CC May 2015 NAFLD (Nonalcoholic fatty liver disease)

echoecho's version from 2015-05-06 20:51


Question Answer
Obesity, insulin resistance, HTN and lipid abnormalities are all features of what syndrome?metabolic syndrome
Metabolic syndrome is a predisposing factor for the development of what?NAFLD (nonalcoholic fatty liver diseaes)
NAFLD refers to what spectrum of disease?from hepatic steatosis (fatty infilatration) to nonalcoholic steatohepatitis (NASH) and potentially to fibrosis, cirrhosis and even HCC (hepatocellular CA)
What % of adults have NAFLD? Of these, how many will have NASH?17-33%; one-third
NAFLD is the most common cause of elevated ____ ____ in the US adults?liver enzymes
NAFLD is the most common cause for ______ that is not due to hepatitis, alcohol toxins, autoimmune disease, congenital hepatic abnormalities or biliary disease?cirrhosis
Predictions are that NAFLD will become the predominant reason for _____ transplantation?liver
NAFLD is the most common type of hepatic dysfunction in US children, true or false?true
In approximately ____% of patients, fatty liver progresses to steatohepatitis and may progress to fibrosis? Of these, what % of patients develop cirrhosis with a smaller % developing complications such as HCC (hepatocellular CA)5% ; 25%
What is the incidence of NAFLD-linked liver cancer?is not known
Suspicion of NAFLD should arise in what patient types?BMI > 25; elevated ALT; diabetes; and "fatty liver" on US.
Why is the search for NAFLD beigns with the need to clarify incidental findings on labs or US studies?because s/s are not common
Progression to additional testing (list 3 studies) should be based on the risks of underlying liver inflammation?1. hepatitis serologies 2. autoimmune markers 3. studies for hemochromatosis
*** List the 7 risk factors that increase the likelihood of progression of NASH in those with NAFLD? 1. female gender 2. age > 50 years 3. HTN 4. AST > 45 5. BMI > 30 kg/m2 6 AST / ALT ratio > 0.80 7. hyaluronic acid concentration > 55 mg/L
For a dx of NAFLD, daily alcohol intake must be < ____ g in men and < ____ g in women (___ drinks and ____ drinks, respectively)?30; 20; 2; 1.5
What is the gold standard for diagnosis? Because of the risks of the procedure, this should be reserved for which patients?liver biopsy; those at significant risk of inflammation or fibrosis
List the 5 categories that NAFLD can also be secondary to?1. medications 2. toxins 3. abdominal surgery 4. metabolic disorders 5. nutrition
List examples of medications associated with NAFLD?amiodarone (Cordarone), estrogens, corticosteroids, antiretroviral agents, tamoxifen (Nolvadex), tetracycline, minocycline, diltiazem (Cardizem)
List examples of toxins associated with NAFLD?organic solvents, pesticides
List examples of abdominal surgery associated with NAFLD?bariatric surgery, extensive small bowel resection
List examples of metabolic disorders associated with NAFLD?hypothyroidism, dyslipidemia
List examples of nutrition states associated with NAFLD?total parenteral nutrition, re-feeding syndrome, starvation
Is there good-quality, evidence-based guidelines available regarding management of NAFLD?no
What vitamin is effective in reducing transaminase levels and inflammatory histologic changes (but not fibrosis) in nondiabetic NAFLD patients?vitamin E
Why is vitamin E recommendation is not forthcoming?1. due to a lack of evidence of benefit in diabetic patients 2. its increased risk for cardiovascular mortality, prostate cancer and CVA
What has Pioglitazone (Actos) been shown to do?1. reduce insulin resistance 2. reduce aminotransferase 3. improve steatosis 4. but NOT to improve fibrosis in NASH (although it does slow the progression of fibrosis)
What are the side effects of Pioglitazone (Actos)? 1. weight gain (4-5% per year) 2. rare hepatotoxicity 3. cardiac disorders (CHF, MI)
Comment on Metformin on it's benefit in hepatic histology?it helps control glucose metabolism but has no proven benefit in hepatic histology
Comment on statins improving aminotransferase levels and US findings? histologic changes? liver related morbidity and mortality?1. statins may improve aminotransferase levels and US findings 2. does not improve histologic changes 3. does not improve morbidity and mortality
What is the cornerstone for improving NAFLD?1. modification of metabolic factors (DM, dyslipidemia) in combination with weight loss
How does weight loss affect the liver?weight loss reverses the progression of fatty liver before fibrosis develops
Bariatric surgery in NAFLD patients with morbid obesity, is shown on serial histologic studies to reduce steatosis in ____% of patients, steaohepatitis in ___% and fibrosis in ___%?92; 82; 65
Why should alcohol consumption be limited (although not necessarily prohibited)? since hepatotoxic effects of > 2 oz daily is well established and small quantities may have some beneficial effects
Comment on coffee consumption on NAFLD?coffee has a beneficial effect on NAFLD (limits its progession)