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- December 1, 2008 |
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| Presentation |
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"Nonalcoholic Fatty Liver Disease"Dr. Graeme Macdonald (biography)
English - 2006-04-05 - 39 minutes
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 | (43 slides) |
Summary :
In this presentation Dr. Macdonald talks about the clinical features, epidemiology, natural history and treatment of nonalcoholic fatty liver disease (NAFLD).
What is the clinical impact of NAFLD? There is a range of symptoms, says Dr. Macdonald. Between 15 and 50 percent of patients will go on to develop hepatic fibrosis, and about 1 in 6 will progress to frank cirrhosis. An increasing number of liver transplants are being performed for cryptogenic cirrhosis, and the incidence of hepatocellular carcinoma in cirrhosis is about 2-3 percent per annum.
The prevalence of NAFLD has been found to increase with obesity. On the more severe end of the spectrum of NAFLD is nonalcoholic steatohepatitis (NASH). The prevalence of NASH is also increasing with the epidemic of obesity and about a third of patients with NASH will go on to develop significant fibrosis or cirrhosis. Dr. Macdonald talks about the diagnosis of NASH and the ballooning of hepatocytes as a key histological feature.
In NAFLD, the ALT/AST ratio is generally greater than 1, however some patients can have normal liver enzymes. In a study of 51 patients with NAFLD and normal ALT values published by Mofrad et al., diabetes was the only predictor of fibrosis (1).
NAFLD has been associated with increased mortality from all causes (2), and insulin resistance is thought to play an important role in the pathogenesis of liver injury in NASH (3). There is strong evidence of a link between insulin resistance, the insulin resistance syndrome and NAFLD (4), and NAFLD appears to be the hepatic manifestation of the metabolic syndrome, says Dr. Macdonald.
Dr. Macdonald talks about investigations that should be done in patients with NAFLD, and ends with a discussion of therapeutic options for NAFLD geared towards improvement of hepatic insulin sensitivity, reducing oxidant stress and reducing the inflammatory response in the host.
Copyright © 2006 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
An overview of nonalcoholic fatty liver disease:
- Clinical features
- Clinical impact
- Prevalence
- Natural history
- Diagnosis
- Therapeutic options
Bibliographic references :
1. Mofrad P, Contos MJ, Haque M, Sargeant C, Fisher RA, Luketic VA, Sterling RK, Shiffman ML, Stravitz RT, Sanyal AJ.Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values Hepatology. 2003 Jun;37(6):1286-92.
2. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ.Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999 Jun;116(6):1413-9.
3. Day CP, James OFW. Gastroenterology 1998.
4. Chitturi S, Abeygunasekera S, Farrell GC, Holmes-Walker J, Hui JM, Fung C, Karim R, Lin R, Samarasinghe D, Liddle C, Weltman M, George J.NASH and insulin resistance: Insulin hypersecretion and specific association with the insulin resistance syndrome Hepatology. 2002 Feb;35(2):373-9.
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