Nonalcoholic Fatty Liver Disease: Definitions, Risk Factors, and Workup
|
|
- Bertram Collins
- 6 years ago
- Views:
Transcription
1 REVIEW REVIEW Nonalcoholic Fatty Liver Disease: Definitions, Risk Factors, and Workup Puneet Puri, M.B.B.S., M.D. and Arun J. Sanyal, M.B.B.S., M.D. Nonalcoholic fatty liver disease (NAFLD) is defined as the presence of fat in the liver (hepatic steatosis) either on imaging or on liver histology after the exclusion of secondary causes of fat accumulation in the liver (e.g., significant alcohol consumption, certain medications, and other medical conditions). NAFLD is further categorized histologically into nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). NAFL is defined as hepatic steatosis with no evidence of hepatocellular injury in the form of hepatocyte ballooning. NASH is defined as the presence of hepatic steatosis and inflammation with hepatocyte injury (ballooning) with or without fibrosis. The common terminology used in the literature is summarized in Table 1. Histology of NAFLD Histology is important in the evaluation of NAFLD, which is a clinicopathological entity (See Brunt in this issue of CLD). 1 Three histological scoring systems for NAFLD have been published: two were reported by Matteoni 3 and Brunt 4 in 1999, and then a semiquantitative scoring system was validated by the National Institutes of Health sponsored Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) in 2005 (Table 2). The NASH CRN system describes the nonalcoholic fatty liver disease activity score (NAS), which is a composite score of steatosis, lobular inflammation, cytological ballooning, and fibrosis (disease stage). Importantly, the NAS score should not be used as a surrogate for the diagnosis of NASH. The NASH CRN system is presently used only for research. Despite these attempts, there is no consensus on the histological diagnosis of NAFLD or its categories in clinical practice, which remains a gestalt (Tables 3 and 4). The characteristic histological features are briefly described here. Steatosis. Steatosis is required for the diagnosis of NAFLD but can be identified in patients with other conditions with elevated liver tests (e.g., alcohol and chronic hepatitis C), and the pathologist should always be alert to other possibilities, particularly when the clinical evaluation is not consistent. The NASH CRN scoring system describes four distribution patterns of steatosis, as shown in Fig. 1. Steatohepatitis. Steatohepatitis is a specific pattern of histological abnormality seen in NAFLD patients. In adults, it is most commonly a zone 3 centered injury pattern that includes steatosis, inflammation, and ballooning injury [often with Mallory-Denk bodies (MDBs)] with or without fibrosis (Fig. 2). Borderline steatohepatitis has some but not all of the features that would allow a diagnosis of steatohepatitis. The presence of the characteristic ballooning injury is the key to the diagnosis. Ballooning injury results in enlarged vacuolated cells that classically will contain MDBs, which are eosinophilic, ropey cytoplasmic inclusions often found near the nucleus. MDBs are composed of hyperphosphorylated, misfolded cytokeratin 8 and 18 filaments. Thus, steatohepatitis can be definite, borderline, or nonexistent according to histological features. Risk Factors Associated With NAFLD Insulin resistance is central to the development of NAFLD, which represents the hepatic manifestation of metabolic syndrome (MS). As defined by Adult Treatment Panel III, MS is the presence of three or more of the following features: (1) a waist circumference greater than 102 cm in men or greater than 88 cm Abbreviations: ALT, alanine aminotransferase; APRI, aspartate aminotransferase-to-platelet ratio index; AST, aspartate aminotransferase; BARD, BMI, AST/ ALT, DM; CT, computed tomography; ELF, European Liver Fibrosis; FIB-4, Non-invasive index to assess fibrosis based on age, AST, ALT, and platelet count; GGT, gamma-glutamyltransferase; HCV, hepatitis C virus; HIV, human immunodeficiency virus; INR, international normalized ratio; MDB, Mallory-Denk body; MR, magnetic resonance; MRI, magnetic resonance imaging; MS, metabolic syndrome; NAFL, nonalcoholic fatty liver; NAFLD, nonalcoholic fatty liver disease; NAS, nonalcoholic fatty liver disease activity score; NASH, nonalcoholic steatohepatitis; NASH CRN, Nonalcoholic Steatohepatitis Clinical Research Network. From the Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA Potential conflict of interest: Nothing to report. View this article online at wileyonlinelibrary.com VC 2012 by the American Association for the Study of Liver Diseases. doi: /cld Clinical Liver Disease, Vol. 1, No. 4, August 2012 An Official Learning Resource of AASLD
