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12 Cards in this Set

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Spectrum
NAFL - fatty liver.
NASH - fatty liver and increased hepatocyte death
Cirrhosis - regen nodules and fibrosis.
prevalent?
yes - correlates with metab syndrome/insulin resistance
what puts you at much more risk of cirrhosis
NASH and fibrosis (compared to NAFL) - makes sense...
pathophys
high insulin or resistance increases TNF and reduces adiponectin.

this leads to steatosis (NAFL), cell death, inflammation (NASH), and insulin resistance.
TNF
pro-apoptotic
recruits WBCs
promotes insulin res
adiponectin
inhibits FA uptake
stim FA oxidation and lipid export
enhances insulin sens.
blood tests of fatty liver disease
ast and alt moderately elev or normal.
things to remember about dx
fat doesn't exclude other liver diseases. and positivity for other diseases doesn't exclude FLD (e.g. ANA or hemochromatosis)
clinical px depends on...
histology.
how to eval px
ast/alt ratio.
thrombocytopenia - suggests cirrhosis.

and increased bili with decreased albumin appears late.

gold standard is biopsy.
Tx
weight loss
exercise
metformin
pioglitazone
vit C and E
consider bariatric surgery if morbidly obese.

best thing is wt loss!!!
patients with cirrhosis should...
eval for portal HTN and screened for hepatocellular carcinoma.