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Non-alcoholic fatty liver disease is the most common liver disease in the western world.
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With worldwide prevalence between 6 and 35%.
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Risk factors include obesity, type 2 diabetes, dyslipidemia and metabloic syndrome.
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Non-alcoholic fatty liver diseases further subdivided into non-alcoholic fatty liver and NASH.
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Most patients with non-alcoholic fatty liver disease fall into this category.
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NAFL is generally benign in most patients who totally asymptomatic.
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Obesity is considered to be the primary cause
and treatment is based largely around lifestyle changes and metabolic correction of hyperlipidemia and blood sugar.
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Some of these patients do experience disease progression and go on to develop a disorder called NASH.
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I want you to focus upon
the dreaded NASH
or Non-Alcoholic Steatotic Hepatitis
(NASH).
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To briefly summarize all the different
classes of liver disease,
from this point onwards,
whenever you're dealing with
liver issues in medicine,
have a huge list of differentials.
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Including auto-immune
causes such as
Auto-immune hepatitis.
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Other auto-immune diseases that
may cause liver disease including
Primary Biliary Cirrhosis,
Primary Cirrhosis Cholangitis.
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Then go into viral hepatitis.
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Think about alcoholic hepatitis
and then here
the most common cause of abnormal
liver function test
in general population
is this;
Once again the patient,
not necessarily an alcoholic
or even
causing or the alcohol causing
liver damage.
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In United States,
obesity is an issue.
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When obesity is kicking in,
then you know that
you have a patient that
insulin resistant
and so therefore,
is suffering from
Hyperglycemia.
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Hypertension is an issue.
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And in addition to that,
with all of that
Hypertriglyceride or hyperlipidemia,
which may then accummulate
in the liver,
we call this Non-Alcoholic Steato.
What's Steato mean?
Fat.
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Where are you?
In the liver.
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So therefore, you call this
Non-Alcoholic
Steato Hepatitis.
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Histologically similar to very much,
now which component
of alcoholic liver disease?
The fatty change.
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Alright, Steatotic Hepatitis.
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However here,
the damage to liver is not being caused
by alcohol.
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I wish to emphasize that
over and over again
and the umbrella or the canvas
of diagnosis is Non-Alcoholic
Fatty Liver disease.
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Under that, I'm having you focus on
Non-Alcoholic Steatotic Hepatitis
because this is the one
that is going to give you
clinical presentation.
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Thus, this is the one
that you will be asked about
in number of ways, on the wards
or on the boards.
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As I've mentioned, the association here
is absolutely Obesity.
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As soon as Obesity kicks in,
morbid Obesity,
doesn't have to be but
let's say that you weigh
more than you should,
then you're thinking about
insulin resistance,
Thus, your patient, along with
liver disease,
is also suffering from Hyperglycemia.
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And this Hyperlipidemia,
accummulation of triglycerides in liver,
as I said, looks like,
would you have found perhaps,
alcohol fatty change.
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Drugs and prolonged
Total Parenteral Nutrition (TPN),
could be risk factors as well for
Non-Alcoholic Steatotic Hepatitis.
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Let's take a look at management
of NASH
and based on
the associations we've talked about.
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If you know you're
patient's obese,
your recommendation is to
obviously lose weight.
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Exercise, diet.
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Next, if you know your patient
is diabetic,
watch as to how much you eat.
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So you will be quite agressive
in terms of how
you manage your patient with NASH.
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Association Obesity.
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Once that has come under control,
then, you are decreasing the amount of
damage that has taken place to the liver.
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Unfortunately,
the risk factor for severe liver disease,
under Non-Alcholic Fatty Liver Disease
and NASH,
is so bad that often times
liver transplantation
for end stage liver disease
may have to be necessary.
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So as benign as it may seem,
just because you hear the
word "non-alcoholic",
doesn't mean that the disease
is any less dangerous.
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Is that clear?
And this is a huge problem in the US.