Non Alcoholic Fatty Liver Disease

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

174

Pages:

4
Author:

Mariam A. A.

Non Alcoholic Fatty Liver Disease Definition More than 5% liver steatosis in the absence of another cause such as excess alcohol consumption Epidemiology 30% of adults 40% of people over 50 Prevalence is expected to rise Advanced fibrosis is unlikely in patients younger than 50 Risk factors Diabetes Obesity Especially if central Older age Hypertension Elevated TG Key info Metabolic dysfunction associated fatty liver disease (MALFD) is a more appropriate term Unlike NALFD it is not a diagnosis of exclusion Proposed diagnostic criteria: Evidence of fat accumulation in hepatocytes ->steatosis At least one of: Overweight/obesity T2DM Evidence of metabolic dysfunction in a person of low or normal weight At least two of: Increased weight circumference Elevated BP Dyslipidaemia Prediabetes Classification Type Description Non-alcoholic fatty liver disease (NAFL) Simple fat deposition without cell injury of fibrosis Non-alcoholic steatohepatitis (NASH) Histological diagnosis characterised by fat deposition with hepatocyte injury and inflammation +/- fibrosis Clinical features Hypertension Central adiposity Investigations LFTs Elevated AST, ALT and GGT AST and ALT -> more than two times the upper normal limit Reversal of AST and ALT ration AST > ALT Most common presentation Hypalbuminaemia Liver U/S Diagnosis confirmation Does not reliability detect in less than 20% of patients Thus -> normal U/S -> does not rule out disease Still consider alternate diagnosis Findings: Hyperechoic Reduced portal vessel visibility Look for features of cirrhosis Elevated TG Low HDL-C Risk stratification NAFLD fibrosis score or FIB-4 Index Biopsy Allows for staging Elastography Assess degree of fibrosis Not possible in obese patients Management No drug management Lifestyle modification If obese Aim to reduce 7 to 10% of body weight -> controlled and over 12 months Improves histological fibrosis and non-alcoholic steatohepatitis Mediterranean type Coffee -> small degree of protection Bariatric surgery If lifestyle factors are not enough for weight reduction Minimise alcohol intake Physical activity Management of cardiovascular factors If high LDL -> satins Complications Higher risk of mortality and morbidity Cardiovascular disease Leading cause of death Cirrhosis 40% die from liver related disease