Non-alcoholic fatty liver disease classification: Difference between revisions
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==Overview== | ==Overview== | ||
Non-alcoholic fatty liver disease may be classified based on clinical presentation into non-alcoholic fatty liver and non-alcoholic steatohepatitis. | Non-alcoholic fatty liver (NAFLD) disease may be classified based on clinical presentation into non-alcoholic fatty liver and non-alcoholic steatohepatitis. | ||
==Clinical Classification== | ==Clinical Classification== | ||
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* Non-progressive | * Non-progressive | ||
| | | | ||
* Can progress to cirrhosis | * Can progress to [[cirrhosis]] | ||
* Rarely can give rise to hepatocellular carcinoma | * Rarely can give rise to [[hepatocellular carcinoma]] | ||
|- | |- | ||
! colspan="2" style="background:#efefef;" |Based on Etiology | ! colspan="2" style="background:#efefef;" |Based on Etiology | ||
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| | | | ||
* If the cause of the liver disease is secondary to: | * If the cause of the liver disease is secondary to: | ||
** Surgery for morbid obesity | ** Surgery for [[morbid obesity]] | ||
** An adverse drug effect | ** An adverse drug effect | ||
** Conditions such as abetalipoproteinemia or Wilson’s disease | ** Conditions such as [[abetalipoproteinemia]] or [[Wilson's disease|Wilson’s disease]] | ||
|} | |} | ||
==Histopathological classification== | ==Histopathological classification== | ||
Histological classification of | Histological classification of NAFLD includes grading and staging. | ||
* Grade: | * Grade: Depending on degree of [[steatosis]] and necro-inflammatory activity | ||
* Stage: | * Stage: Depending on degree of [[fibrosis]]. | ||
===Grading=== | ===Grading=== | ||
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|3 | |3 | ||
|- | |- | ||
| rowspan="3" |Hepatocyte | | rowspan="3" |Hepatocyte -Balloning | ||
|None | |None | ||
|0 | |0 | ||
| Line 100: | Line 100: | ||
|} | |} | ||
===Staging=== | ===Staging=== | ||
Based on the degree of fibrosis on | Based on the degree of [[fibrosis]] on [[biopsy]] non-alochoic fatty liver disease can be classified into 4 stages. | ||
{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable" | {| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable" | ||
! colspan="2" style="background:#efefef;" |Staging | ! colspan="2" style="background:#efefef;" |Staging | ||
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|Stage 1 | |Stage 1 | ||
| | | | ||
Zone 3 fibrosis<br> | Zone 3 [[fibrosis]]<br> | ||
Perisinusoidal fibrosis<br> | Perisinusoidal [[fibrosis]]<br> | ||
Portal/ periportal fibrosis | Portal/ periportal [[fibrosis]] | ||
|- | |- | ||
|Stage 2 | |Stage 2 | ||
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|- | |- | ||
|Stage 3 | |Stage 3 | ||
|Bridging fibrosis | |Bridging [[fibrosis]] | ||
|- | |- | ||
|Stage 4 | |Stage 4 | ||
|Cirrhosis | |[[Cirrhosis]] | ||
|} | |} | ||
Latest revision as of 13:57, 27 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
Non-alcoholic fatty liver (NAFLD) disease may be classified based on clinical presentation into non-alcoholic fatty liver and non-alcoholic steatohepatitis.
Clinical Classification
Non-alcoholic fatty liver disease may be classified based on clinical presentation into non-alcoholic fatty liver and non-alcoholic steatohepatitis.[1][2][3]
| Based on clinical presentation | |
|---|---|
| Non-alcoholic fatty liver | Non-alcoholic steatohepatitis |
|
|
|
|
| Based on Etiology | |
|
|
|
|
Histopathological classification
Histological classification of NAFLD includes grading and staging.
- Grade: Depending on degree of steatosis and necro-inflammatory activity
- Stage: Depending on degree of fibrosis.
Grading
NAFLD activity score is employed for grading steatohepatitis of NASH. NAS represents the sum of scores for steatosis, lobular inflammation, and ballooning.[4]
| Component | Range | Score |
|---|---|---|
| Steatosis | <5% | 0 |
| 5-33% | 1 | |
| 34-66% | 2 | |
| >66% | 3 | |
| Lobular Inflammation | None | 0 |
| <2 focci | 1 | |
| 2-4 | 2 | |
| >4 | 3 | |
| Hepatocyte -Balloning | None | 0 |
| Few ballooned cells | 1 | |
| Many ballooned cells | 2 | |
| Interpretation | 0-2 | Non-diagnostic |
| 3-4 | Borderline | |
| 5-8 | Diagnostic |
Staging
Based on the degree of fibrosis on biopsy non-alochoic fatty liver disease can be classified into 4 stages.
| Staging | |
|---|---|
| Stage 1 |
Zone 3 fibrosis |
| Stage 2 | Perisinusoidal and portal/periportal fibrosis |
| Stage 3 | Bridging fibrosis |
| Stage 4 | Cirrhosis |
References
- ↑ Hashimoto E, Tokushige K, Ludwig J (2015). "Diagnosis and classification of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: Current concepts and remaining challenges". Hepatol Res. 45 (1): 20–8. doi:10.1111/hepr.12333. PMID 24661406.
- ↑ Cobbina E, Akhlaghi F (2017). "Non-alcoholic fatty liver disease (NAFLD) - pathogenesis, classification, and effect on drug metabolizing enzymes and transporters". Drug Metab Rev. 49 (2): 197–211. doi:10.1080/03602532.2017.1293683. PMC 5576152. PMID 28303724.
- ↑ Monteiro JM, Monteiro GM, Caroli-Bottino A, Pannain VL (2014). "Nonalcoholic fatty liver disease: different classifications concordance and relationship between degrees of morphological features and spectrum of the disease". Anal Cell Pathol (Amst). 2014: 526979. doi:10.1155/2014/526979. PMC 4333905. PMID 25763333.
- ↑ Vizuete J, Camero A, Malakouti M, Garapati K, Gutierrez J (2017). "Perspectives on Nonalcoholic Fatty Liver Disease: An Overview of Present and Future Therapies". J Clin Transl Hepatol. 5 (1): 67–75. doi:10.14218/JCTH.2016.00061. PMC 5411359. PMID 28507929.