Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
12 Cards in this Set
- Front
- Back
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.
|