Non-Alcoholic Fatty Liver Disease (NAFLD) + NASH

Excessive fat buildup in the liver associated with insulin resistance due to causes other than alcohol use

Aetiology

  • Obesity - associated with insulin resistance and dyslipideamia

Pathophysiology

1. Steatosis (NAFLD)

  • Accumulation of fat within hepatocytes

2. Steatohepatitis (NASH)

  • Inflammation - mononuclear and neutrophilic
  • Hepatocytes degradation - ballooning and Mallory bodies
  • Fibrosis - initially pericellular, later bridging

3. Cirrhosis

  • Occurs in up to 20% of patients over 10 years
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Clinical presentation

  • Majority of patients with steatosis have no symptoms
  • Patients with steatohepatitis (NASH) may present with fatigue, malaise and RUQ pain
  • Advanced disease may present with S+S of cirrhosis

NAFLD

  • No liver outcomes
  • Increased cardiovascular risk

Investigations

  • USS

Management

  • Weight loss and exercise
  • Aim is to prevent progression to NASH

NASH

Investigations

  • Liver biopsy

Management

  • Weight loss and exercise
  • Aim is to prevent progression to cirrhosis