Hypopituitarism
• Hypogonadism
• Pancreatic-duodenal resection
• Medications
Risk factor: Bacteria overgrowth
• Liver is 1st line of defense against gut-derived antigens
• Levels of bacterial lipopolysaccharide (component of
GN bacteria) are increased in the circulation in several
types of chronic liver disease
• Can modulation of gut microbia represent a new way to
treat/prevent NAFLD????
Further work-up indicated
• Abnormal liver enzymes
• Symptoms of liver disease
• Rule out other causes: alcohol, medications,
hepatitis, etc.

NAFLD fibrosis score


Age Albumin
BMI AST
Hyperglycemia ALT
Platelet count
Liver biopsy
• Incidental finding on imagery with normal enzymes:
no biopsy indicated, monitor.
• Presence of metabolic syndrome and persistently
elevated biochemistries may benefit from liver biopsy
• Patients with biopsy proven NASH cirrhosis should be
screened routinely for esophageal varices and HCC
Assessment
• Symptoms
• Malaise, fatigue, RUQ discomfort
• Snores, disturbed sleep, wakes up tired
• Chronic pain disorders, achy muscles
• Physical exam
• Abdominal obesity
• Enlarged liver
• RUQ tenderness on palpation
• Labs
• Consistent with metabolic syndrome
• Elevated bilirubin, AST, ALT, AP, GGT

Lifestyle Interventions
Weight loss by lower caloric intake and increased
physical exercise * led to improvement in biopsy.
9.3% weight loss: improvement in steatosis,
necrosis, and inflammation; not fibrosis
• 3-5% weight loss improves steatosis but more is needed
to improve inflammation
• Alcohol consumption:
• heavy intake should be avoided
• light intake (<1/day) may have benefits**, may not***

You might also like