Non-alcoholic fatty liver disease other diagnostic studies: Difference between revisions
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Liver biopsy may be helpful in the diagnosis of non-alcoholic fatty liver disease. Findings on biopsy include macrovesicular steatosis, inflammation, ballooning degeneration, zone 3 perivenular/periportal/perisinusoidal fibrosis and, finally, mallory bodies. | Liver biopsy may be helpful in the diagnosis of non-alcoholic fatty liver disease. Findings on biopsy include macrovesicular steatosis, inflammation, ballooning degeneration, zone 3 perivenular/periportal/perisinusoidal fibrosis and, finally, mallory bodies. | ||
==Other Diagnostic Studies== | ==Other Diagnostic Studies== | ||
* | *Liver biopsy is considered as a gold-standard for diagnosing, grading, and staging NAFLD. | ||
* | ===Complications=== | ||
*Requires dexterity and skill | |||
* Classically, biopsy reveals | *Invasive test | ||
*Associated with significant bleeding risk in patients with clotting abnormalities due to hepatic disease. | |||
===Complications=== | |||
Complications of liver biopsy are rare but include | |||
*Pain | |||
*Hypotension | |||
*Peritonitis | |||
*Intraperitoneal hemorrhage | |||
*Biliary injury | |||
===Findings=== | |||
Classically, biopsy reveals:<ref>Angula P. Nonalcoholic Fatty Liver Disease. NEJM. 2002 346(16):1221-31</ref><ref>Brunt EM, Janney CG, Di Bisceglie AM et al. Nonalcoholic steatohepatitis: A proposal for grading and staging the histological lesions. Am. J. Gastroenterol. 1999; 94(9):2467-2474</ref> | |||
*Macrovesicular steatosis | |||
*Inflammatory cells | |||
*Ballooning degeneration | |||
*Zone 3 perivenular/periportal/perisinusoidal fibrosis | |||
*Mallory bodies | |||
===Interpretation=== | |||
*Histologic changes in NAFLD are very similar to those in alcoholic hepatitis and may also mimic those seen in chronic HCV infection | |||
*The spectrum of abnormalities varies from simple bland steatosis to NASH, in which steatosis is associated with mixed inflammatory cell infiltration, mostly lobular, and liver injury. | |||
*Cell injury is manifested by hepatocyte ballooning as well as by Mallory hyaline and acidophilic bodies. | |||
*Fibrosis is classically perisinusoidal/perivenular and may lead to bridging fibrosis and cirrhosis. | |||
*Although portal tracts are relatively spared in adult NAFLD, children with this condition may have a predominance of portal inflammation and fibrosis as opposed to lobular involvement. | |||
*Compared with alcoholic hepatitis, NASH is associated with a higher prevalence of nuclear vacuoles and steatosis, while alcoholic hepatitis tends to produce periportal and pericellular fibrosis. | |||
*Alcoholic hepatitis presents with identical histology but patient history and/or biochemistry will indicate prolonged, excessive alcohol intake.<ref>Skelly et al. Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. J Hepatol 2001;35:195-9 | |||
</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 16:33, 22 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Liver biopsy may be helpful in the diagnosis of non-alcoholic fatty liver disease. Findings on biopsy include macrovesicular steatosis, inflammation, ballooning degeneration, zone 3 perivenular/periportal/perisinusoidal fibrosis and, finally, mallory bodies.
Other Diagnostic Studies
- Liver biopsy is considered as a gold-standard for diagnosing, grading, and staging NAFLD.
Complications
- Requires dexterity and skill
- Invasive test
- Associated with significant bleeding risk in patients with clotting abnormalities due to hepatic disease.
Complications
Complications of liver biopsy are rare but include
- Pain
- Hypotension
- Peritonitis
- Intraperitoneal hemorrhage
- Biliary injury
Findings
Classically, biopsy reveals:[1][2]
- Macrovesicular steatosis
- Inflammatory cells
- Ballooning degeneration
- Zone 3 perivenular/periportal/perisinusoidal fibrosis
- Mallory bodies
Interpretation
- Histologic changes in NAFLD are very similar to those in alcoholic hepatitis and may also mimic those seen in chronic HCV infection
- The spectrum of abnormalities varies from simple bland steatosis to NASH, in which steatosis is associated with mixed inflammatory cell infiltration, mostly lobular, and liver injury.
- Cell injury is manifested by hepatocyte ballooning as well as by Mallory hyaline and acidophilic bodies.
- Fibrosis is classically perisinusoidal/perivenular and may lead to bridging fibrosis and cirrhosis.
- Although portal tracts are relatively spared in adult NAFLD, children with this condition may have a predominance of portal inflammation and fibrosis as opposed to lobular involvement.
- Compared with alcoholic hepatitis, NASH is associated with a higher prevalence of nuclear vacuoles and steatosis, while alcoholic hepatitis tends to produce periportal and pericellular fibrosis.
- Alcoholic hepatitis presents with identical histology but patient history and/or biochemistry will indicate prolonged, excessive alcohol intake.[3]
References
- ↑ Angula P. Nonalcoholic Fatty Liver Disease. NEJM. 2002 346(16):1221-31
- ↑ Brunt EM, Janney CG, Di Bisceglie AM et al. Nonalcoholic steatohepatitis: A proposal for grading and staging the histological lesions. Am. J. Gastroenterol. 1999; 94(9):2467-2474
- ↑ Skelly et al. Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. J Hepatol 2001;35:195-9