Introduction
Many diseases morph silently into deadly conditions. One of those silent disease is nonalcoholic fatty liver disease (NAFLD) which is known to affect our liver. Liver has many important functions in our body among which some of them are detoxifying and purifying blood, production and secretion of bile, excretion of bilirubin, cholesterol, hormones, and drugs, metabolism of fats, proteins, and carbohydrates, enzyme activation, storage of glycogen, vitamins, and minerals and synthesis of plasma proteins, such as albumin and clotting factors (Stanford Children Health, 2016). Liver diseases have multiple causations among which some are bacterial infections, viral infections, autoimmune diseases, metabolic diseases, nutrition and …show more content…
Fatty liver disease has also been given a name of silent liver disease because it can happen without any visible symptoms and no liver damage. However, some people with fatty liver may develop NASH, and it can lead to permanent scarring and hardening of liver which is known as cirrhosis that can cause liver failure and requirement of an organ transplant (John Hopkins Medicine, 2015). According to Brunt and Tiniakos (2010), of all individuals with some form of fatty liver, 3%-5% may develop cirrhosis. Since, NAFLD affects such an important organ in our body, it was a disease that I wanted to understand more. I also wanted to know the steps that are taken for the diagnosis of NAFLD and NASH while very little physical symptoms can be observed. According to Brunt and Tiniakos (2010), liver biopsy evaluation remains the standard for diagnosing NAFLD. Hence, the focus of this paper is about staining techniques and scoring methods used on liver biopsy to identify NAFLD by reviewing journal articles by Brunt and Tiniakos (2010), Dixon et al. (2004) and Kleiner et al. …show more content…
(2004) and Kleiner et al. (2005) assed multiple independent features for the diagnosis of steatohepatitis and did not just based their findings on a single histological feature. The lesion due to accumulation of fat in the form of triglycerides within hepatocytes is termed as steatosis and the minimum criteria for diagnosing NAFLD the presence of > 5% steatotic hepatocytes in a liver tissue section (Brunt and Tiniakos, 2010). On the other hand, the minimal criteria for the histological diagnosis of adult NASH includes steatosis, hepatocyte injury, usually in the form of ballooning, and lobular inflammation, typically localized in acinar zone 3 while fibrosis is not a required diagnostic feature of NASH (Brunt and Tiniakos, 2010). According to Brunt and Tiniakos (2010), hepatocellular injury in NASH can take the form of ballooning, apoptosis, or lytic necrosis. Brunt and Tiniakos (2010) reported that ballooned hepatocytes can be observed as enlarged, swollen, rarefied, pale cytoplasm and, show a hyperchromatic nucleus, usually with a prominent nucleolus. Apoptotic bodies are acidophilic and lobular inflammation is usually mild which consists of a mixed inflammatory cell infiltrate composing lymphocytes, some neutrophils and eosinophils (Brunt and Tiniakos, 2010). Similar to other liver diseases, sinusoidal collagen formation can also be observed in NASH (Brunt and Tiniakos, 2010). Brunt and Tiniakos (2010) noted that other histological
Many diseases morph silently into deadly conditions. One of those silent disease is nonalcoholic fatty liver disease (NAFLD) which is known to affect our liver. Liver has many important functions in our body among which some of them are detoxifying and purifying blood, production and secretion of bile, excretion of bilirubin, cholesterol, hormones, and drugs, metabolism of fats, proteins, and carbohydrates, enzyme activation, storage of glycogen, vitamins, and minerals and synthesis of plasma proteins, such as albumin and clotting factors (Stanford Children Health, 2016). Liver diseases have multiple causations among which some are bacterial infections, viral infections, autoimmune diseases, metabolic diseases, nutrition and …show more content…
Fatty liver disease has also been given a name of silent liver disease because it can happen without any visible symptoms and no liver damage. However, some people with fatty liver may develop NASH, and it can lead to permanent scarring and hardening of liver which is known as cirrhosis that can cause liver failure and requirement of an organ transplant (John Hopkins Medicine, 2015). According to Brunt and Tiniakos (2010), of all individuals with some form of fatty liver, 3%-5% may develop cirrhosis. Since, NAFLD affects such an important organ in our body, it was a disease that I wanted to understand more. I also wanted to know the steps that are taken for the diagnosis of NAFLD and NASH while very little physical symptoms can be observed. According to Brunt and Tiniakos (2010), liver biopsy evaluation remains the standard for diagnosing NAFLD. Hence, the focus of this paper is about staining techniques and scoring methods used on liver biopsy to identify NAFLD by reviewing journal articles by Brunt and Tiniakos (2010), Dixon et al. (2004) and Kleiner et al. …show more content…
(2004) and Kleiner et al. (2005) assed multiple independent features for the diagnosis of steatohepatitis and did not just based their findings on a single histological feature. The lesion due to accumulation of fat in the form of triglycerides within hepatocytes is termed as steatosis and the minimum criteria for diagnosing NAFLD the presence of > 5% steatotic hepatocytes in a liver tissue section (Brunt and Tiniakos, 2010). On the other hand, the minimal criteria for the histological diagnosis of adult NASH includes steatosis, hepatocyte injury, usually in the form of ballooning, and lobular inflammation, typically localized in acinar zone 3 while fibrosis is not a required diagnostic feature of NASH (Brunt and Tiniakos, 2010). According to Brunt and Tiniakos (2010), hepatocellular injury in NASH can take the form of ballooning, apoptosis, or lytic necrosis. Brunt and Tiniakos (2010) reported that ballooned hepatocytes can be observed as enlarged, swollen, rarefied, pale cytoplasm and, show a hyperchromatic nucleus, usually with a prominent nucleolus. Apoptotic bodies are acidophilic and lobular inflammation is usually mild which consists of a mixed inflammatory cell infiltrate composing lymphocytes, some neutrophils and eosinophils (Brunt and Tiniakos, 2010). Similar to other liver diseases, sinusoidal collagen formation can also be observed in NASH (Brunt and Tiniakos, 2010). Brunt and Tiniakos (2010) noted that other histological