2 TABLE 1: Terminology for NAFLD Term NAFLD Simple steatosis NASH Primary NAFLD Secondary NAFLD Presumed NAFLD Description Indicates fatty infiltration of the liver Defined as a fat concentration > 5% 10% of the liver weight Hepatic steatosis > 5% in biopsy specimens Fatty infiltration with no or minimal inflammation and no fibrosis Hepatic steatosis with inflammation, ballooned hepatocytes, and/or fibrosis (which may progress to cirrhosis) Occasionally used in the literature but not uniformly accepted Indicates typical disease associated with features of MS but without a specific, additional etiology NAFLD associated with a specific cause Implies the absence of insulin resistance May represent exacerbation of underlying primary NAFLD Not a very useful distinction Presumptive diagnosis of NAFLD Used in epidemiological and pediatric studies Based on the following: Abnormal liver enzyme levels Negative results from viral studies Exclusion of other common liver disease etiologies Echogenic or bright liver on imaging (often abdominal ultrasound) consistent with fatty infiltration Types of NAFLD* 1 Simple steatosis (no inflammation or fibrosis) 2 Steatosis with lobular inflammation but no fibrosis or balloon cells 3 Steatosis, inflammation, and fibrosis of varying degrees (NASH) 4 Steatosis, inflammation, ballooned cells, and Mallory s hyaline or fibrosis (NASH) *According to Matteoni et al. 3 in women, (2) a triglyceride level greater than or equal to 150 mg/dl, (3) a high-density lipoprotein cholesterol level less than 40 mg/dl in men and less than 50 mg/dl in women, (4) a systolic blood pressure greater than or equal to 130 mm Hg or a diastolic pressure greater than or equal to 85 mm Hg, and (5) a fasting plasma glucose level greater than or equal to 110 mg/dl. Patients with features of MS are at high risk for NAFLD. Additionally, ethnicity influencestheprevalenceofnafld:even with a lower degree of obesity, Hispanics and Asians are at higher risk than African Americans, who despite features of MS are known to have less severe NAFLD and a lower prevalence of NAFLD. Common conditions associated with hepatic steatosis arenotedintable5. Workup of NAFLD The diagnosis of NAFLD requires the following: (1) hepatic steatosis according to imaging or histology, (2) no significant alcohol consumption, (3) no competing etiologies for hepatic steatosis, and (4) no coexisting causes for chronic liver disease. It is important to evaluate people at risk for NAFLD and to further determine those at higher risk for steatohepatitis and advanced fibrosis. NAFLD is the most common cause of abnormal liver chemistry, so other causes should be ruled out. The majority of patients diagnosed with NAFLD are asymptomatic. When symptomatic, it commonly presents as vague right upper TABLE 2: NASH CRN Scoring System: NAS and Fibrosis Score Degree Steatosis Grade Lobular Inflammation Hepatocellular Ballooning Fibrosis Score Description (%) Degree Description Degree Description Degree Description 0 <5 0 None 0 None 0 None <2 foci/20 optical field 1 Mild, few 1a Mild (delicate) zone 3 perisinusoidal fibrosis 1b Moderate (dense) zone 3 perisinusoidal fibrosis foci/20 optical field 2 Moderate/marked, many 1c Portal/periportal fibrosis only 2 Zone 3 perisinusoidal fibrosis with portal/periportal fibrosis 3 >66 3 >4 foci/20 optical field 3 Bridging fibrosis 4 Cirrhosis TABLE 3: Histological Categorization of Disease States in Patients at Risk for NAFLD Category No Significant evidence of fatty liver disease (Not NAFLD) Steatosis Steatosis with inflammation Steatosis with nonspecific fibrosis Steatohepatitis Zone 3 borderline Steatohepatitis Definition Insufficient steatosis for a diagnosis of steatosis (the NASH