|
|
| (48 intermediate revisions by the same user not shown) |
| Line 2: |
Line 2: |
|
| |
|
| =Nonalcoholic fatty liver disease= | | =Nonalcoholic fatty liver disease= |
| {{CMG}}; {{AE}}{{VKG}} | | * {{CMG}}; {{AE}}{{VKG}} |
|
| |
|
| === Overview ===
| |
|
| |
|
| Nonalcoholic fatty liver disease [NAFLD] is due to the deposition of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. However, when there is more than 5 -10 percent of the liver’s weight is fat, then it is called a fatty liver (steatosis).NAFLD is marked by inflammation that can progress to irreversible damage.NAFDL is similar to the damage caused by alcohol consumption in most of the cases. It is estimated that in united states approximately 80 to 100 million people are affected with NAFDL. NAFLD most commonly effects people in the age group 2-19 and 40-50 years.It is most commonly seen in Hispanic population when compared to Caucasian and African American populations
| |
|
| |
|
| === Historical Perspective === | | ==Diagnosis== |
| NAFLD is relatively new concept first introduced in 1980. Based on histology it is classified into the non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH).NAFL mostly considered as a benign condition but recent studies show it can progress to NASH up to 44%.On the other hand NASH progress to fibrosis that can lead to cirrhosis and hepatocellular cancer (HCC).<ref name="urlEvidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed/25477264 |title=Evidence of NAFLD progression from steatosis to fibrosing-steatohepatitis using paired biopsies: implications for prognosis and clinical management. - PubMed - NCBI |format= |work= |accessdate=}}</ref>
| |
|
| |
|
| === Risk Factors ===
| | {{Family tree/start}} |
| * NAFLD is related to [[obesity]] which will result in insulin resistance and [[metabolic syndrome]].<ref>{{Cite web|url=https://www.medscape.com/viewarticle/757336_2|title=Nonalcoholic Fatty Liver Disease|last=|first=|date=|website=|publisher=|access-date=}}</ref><ref name="pmid22338098">{{cite journal |vauthors=Sung KC, Jeong WS, Wild SH, Byrne CD |title=Combined influence of insulin resistance, overweight/obesity, and fatty liver as risk factors for type 2 diabetes |journal=Diabetes Care |volume=35 |issue=4 |pages=717–22 |year=2012 |pmid=22338098 |pmc=3308286 |doi=10.2337/dc11-1853 |url=}}</ref>
| | {{Family tree ||| | A01 | | | |A01= Incidental finding of Fatty liver on ultrasound}} |
| *It is estimated that approximately 80% of the obese people suffer from NAFLD.<ref>{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/symptoms-causes/syc-20354567|title=Nonalcoholic fatty liver disease|last=|first=|date=|website=|publisher=|access-date=}}</ref>
| | {{Family tree | | | | |!| | | | | }} |
| * Patients with type 2 diabetes mellitus are more prone to develop Nafld<ref>{{Cite web|url=https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash|title=Nafld|last=|first=|date=|website=|publisher=|access-date=}}</ref><ref>{{Cite web|url=https://www.medscape.com/viewarticle/757336_2|title=Nonalcoholic Fatty Liver Disease|last=|first=|date=|website=|publisher=|access-date=}}</ref>
| | {{Family tree ||| | A01 | | | |A01= Check for persistently raised LFTs}} |
| | {{Family tree | | | | |!| | | | | }} |
| | {{Family tree || | | B01 | | | |B01= Ask the patient for significant alcohol intake}} |
| | {{Family tree | |,|-|-|^|-|-|.| | }} |
| | {{Family tree | C01 | | | | C02| |C01= NO| C02= YES}} |
| | {{familytree | |!| | | | | |!| | | | | | | | | | }} |
| | {{Family tree | D01 | | | | D02 |D01= Diagnose NAFLD| D02= Consider other<br> alcoholic related diseases}} |
| | {{Family tree/end}} |
|
| |
|
| *Patients with hypertension and dyslipidemia are also associated with developing NAFLD
| |
|
| |
|
| =
| | '''Monitor severity of the disease''' |
|
| |
|
| ==Risk Factors==
| | |
| *There are no established risk factors for [disease name].
| | {{Family tree/start}} |
| OR
| | {{Family tree | | | | | | A01 | | | |A01= Offer Enhanced Liver Fibrosis Test (ELF)}} |
| *The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
| | {{Family tree | | | | | | |!| | | | | }} |
| | | {{Family tree | | | |,|-|-|^|-|-|.| | }} |
| *Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
| | {{Family tree | | | C01 | | | | C02 |C01= (>10.51) ELF Positive| C02= (<10.51) ELF Negative}} |
| ===Common Risk Factors=== | | {{Family tree | | | |!| | | | | |!| | }} |
| *Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.
| | {{Family tree | | | D01 | | | | D02 |D01= Indicating advanced fibrosis and risk of progression to cirrhosis| D02= Typically Benign -- Advanced fibrosis unlikely}} |
| *Common risk factors in the development of [disease name] include:
| | {{Family tree | | | |!| | | | | | | | }} |
| **[Risk factor 1]
| | {{Family tree | | | E01 | | | | |E01= Refer the patient to Heptologist}} |
| **[Risk factor 2]
| | {{Family tree/end}} |
| **[Risk factor 3]
| | * On negative ELF test offer retest for every 3 years for adults and 2 years for children. |
| | |
| ===Less Common Risk Factors=== | |
| *Less common risk factors in the development of [disease name] include:
| |
| **[Risk factor 1]
| |
| **[Risk factor 2]
| |
| **[Risk factor 3]
| |
| | |
| === Signs and Symptoms ===
| |
| Usually, Nafdl [Nonalcoholic fatty liver disease] presents with no or few symptoms and sighs but when it does it shows the following<ref>{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/symptoms-causes/syc-20354567|title=Nafld|last=|first=|date=|website=|publisher=|access-date=}}</ref>
| |
| * Hepatomegaly
| |
| * Patient presents with fatigue
| |
| * Abdominal swelling (ascites)
| |
| * Enlarged breasts in men ( due to decreased estrogen clearance by liver damage )
| |
| * Pain in the upper right abdomen
| |
| * Yellowing of the skin and eyes (jaundice) | |
| <references />
| |
Nonalcoholic fatty liver disease
Diagnosis
| | | Incidental finding of Fatty liver on ultrasound | | | |
|
| | | | | | | | | | |
|
| | | Check for persistently raised LFTs | | | |
|
| | | | | | | | | | |
|
| | | Ask the patient for significant alcohol intake | | | |
|
| | | | | | | | | | | | |
| | | | | | | |
| NO | | | | YES | |
|
| | | | | | | | | | | | | | | | | | | |
|
| Diagnose NAFLD | | | | Consider other
alcoholic related diseases |
|
Monitor severity of the disease
| | | | | Offer Enhanced Liver Fibrosis Test (ELF) | | | |
|
| | | | | | | | | | | | |
|
| | | | | | | | | | | | | | |
| | | | | | | |
| | (>10.51) ELF Positive | | | | (<10.51) ELF Negative |
|
| | | | | | | | | | | | | |
|
| | Indicating advanced fibrosis and risk of progression to cirrhosis | | | | Typically Benign -- Advanced fibrosis unlikely |
|
| | | | | | | | | | | | |
|
| | Refer the patient to Heptologist | | | | |
|
- On negative ELF test offer retest for every 3 years for adults and 2 years for children.