DR Yaghoubpour-Diagnosis and Management of Nonalcoholic Fatty Liver

The Diagnosis and Management of Nonalcoholic Fatty Liver Disease:

Practice Guidance From the American Association for the Study of Liver Diseases

AGENDA:

21. Definition
21. The importance of taking care about NAFLD in diabetic patients
21. Diagnosis(laboratory evaluations,imaging,Bx…)
21. Treatment(Wt loss,role of antihyperglycemic agents,role of statins ,role of ACE and ARB…)

defining NAFLD:

 (1) evidence of hepatic steatosis (HS), either by imaging or histology,

 and

(2) lack of secondary causes of hepatic fat accumulation such as significant alcohol consumption, long‐term use of a steatogenic medication, or monogenic hereditary disorders .

In the majority of patients,

 NAFLD is commonly associated with metabolic comorbidities such as obesity, diabetes mellitus, and dyslipidemia.

21. 1) the presence of hepatic steatosis (5% of hepatocytes determined by histology or 5.6% determined by nuclear MR techniques);
21. 2) no significant alcohol consumption (defined as ongoing or recent alcohol consumption of 21 drinks/week for men and 14 drinks/week for women);
21. 3) no competing etiologies for hepatic steatosis.

NAFLD can be categorized histologically into:

• NAFL is defined as the presence of 5% HS without evidence of hepatocellular injury in the form of hepatocyte ballooning.
• NASH is defined as the presence of 5% HS and inflammation with hepatocyte injury (e.g., ballooning), with or without any fibrosis.