Liver & GIT
All of the following statements about Non Alcoholic Fatty Liver disease are true, except: (PGI MAY 12)
|A||Common in Diabetics|
|B||Clofibrate provides effective treatment|
|C||Commonest cause of cryptogenic cirrhosis|
|D||Associated with elevated transaminases|
Non-alcoholic fatty liver disease (NAFLD)
a. Simple fatty liver disease (or non-alcoholic fatty, NAFL) - benign prognosis
b. Non-alcoholic steatohepatitis (NASH). - Associated with fibrosis and prognosis to cirrhosis.
Aetiology and pathogenesis
1. Most individuals with NAFLD have insulin resistance but not necessarily overt glucose intolerance.
2. The current two-hit hypothesis explains why not everyone with fatty liver disease develops hepatic fibrosis.
3. The ‘first hit’ result in steatosis (fatty liver), which is only complicated by inflammation if a ‘second hit occurs’.
4. Leptin is then needed to cause hepatic fibrosis.
NASH associated with: 1. DM 2. Obesity 3. Dyslipidemic 4. Increase insulin resistance)
1. Most patient have Asymptomatic but have abnormal LFTs, particularly elevation of the transaminases or isolated elevation of the GGT.
2. May presents with a complication of cirrhosis such as varicealheamorrhage or hepatocellular carcinoma.
3. In contrast to alcoholic liver disease, NAFLD is the most likely diagnosis in a patient abuse and a negative chronic liver disease screen.
Liver & GIT