CRN uses a threshold of 5% of hepatocytes showing steatosis), without other changes (ballooning, fibrosis) that would suggest steatohepatitis Steatosis witout specific changes to suggest a form of steatohepatitis. This category may include spotty lobular inflammation and/or mild degrees of fibrosis of uncertain significance. Form of steatopepatitis most common in adults defined as a zone 3 centered injury pattern that includes steatosis, inflammation, ballooning injury (often with Mallory-Denk bodies) with or without fibrosis. Borderline steatohepatitis has some, but not all of the features that would allow a diagnosis of steatohepatitis. Zone 1, Borderline pattern Form of steatohepatitis that occurs mainly in young children, characterized by zone 1-centered injury (portal inflammation, portal-based fibrosis, zone 1 steatosis, ballooning injury in zone 1 if present). Cryptogenic fibrosis/cirrhosis Presence of fibrosis (usually advanced) or cirrhosis, with little to no steatosis and no changes (ballooning, Mallory-Denk bodies) that would suggest borderline or definite steatopatitis. Other explanations for fibrosis (besides steatohepatitis) should be considered. Table 3 is adapted from Kleiner and Brunt Clinical Liver Disease, Vol. 1, No. 4, August 2012 An Official Learning Resource of AASLD
3 TABLE 4: Comparison of the Features of NAFLD Categories Lesion Not NAFLD Steatosis Steatohepatitis Zone 1 Borderline Pattern Steatosis None to minimal (<5%) Any degree > 5%, often in zone 3 or panacinar Inflammation Usually mild Any degree, usually mainly lobular Any degree, often in zone 3 or panacinar when fibrosis is mild Any degree, usually more lobular when fibrosis is mild Ballooning None None Present when the pattern is definite and may be mild or absent in borderline cases when characteristic fibrosis is seen Fibrosis NAS (typical range) Usually none but there may be stage 1 2 fibrosis Usually none but there may be stage 1 2 fibrosis Sometimes none but fibrosis is usually present and often perisinusoidal in zone (definite) or 2 6 (borderline) Table 4 is adapted from Kleiner and Brunt. 8 Any degree, often in zone 1 or panacinar Any degree, and portal inflammation may be more prominent Usually absent but usually in zone 1 when present Usually present as periportal fibrosis (stage 1c) or portal-portal bridging fibrosis (stage 3) Cryptogenic Fibrosis/ Cirrhosis None to minimal Any degree, and portal inflammation may be more prominent None More than stage 2 fibrosis FIGURE 2. Insulin resistance is central to pathophysiology of NAFLD and plays an important role in the development and progression of disease as demonstrated by key histologic changes. It also shows that insulin resistance contributes to disease progression as seen in a simplified schema that illustrates the spectrum of NAFLD and progression of fibrosis to cirrhosis. FIGURE 1. Four distribution patterns of steatosis according to the NASH CRN scoring system. The red rectangles represent stylized liver biopsies with triangular portal areas (P) and round central veins (V). The small white circles denote steatotic hepatocytes. The amount of steatosis is the same in each pattern and is relatively mild for demonstration purposes. (A) Zone 3 steatosis, (B) Zone 1 steatosis, (C) Panacinar steatosis, and (D) Azonal steatosis. Table 3 is adapted from Kleiner and Brunt. 8 quadrant dull ache or discomfort. On examination, hepatomegaly is the most common physical finding. Other clinical symptoms and physical findings are nonspecific, and they most commonly include general malaise, abdominal discomfort, nausea, and other nonspecific symptoms referred to the gastrointestinal tract. Celiac disease should be ruled out in suspected individuals. Common imaging studies such as ultrasound, computed tomography, and magnetic resonance imaging aid in the diagnosis of NAFLD. Once NAFLD is diagnosed, the next step is to determine the severity, and this information is necessary to understand the prognosis. Clinical examinations and laboratory and imaging studies in combination lack the sensitivity and specificity for distinguishing NAFL from NASH and for determining the presence and stage of fibrosis, which is the most important determinant for the severity and progression of disease. Circulating levels of cytokeratin 18 fragments have been investigated extensively as novel biomarkers for the presence of steatohepatitis in patients with NAFLD, but this testing is not routinely recommended. Other noninvasive tests are emerging; however, these are not yet ready for prime time. Figure 3 outlines the approach to the workup of patients suspected to have NAFLD. 101 Clinical Liver Disease, Vol. 1, No. 4, August 2012 An Official Learning Resource of AASLD
