Nonalcoholic Fatty Liver Disease. Definition and Causes. Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease. It encompasses a spectrum of conditions associated with lipid deposition in hepatocytes. It ranges from steatosis (simple fatty liver), to nonalcoholic steatohepatitis (NASH–fatty changes with inflammation and hepatocellular injury or fibrosis), to advanced fibrosis and cirrhosis (Figure 1). Studies suggest that although simple fatty liver is a benign condition, NASH can progress to fibrosis and lead to end- stage liver disease. The disease is mostly silent and is often discovered through incidentally elevated liver enzyme levels.
It is strongly associated with obesity and insulin resistance and is currently considered by many as the hepatic component of the metabolic syndrome. NASH cirrhosis is now one of the leading indications for liver transplantation in the United States. Because NAFLD resembles alcoholic liver disease but occurs in people who drink little or no alcohol, excessive daily alcohol consumption must be ruled out before making the diagnosis.
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- A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of.
- BackgroundPreventive care for adults with diabetes has improved substantially in recent decades. We examined trends in the incidence of diabetes-related complications.
- Cirrhosis (end stage liver disease) is a diffuse hepatic process characterised by fibrosis and the conversion of normal liver architecture into structurally abnormal.
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Numerous other conditions leading to fatty liver must be excluded by history, physical examination, and appropriate testing (Table 1). Back to Top. Prevalence and Risk Factors. Accurate epidemiologic data are not available because of a lack of population- based studies and reliable noninvasive screening tools. There is disagreement about the methods used to diagnose NASH, and there is no clear consensus on the clinical implications of histologic changes or on the influence of the amount of alcohol ingested. The prevalence of NAFLD is affected by many factors, including genetics (predilection to alcohol abuse, sex) and environment and is therefore difficult to define. In general, the risk of liver disease increases with the patient's body mass. Based on the available data, NAFLD is estimated to occur in one- third of the general population in the US.
Researchers discovered that drinking a single cup of coffee every day cuts your risk of developing a serious liver cancer called hepatocellular (HCC). Dematogenous dissemiantion Particularly with US strains; Often results in a multifocal rash Each focus represents a separate nidus of metastatic infection. General Discussion Cyclic vomiting syndrome (CVS) is an uncommon disorder affecting both children and adults and characterized by recurrent, episodes of severe nausea.
The prevalence of NASH is more difficult to determine. It seems to occur in approximately 3% of the US population but may be found in more than 2. The prevalence of overweight persons (body mass index [BMI] ≥2.
US has risen to more than 6. BMI ≥3. 0 kg/m. 2) is now present in more than 3. US population. The prevalence is increased in men, older individuals (those aged 4. The prevalence of childhood obesity and NAFLD is at similar levels. NAFLD has been observed in all ethnic groups with the highest prevalence seen in Hispanics compared with Caucasians and African Americans. Table 1. Conditions associated with macrovesicular steatosis. Nonalcoholic fatty liver disease.
Excessive alcohol consumption. Drugs. Estrogens. Coumadin. Tamoxifen. Valproic acid. Methotrexate. Isoniazid. Corticosteroids. Vitamin ATroglitazonel- Asparaginase.
Amiodarone. Perhexiline. Calcium channel blockers. Nucleoside analogues. Hepatitis C (genotype 3)Nutritional factors. Rapid weight loss. Total parenteral nutrition. Starvation. Protein- calorie malnutrition.
Surgical considerations. Gastrointestinal surgery for obesity. Extensive small- bowel resection. Metabolic disorders. Cystic fibrosis. Abetalipoproteinemia. Majorca Hotels Adults Only. Others. Syndromes associated with obesity and insulin resistance. Lipodystrophies. Hypopituitarism.
Prader- Willi syndrome. Other. Inflammatory bowel disease. Small- bowel diverticulosis with bacterial overgrowth. Virus infection. Petrochemicals. Toxic mushrooms. Copyright © 2. The Cleveland Clinic Foundation.
Back to Top. Pathophysiology and Natural History. Pathophysiology. Development of NASH may be the result of 2 liver insults.
With the initial insult, macrovesicular steatosis occurs which is a manifestation of excessive triglyceride accumulation in the liver. Insulin resistance and subsequent hyperinsulinemia appear to lead to alterations in the hepatic pathways of uptake, synthesis, degradation, and secretion of free fatty acids and ultimately to accumulation of lipids in the hepatocytes. These changes seem to make the liver susceptible to a second insult, resulting in an inflammatory response and progression of liver damage. Oxidative stress, mainly caused by mitochondrial dysfunction, and proinflammatory cytokines such as tumor necrosis factor- alpha (TNF- alpha), are believed to play an important role in the progression of liver damage in NAFLD. Potential oxidative stressors include hepatic iron, leptin, antioxidant deficiencies, and intestinal bacteria.
Hepatocyte apoptosis, an organized form of cell death, has been identified as a potential key component of the second insult involved in NAFLD progression. Natural History. Overall, morbidity and mortality have been shown to be significantly higher in NASH patients compared with the general population. Coronary artery disease and malignancy followed by liver- related mortality are the most common causes of death in NASH patients. Scavenger Hunts For Adults In Philadelphia. Children with NASH also have a significantly shorter duration of survival compared with people in the general population.
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