Non-Alcoholic Fatty Liver Disease (NAFLD)/Non-Alcoholic Steatohepatitis (NASH)/Non-Alcoholic Fatty Liver (NAFL)



Non-Alcoholic Fatty Liver Disease (NAFLD)/Non-Alcoholic Steatohepatitis (NASH)/Non-Alcoholic Fatty Liver (NAFL)





(Dig Dis Sci 2005:50;171-80. Clin Gastroenterol Hepatol. 2004;2:1048-58. Gastroenterology. 2002:123: 1702-04 & 1705-25)


DEFINITION:



  • The presence of macrovesicular fatty changes without inflammation (steatosis) and lobular inflammation in the absence of alcohol


  • NAFLD can be divided into NASH or NAFL



    • NASH: 10-20%, biopsy proven, is macrovesicular steatosis with inflammation and can progress to cirrhosis


    • NAFL/Steatosis: 80%, comprising the majority of NAFLD, typically does not progress to NASH or cirrhosis


  • Classifications of NASH:



    • Primary NASH: Obesity, Diabetes, Hyperlipidemia


    • Secondary NASH: Drug therapy: See Associated Meds, under Etiologies



      • Surgical procedures: Jejunal bypass, Gastric bypass, Extensive small bowel resection


      • Other Metabolic: TPN, Acute starvation, Rapid weight loss


      • Miscellaneous: Bacterial overgrowth, Abetalipoproteinemia, Weber-Christian disease


EPIDEMIOLOGY:



  • Prevalence of NAFLD: 7-9%; Most are Women (60-95%) but the gap is closing so that men = women


  • Mean age at diagnosis: 50 years (range 16-80)


  • Most common adolescent liver disease and increasing due to obesity epidemic (adolescents with abnormal LFTs, 60% are obese/overweight)


  • A substantial portion of cases of cryptogenic cirrhosis may be ‘burnt-out’ NASH, as many are associated with obesity, DM, Lipids


ETIOLOGIES:

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Aug 24, 2016 | Posted by in GASTROENTEROLOGY | Comments Off on Non-Alcoholic Fatty Liver Disease (NAFLD)/Non-Alcoholic Steatohepatitis (NASH)/Non-Alcoholic Fatty Liver (NAFL)

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