4 TABLE 5: Conditions Associated With the Risk of Hepatic Steatosis Insulin resistance Obesity Sedentary lifestyle Type 2 diabetes mellitus Hypertension Dyslipidemia Drugs Tamoxifen Corticosteroids Amiodarone Methotrexate Estrogens Valproic acid Antiretroviral medications Carbohydrate excess (e.g., diet and total parenteral nutrition) Rapid weight loss Altered small bowel anatomy Obesity surgery (e.g., jejunoileal bypass) Pancreaticoduodenal resection Short gut Metabolic diseases (resulting in a NASH-like histology) Hypobetalipoproteinemia Abetalipoproteinemia Wilson s disease Lipodystrophies Andersen disease Weber-Christian syndrome Infections Chronic hepatitis C virus, mainly genotype 3 Human immunodeficiency virus and acquired immune deficiency syndrome Emerging associations Polycystic ovarian syndrome Hypothyroidism Obstructive sleep apnea Hypopituitarism Hypogonadism Liver biopsy still remains the most reliable approach for identifying the presence of steatohepatitis and fibrosis in patients with NAFLD, but its widespread use is limited by cost, sampling error, and procedure-related morbidity and mortality. Advanced disease is often associated with older age, obesity, diabetes, hypertension, or multiple features of MS. A small subset of patients may present with stigmata of liver disease with suspected advanced fibrosis or cirrhosis. Therefore, the performance of liver biopsy according to clinical judgment is an important step in the workup of NAFLD. When should liver biopsy be performed in patients with NAFLD? Liver biopsy remains the gold standard for characterizing liver histology in patients with NAFLD. As mentioned previously, it should be performed in those who would benefit the most from diagnosis, therapeutic guidance, and prognostic perspectives (See Noureddin and Loomba in this issue of CLD). 9 The recommendations for liver biopsy are as follows: 1. Patients at increased risk for steatohepatitis and advanced fibrosis according to the presence of features of MS and possibly the NAFLD fibrosis score. 2. Patients with suspected NAFLD for whom competing etiologies of hepatic steatosis and coexisting chronic liver diseases cannot be excluded without liver biopsy. CORRESPONDENCE: Arun J. Sanyal, M.B.B.S., M.D., Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, P.O. Box 98034, Richmond, VA asanyal@mcvh-vcu.edu. FIGURE 3. Workup for NAFLD: incidentally detected abnormal liver chemistry/imaging. Abbreviations: ALT, alanine aminotransferase; APRI, aspartate aminotransferase-to-platelet ratio index; AST, aspartate aminotransferase; BARD, BMI, AST/ALT, DM; CT, computed tomography; ELF, European Liver Fibrosis; FIB-4, Non-invasive index to assess fibrosis based on age, AST, ALT, and platelet count; GGT, gamma-glutamyltransferase; HCV, hepatitis C virus; HIV, human immunodeficiency virus; INR, international normalized ratio; MR, magnetic resonance; MRI, magnetic resonance imaging. 102 Clinical Liver Disease, Vol. 1, No. 4, August 2012 An Official Learning Resource of AASLD
5 References 1. Brunt EM. Histological assessment of nonalcoholic fatty liver disease in adults and children. Clin Liver Dis 2012;1: Chalasani N, Younossi Z, Lavine JE, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology 2012;142: Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999;116: Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol 1999;94: Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41: Brunt EM, Kleiner DE, Wilson L, Belt P, Neuschwander-Tetri BA; for NASH Clinical Research Network. The NAS and the histopathologic diagnosis of NASH: distinct clinicopathologic meanings. Hepatology 2011;53: Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346: Kleiner DE, Brunt EM. Nonalcoholic fatty liver disease: pathologic patterns and biopsy evaluation in clinical research. Semin Liver Dis 2012; 32: Noureddin M, Loomba R. Nonalcoholic fatty liver disease: indications for liver biopsy and noninvasive biomarkers. Clin Liver Dis 2012;1: Clinical Liver Disease, Vol. 1, No. 4, August 2012 An Official Learning Resource of AASLD
