Non-Alcoholic Fatty Liver Disease: Waters

Question 1

What is non-alcoholic fatty liver disease?

Answer 1

Macrovesicular fatty liver seen in ppl who drink 80g/day = AFLD

Question 2

There are two conditions present in Non-alcoholic fatty liver disease. The first is the steatosis. What is the other?

Answer 2

Steatohepatitis (NASH)- steatosis in a background of inflammation.

Question 3

Describe the common co-morbidities of of NASH.

Answer 3

Obesity
T2DM
Hyperlipidemia
Metabolic syndrome

Question 4

Describe the pathophysiology of steatosis in NASH.

Answer 4

More lipogenesis in liver and more peripheral FFAs released from periphery–> liver.
More FFAs in liver–> oxidative stress–> damage/inflammation

Question 5

Describe the two hit model of NASH.

Answer 5

1) fat accumulation in liver

2) Oxidative stress via lipid peroxidation and free radicals

Question 6

Describe the physical exam of someone with NASH.

Answer 6

Obesity (30-100% of cases)
Hepatomegaly (up to 50% of cases)
Spider angiomata
Palmar erythema

Question 7

Describe the labs of someone w/ NASH

Answer 7

AST/ALT up to 4x normal- AST rarely 2x ALT, unlike AFLD.

Alk phos up to 2x normal

Question 8

What is the tx for NASH?

Answer 8

*Weight reduction*
Maybe bariatric surg. 
Liver transplant
Tx underlying metabolic syndrome
No magic pill.