NAFLD

Represents a spectrum of conditions

characterized
by
macrovesicular
hepatic steatosis in the absence of
significant alcohol intake.
Includes histological pattern:
Simple steatosis( without
inflammation)
Steatohepatitis(NASH)

Normal liver

Cirrhosis

Fatty liver (Steatosis)

Steatohepatitis
- inflammation
- fibrosis

 NASH is frequently seen in

conjunction with metabolic
syndrome (hypertension, diabetes
mellitus, elevated lipids, and
obesity)
NAFLD being considered the
hepatic manifestation of this
syndrome.
Virtually all patients with NASH
have insulin resistance.

 Liver biopsy
Macrovesicular steatosis.
Lobular mixed inflammatory infiltrate.
Mallory's hyaline can be seen.
The fibrosis has a characteristic
perivenular and perisinusoidal
distribution.

 S/S
Incidentally discovered - Most patients , on
routine biochemistry analysis .
Symptomatic
Non specific - fatigue or a vague right
upper quadrant discomfort.
Signs of liver cell failure..

 ALT is generally higher than AST,

and aminotransferases are only
mildly (1.52 times the upper limit
of normal) elevated.
Ferritin values in 50% of patients
with NASH.

 Diagnosis
1.History
. To determine the amount of alcohol used. <20 g/d
of alcohol be consumed to exclude alcoholic liver
disease.
2.Laboratory testing for other liver diseases such
as hepatitis B and C, iron studies, ceruloplasmin, 1
antitrypsin levels, and autoimmune serologies .
3. Imaging studies can show characteristic features
of a fatty liver
4. Liver biopsy - Ultimate diagnosis of either hepatic
steatosis or NASH.
5. Work up for Metabolic syndrome. Eg FBSL,
lipids,BMI

 Treatment:
1. Weight loss - The mainstay of treatment
2. Exercise
3. Drugs - Orlistat, reversible inhibitor of gastric and
pancreatic lipase.
4. Bariatric surgery
5. insulin resistance - The thiazolidinedione
medications are PPAR gamma inhibitors, which
improve insulin sensitivity within the adipocyte
and skeletal muscle by up regulating specific
protein kinases involved in decreasing fatty acid
synthesis. Eg Rosiglitazone.
6. Antioxidants have also been used eg vitamin E
supplementation.
7. Treatment of hyperlipidemia with statin-type
agents.