Challenges in the Diagnosis of Steatohepatitis
The Bugaboos of Fatty Liver Disease: Ballooning and Fibrosis Hans Popper Hepatopathology Society Companion Meeting San Antonio, Tx March, 2017 David Kleiner, M.D., Ph.D. NCI/Laboratory of Pathology Challenges
More informationSteatotic liver disease
Steatotic liver disease Fatty liver disease Prof. Dr. ANNE HOORENS Non-Neoplastic Liver Pathology December 8th 2018 Working Group of Digestive Pathology Belgian Society of Pathology OUTLINE NAFLD = Non-Alcoholic
More informationLinda Ferrell, MD Distinguished Professor Vice Chair Director of Surgical Pathology Dept of Pathology
Linda Ferrell, MD Distinguished Professor Vice Chair Director of Surgical Pathology Dept of Pathology Nonalcoholic steatohepatitis and Fatty Liver Disease Liver manifestations of the obesity epidemic Changes
More informationUpdate on Non-Alcoholic Fatty Liver Disease. Timothy R. Morgan, MD Chief, Hepatology, VA Long Beach Professor of Medicine, UCI
Update on Non-Alcoholic Fatty Liver Disease Timothy R. Morgan, MD Chief, Hepatology, VA Long Beach Professor of Medicine, UCI February 3, 2018 Disclosure Clinical trials: Genfit Speaker s Bureau: none
More informationAAIM: GI Workshop Follow Up to Case Studies. Non-alcoholic Fatty Liver Disease Ulcerative Colitis Crohn s Disease
AAIM: GI Workshop Follow Up to Case Studies Non-alcoholic Fatty Liver Disease Ulcerative Colitis Crohn s Disease Daniel Zimmerman, MD VP and Medical Director, RGA Global October 2015 Non-alcoholic Fatty
More informationAt Least 1 in 5 Patients in Your Practice Have Fatty Liver
At Least 1 in 5 Patients in Your Practice Have Fatty Liver What Can You Tell Your Patients Magnus McLeod MD FRCPC Assistant Professor Dalhousie University 30-NOV-2017 NAFLD Non-Alcoholic Fatty Liver Disease
More informationNONALCOHOLIC FATTY LIVER DISEASE. Non-Alcoholic Fatty Liver Disease (NAFLD) Primary NAFLD. April 13, 2012
NONALCOHOLIC FATTY LIVER DISEASE Kiran Bambha, MD University of Colorado Denver April 13, 2012 Non-Alcoholic Fatty Liver Disease (NAFLD) Primary NAFLD Simple Steatosis Fatty hepatocytes Intracellular fat
More informationCDHNF & NASPGHAN A Partnership for Research and Education for Children s Digestive and Nutritional Health
CDHNF & NASPGHAN A Partnership for Research and Education for Children s Digestive and Nutritional Health Obesity and NAFLD Definitions: Nonalcoholic steatohepatitis (NASH) and nonalcoholic fatty liver
More informationLiver Pathology in the 0bese
Liver Pathology in the 0bese Rob Goldin Centre for Pathology, Imperial College r.goldin@imperial.ac.uk Ludwig et al. Non-alcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease.
More informationPEDIATRIC FOIE GRAS: NON-ALCOHOLIC FATTY LIVER DISEASE
PEDIATRIC FOIE GRAS: NON-ALCOHOLIC FATTY LIVER DISEASE Updates on New insights into NAFLD and NASH pathophysiology New AASLD/AGA/ACG guidelines for NAFLD and NASH, as pertains to pediatrics Evidence-based
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Abetalipoproteinemia NASH and, 537 Acquired errors of metabolism NASH and, 536 537 Amiodarone steatohepatitis due to, 527 Anticonvulsant mood
More informationIn Search of New Biomarkers for Nonalcoholic Fatty Liver Disease
REVIEW In Search of New Biomarkers for Nonalcoholic Fatty Liver Disease Ting-Ting Chan, M.R.C.P., and Vincent Wai-Sun Wong, M.D. Nonalcoholic fatty liver disease (NAFLD) affects 15% to 40% of the general
More informationALT and aspartate aminotransferase (AST) levels were measured using the α-ketoglutarate reaction (Roche,
Supplemental Methods Analytical determinations ALT and aspartate aminotransferase (AST) levels were measured using the α-ketoglutarate reaction (Roche, Basel, Switzerland). Glucose, triglyceride, total
More informationEarly life determinants of Non-Alcoholic Fatty Liver Disease and NASH DR JULIANA MUIVA-GITOBU KENYA PAEDIATRIC ASSOCIATION CONFERENCE APRIL 2016.
