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=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.NAFLD 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 NAFLD. 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>Rate of progression does not correlate with body mass index (BMI) or hyperlipidemia


== Ptahophysiology ==
{{Family tree/start}}
{{Family tree ||| | A01 | | | |A01= Incidental finding of Fatty liver on ultrasound}}
{{Family tree | | | | |!| | | | | }}
{{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}}


It is thought that pathophysiology of NAFLD  is multifactorial that includes numerous genetic, dietary, metabolic and hormonal factors.Most experts believe that NAFLD is a 2 hit model


The progression to [disease name] usually involves the [molecular pathway].
'''Monitor severity of the disease'''


OR
 
{{Family tree/start}}
The pathophysiology of [disease/malignancy] depends on the histological subtype.
{{Family tree | | | | | | A01 | | | |A01= Offer Enhanced Liver Fibrosis Test (ELF)}}
 
{{Family tree | | | | | | |!| | | | | }}
 
{{Family tree | | | |,|-|-|^|-|-|.| | }}
=== Risk Factors ===
{{Family tree | | | C01 | | | | C02 |C01= (>10.51)  ELF  Positive| C02= (<10.51) ELF Negative}}
* Common risk factors in the development of 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>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 who are having [[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 | | | D01 | | | | D02 |D01= Indicating advanced fibrosis and risk of progression to cirrhosis| D02= Typically Benign -- Advanced fibrosis unlikely}}
 
{{Family tree | | | |!| | | | | | | | }}
*Less commonly Patients with [[hypertension]] and [[dyslipidemia]] are also associated with developing NAFLD
{{Family tree | | | E01 | | | | |E01= Refer the patient to Heptologist}}
 
{{Family tree/end}}
 
* On negative ELF test offer retest for every 3 years for adults and 2 years for children.
=== 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 />

Latest revision as of 15:04, 18 December 2017


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.
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