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fatty liver disease (Clinical Essentials) - Dr. Kiran Peddi MRCP(UK), FRCP(London), CCT(Gastro)
Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH)
NAFLD: non-alcohol-related accumulation of fat in the liver cells
NASH: NAFLD with chronic inflammation and damage of liver cells
Etiology
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Obesity and/or type 2 diabetes (metabolic syndrome)
Pathology
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Hepatocellular lipid accumulation, mostly macrovesicular
Ballooning degeneration and necrosis
Inflammatory infiltrates, with scattered lymphocytes, neutrophils, and Kupffer cells
Pathophysiology
↑ Insulin resistance
↑ Triglyceride synthesis
↑ Hepatic uptake of fatty acids
Clinical presentation
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Often asymptomatic
Hepatomegaly
May progress to cirrhosis
Diagnostics
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↑ Transaminases (AST/ALT ratio greater than 1)
The reversal of the AST/ALT ratio to values greater than 1 may indicate progression to cirrhosis.
Rule out other causes of chronic hepatitis (e.g., heavy alcohol use, hepatitis B, hepatitis C, Wilson disease, autoimmune hepatitis, hemochromatosis, α1-antitrypsin deficiency)
Therapy
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Weight loss, optimization of diabetic treatment
Complications: cirrhosis, hepatocellular carcinoma
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Негізгі бет fatty liver disease (Clinical Essentials) - Dr. Kiran Peddi MRCP(UK), FRCP(London), CCT(Gastro)
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