Early life determinants of Non-Alcoholic Fatty Liver Disease and NASH DR JULIANA MUIVA-GITOBU KENYA PAEDIATRIC ASSOCIATION CONFERENCE APRIL 2016. Outline Definition NAFLD and NASH Magnitude of the problem
More informationFatty Liver Disease A growing epidemic
Fatty Liver Disease A growing epidemic Updates in GIM for Primary Care Don C. Rockey March 9 th, 2018 Disclosures 2018 Research Funding (all to MUSC) NIH/NIDDK Actelion Pharmaceuticals Gilead Sciences
More informationUpdate on Nonalcoholic Fatty Liver Disease. Kathleen E Corey, MD, MPH, MMSc Director, Mass General Fatty Liver Clinic
Update on Nonalcoholic Fatty Liver Disease Kathleen E Corey, MD, MPH, MMSc Director, Mass General Fatty Liver Clinic Outline Defining the phenotypes of nonalcoholic fatty liver disease NAFLD Diagnostics
More informationWhat is NAFLD?.NASH? Presenter Disclosure Information. Learning Objectives. Case 1: Rob. Questions Pertinent to Rob
Presenter Disclosure Information 5 6pm Nonalcoholic Fatty Liver Disease (NAFLD): Another Obesity-Related Epidemic SPEAKER Elliot Tapper, MD The following relationships exist related to this presentation:
More informationOriginal Article. Significance of Hepatic Steatosis in Chronic Hepatitis B Infection INTRODUCTION
Original Article Bhanthumkomol P, et al. THAI J GASTROENTEROL 2013 Vol. 14 No. 1 Jan. - Apr. 2013 29 Bhanthumkomol P 1 Charatcharoenwitthaya P 1 Pongpaiboon A 2 ABSTRACT Background: Significance of liver
More informationFat, ballooning, plasma cells and a +ANA. Yikes! USCAP 2016 Evening Specialty Conference Cynthia Guy
Fat, ballooning, plasma cells and a +ANA. Yikes! USCAP 2016 Evening Specialty Conference Cynthia Guy Goals Share an interesting case Important because it highlights a common problem that we re likely to
More informationNASH : Diagnosis and investigation. VII Workshop international, Curitiba, Brazil 29/08/2014
NASH : Diagnosis and investigation VII Workshop international, Curitiba, Brazil 29/08/2014 Vlad Ratziu, Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France Usual diagnostic circumstances
More informationNON-ALCOHOLIC STEATOHEPATITIS AND NON-ALCOHOLIC FATTY LIVER DISEASES
NON-ALCOHOLIC STEATOHEPATITIS AND NON-ALCOHOLIC FATTY LIVER DISEASES Preface Zobair M. Younossi xiii Epidemiology and Natural History of NAFLD and NASH 1 Janus P. Ong and Zobair M. Younossi Understanding
More informationNAFLD and NASH: The Not-So-New Kids on the Block
NAFLD and NASH: The Not-So-New Kids on the Block Mary E. Rinella, MD Associate Professor of Medicine Feinberg School of Medicine Northwestern University Chicago, Illinois This program is supported by an
More informationDesign and Validation of a Histological Scoring System for Nonalcoholic Fatty Liver Disease
Design and Validation of a Histological Scoring System for Nonalcoholic Fatty Liver Disease David E. Kleiner, 1 Elizabeth M. Brunt, 2 Mark Van Natta, 3 Cynthia Behling, 4 Melissa J. Contos, 5 Oscar W.
More informationNONALCOHOLIC FATTY LIVER DISEASE
NONALCOHOLIC FATTY LIVER DISEASE Kiran Bambha, MD, MSc Hepatology and Liver Transplantation University of Colorado Denver April 13, 2012 Non-Alcoholic Fatty Liver Disease (NAFLD) Terminology Pathogenesis
More informationImproving Access to Quality Medical Care Webinar Series
Improving Access to Quality Medical Care Webinar Series Presented by The Arizona Telemedicine Program and the Southwest Telehealth Resource Center 2015 UA Board of Regents Welcome AZ, UT, CO, NM & NV FLEX
More informationThe role of non-invasivemethods in evaluating liver fibrosis of patients with non-alcoholic steatohepatitis
The role of non-invasivemethods in evaluating liver fibrosis of patients with non-alcoholic steatohepatitis Objectives: Liver biopsy is the gold standard for diagnosing the extent of fibrosis in NAFLD/NASH;
More informationLIVER, PANCREAS, AND BILIARY TRACT
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2012;10:1028 1033 LIVER, PANCREAS, AND BILIARY TRACT Prevalence and Indicators of Portal Hypertension in Patients With Nonalcoholic Fatty Liver Disease FLAVIA D.
