non-viral hepatitis Flashcards
(42 cards)
what is NAFLD ?
non-alcoholic fatty liver disease
what are the requirements for defining NAFLD ?
- evidence of hepatic steatosis either by imaging or histology
along with lack of secondary causes of hepatic fat accumulation
- lack of secondary cause of hepatic fat accumulation such as significant alcohol consumption
what is defined as significant alcohol consumption ?
> 21 drinks for men per week
>14 drinks for women per week
what is the difference between NASH and NAFLD ?
NASH - non alcoholic steato-hepatitis where there is inflammation around the fatty tissue
NAFLD - no inflammation
what are the commonly associated abnormalities with NASH?
insulin resistance metabolic syndrome T2DM obesity dyslipidemia hypertension
what is metabolic syndrome ?
it is defined as having at least two of the following: obesity Insulin resistance dyslipidemia hypertension
how does insulin resistance result in the accumulation of triglycerides in hepatocytes ?
impaired oxidation of fatty acids
increased synthesis and uptake of fatty acids
decreased hepatic secretion of LDL cholesterol
what happens to fat laden hepatocytes ?
they become exposed to free oxygen radicals which causes oxidative stress
causes mitochondrial death
and eventually cell death
what is the presentation of NAFLD like ?
usually asymptomatic but may present with vague right upper quadrant pain with elevated transaminases
what may appear upon ultrasound in NAFLD?
bright liver
what is the management of NAFLD ?
most importantly lifestyle modification
weight loss reduces hepatic steatosis
what medical treatment can be taken for cases of NASH ?
Pioglitazone ( improves histology of the patient)
Vitamin E
what surgical treatment may be considered for NAFLD ?
bariatric surgery
what are medications that are not recommended for the treatment of NASH ?
Metformin
GLp-1 agonists
Omega 3 fatty acids ( non specific for NASH)
what are the treatment options for advanced cases of NASH and NAFLD ?
liver transplantation
patients with cirrhosis should be screened for HCC
what is the pathogenesis of primary biliary cholangitis ?
chronic inflammatory autoimmune, more common in smokers
if primary biliary cholangitis is left untreated what is the outcome ?
end stage biliary cirrhosis
what is PBC characterized by ?
destruction of intrahepatic bile ducts
portal inflammation
scarring
what are the cardinal features of PBC ?
non-suppurative destruction of small and medium sized intrahepatic bile ducts
what is the onset of PBC ?
insidious onset
what cann be found in serology in PBC ?
AMA positive
what are the AMA directed against ?
pyruvate dehydrogenase complex
what genetic association is there with PBC ?
HLA-DR8
what is the clinical picture of PBC ?
fatigue pruritus may precede by jaundice scratch marks right upper quadrant abdominal discomfort jaundice bone pain or fractures xanthelasma mild hepatomegaly splenomegaly with the development of portal hypertension