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NONALCOHOLIC FATTY LIVER DISEASE

Nonalcoholic fatty liver disease is having excessive fat (in the form of triglycerides) accumulation not due to excessive alcohol consumption or other secondary causes.

It is considered as a hepatic manifestation of metabolic syndrome.

Progression of nonalcoholic fatty liver disease is variable.

Introduction

  • Fatty liver is usually an incidental finding on abdominal imaging that reveals hepatic steatosis & laboratory study results of elevated liver enzymes
  • Considered as hepatic manifestation of metabolic syndrome (obesity, type 2 diabetes mellitus, insulin resistance, dyslipidemia & hypertension)
  • Most common liver disorder in the Western countries & becoming a serious health issue in many Asian countries
  • Progression of nonalcoholic fatty liver disease (NAFLD) is variable; ranges from hepatic steatosis through inflammatory nonalcoholic steatohepatitis (NASH) to fibrosis or cirrhosis
  • Major cause of mortality in patients w/ nonalcoholic fatty liver disease is cardiovascular disease

Definition

  • Excessive hepatic fat (in the form of triglycerides) accumulation not due to excessive alcohol consumption or other secondary causes

Signs and Symptoms

  • Patient usually presents asymptomatic but may describe vague right upper quadrant pain, fatigue & malaise

Risk Factors

  • Obesity
  • Insulin resistance/metabolic syndrome
  • High-calorie diet w/ saturated fats, refined carbohydrates, sugar-sweetened beverages & high fructose
  • Jejunoileal bypass surgery
  • Highest risk in 40-65 years old
  • Higher risk in Hispanics & Asians while lower risk in African-Americans
  • Genetic predisposition
  • Drugs & toxins (eg Amiodarone, Coralgil, corticosteroids, synthetic estrogens, Methotrexate, IV tetracycline)
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