More informationThe effect of aerobic exercise on serum level of liver enzymes and liver echogenicity in patients with non-alcoholic fatty liver disease
Gastroenterology and Hepatology From Bed to Bench. 2013 RIGLD, Research Institute for Gastroenterology and Liver Diseases ORIGINAL ARTICLE The effect of aerobic exercise on serum level of liver enzymes
More informationLiver biopsy as the gold standard for diagnosis. Pierre BEDOSSA
Liver biopsy as the gold standard for diagnosis Pierre BEDOSSA 1 PATHOLOGY OF NAFLD CONFLICTS OF INTEREST Grants and funding from Genfit, Intercept, Allergan, Inventiva, OWL, Echosens CEO and funding of
More informationCase #1. Digital Slides 11/6/ year old woman presented with abnormal liver function tests. Liver Biopsy to r/o autoimmune hepatitis
45 year old woman presented with abnormal liver function tests Liver Biopsy to r/o autoimmune hepatitis Further down. ANA 1: 160; ASMA 1:80 ANA 1: 160; ASMA 1:80 IgG = 14.5 g/l (upper normal range: 16)
More informationNAFLD & NASH. Naga Chalasani, MD, FACG Professor of Medicine and Cellular & Integrative Physiology Director, Division of GI and Hepatology
NAFLD & NASH Naga Chalasani, MD, FACG Professor of Medicine and Cellular & Integrative Physiology Director, Division of GI and Hepatology Indiana University School of Medicine ACG Midwest Regional Course,
More informationNew insights into fatty liver disease. Rob Goldin Centre for Pathology, Imperial College
New insights into fatty liver disease Rob Goldin Centre for Pathology, Imperial College r.goldin@imperial.ac.uk Prevalence of NASH Global prevalence of NAFLD is 25% with highest prevalence in the Middle
More informationAmerican Journal of Oral Medicine and Radiology
American Journal of Oral Medicine and Radiology e - ISSN - XXXX-XXXX ISSN - 2394-7721 Journal homepage: www.mcmed.us/journal/ajomr PREVALENCE OF NONALCOHOLIC FATTY LIVER DISEASE AMONG TYPE 2 DIABETIC POPULATION
More informationNormal ALT for men 30 IU/L 36% US males abnormal. Abnl ALT. Assess alcohol use/meds. Recheck in 6-8 weeks. still pos
Fatty liver disease Its not just for big boys anymore Ken Flora, MD, FAASLD, FACG, AGAF No disclosures Common situation Normal ALT for men 30 IU/L 36% US males abnormal Normal ALT for women 20 IU/L 28%
More informationBackground of the FIB-4 Index in Japanese Non-Alcoholic Fatty Liver Disease
ORIGINAL ARTICLE Background of the FIB-4 Index in Japanese Non-Alcoholic Fatty Liver Disease Takashi Wada and Mikio Zeniya Abstract Objective We investigated the distribution and characteristics of the
More informationNonalcoholic Fatty Liver Disease in Children: Typical and Atypical
Nonalcoholic Fatty Liver Disease in Children: Typical and Atypical Disclosure Naim Alkhouri, MD discloses the following relationships with commercial companies: Membership in the Speakers Bureau for Alexion
More informationLaboratory analysis of the obese child recommendations and discussion. MacKenzi Hillard May 4, 2011
Laboratory analysis of the obese child recommendations and discussion MacKenzi Hillard May 4, 2011 aka: What to do with Fasting Labs The Obesity Epidemic The prevalence of obesity in adolescents has tripled
More informationDietary supplementation in treating non-alcoholic fatty liver disease Dr. Ahmad Saedi Associate Professor School of Nutritional Sciences and
Dietary supplementation in treating non-alcoholic fatty liver disease Dr. Ahmad Saedi Associate Professor School of Nutritional Sciences and Dietetics Tehran University of Medical Sciences Honorary Academic
More informationDisclosure. Objectives. Smash the Nash: A practical approach to fatty liver disease
Smash the Nash: A practical approach to fatty liver disease Bruce D. Askey, MS, ANP-BC Associate Lecturer North Andover, MA Adult Nurse Practitioner Dept. of Hepatology/Gastroenterology Guthrie Clinic
More informationNon alcoholic fatty liver and Non alcoholic Steatohepatitis. By Dr. Seham Seif
Non alcoholic fatty liver and Non alcoholic Steatohepatitis By Dr. Seham Seif Definition NAFL describe a common clinicopathological conditions characterized by significant lipid deposition in the hepatocytes
More informationBasic patterns of liver damage what information can a liver biopsy provide and what clinical information does the pathologist need?
Basic patterns of liver damage what information can a liver biopsy provide and what clinical information does the pathologist need? Rob Goldin r.goldin@imperial.ac.uk Fatty liver disease Is there fatty
More informationNon-Alcoholic Steatohepatitis (NASH): What the Gastroenterologist Should Know
Non-Alcoholic Steatohepatitis (NASH): What the Gastroenterologist Should Know Naga P. Chalasani, MD, FACG Professor of Medicine and Cellular & Integrative Physiology Director, Division of GI and Hepatology
More informationEASL EASD EASO Clinical practice guidelines for the management of nonalcoholic fatty liver disease.
Commentary. EASL EASD EASO Clinical practice guidelines for the management of nonalcoholic fatty liver disease. Christopher D. Byrne 1,2, Giovanni Targher 3 1 Nutrition and Metabolism, Faculty of Medicine,
More informationNON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) NON-ALCOHOLIC STEATOHEPATITIS (NASH) ADDRESSING A GROWING SILENT EPIDEMIC
NON-ALCOHOLIC FATTY LIVER DISEASE () & NON-ALCOHOLIC STEATOHEPATITIS () ADDRESSING A GROWING SILENT EPIDEMIC PREVALENCE OF / USA Prevalence in Middle Age Patients San Antonio, Texas (Williams et al., Gastroenterology
More informationNAFLD & NASH: Russian perspective
NAFLD & NASH: Russian perspective Vasily Isakov, MD, PhD Professor, Chief, Department Gastroenterology & Hepatology, Federal Research Center of nutrition, biotechnology and food safety Disclosures Received
More informationNon-Alcoholic Fatty Liver Disease An Update
Non-Alcoholic Fatty Liver Disease An Update Stefan Hübscher, School of Cancer Sciences, University of Birmingham Dept of Cellular Pathology, Queen Elizabeth Hospital, Birmingham First described in 1980
More informationNon-Alcoholic Fatty Liver Disease
Non-Alcoholic Fatty Liver Disease Varun Saxena, MD MAS Gastroenterology and Hepatology Kaiser Permanente South San Francisco Assistant Clinical Professor University of California San Francisco January
More informationEvaluating Obese Persons With Abnormal Liver Chemistries
Mary E. Rinella, MD, FAASLD Evaluating Obese Persons With Abnormal Liver Chemistries Postgraduate Course: Challenges in Management of Common Liver Diseases 275 1 25 year old obese Hispanic man with obesity,
More informationNON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) NON-ALCOHOLIC STEATOHEPATITIS (NASH) ADDRESSING A GROWING SILENT EPIDEMIC
NON-ALCOHOLIC FATTY LIVER DISEASE () & NON-ALCOHOLIC STEATOHEPATITIS () ADDRESSING A GROWING SILENT EPIDEMIC PREVALENCE OF / USA Prevalence in Middle Age Patients San Antonio, Texas (Williams et al., Gastroenterology
More informationFatty Liver Disease. Mark Thursz. Imperial College
Fatty Liver Disease Mark Thursz Imperial College Non-Alcoholic Fatty Liver Disease UK adult obesity (BMI>30) 1980: 6% [M], 8% [F]. 1997: 17% [M], 20% [F]. By 2004, 23.6% of men and 23.8% of women were
More informationNon-Alcoholic Fatty Liver Diseasean underestimated epidemic
Non-Alcoholic Fatty Liver Diseasean underestimated epidemic Amir Shlomai MD,PhD Head, Department of Medicine D The Liver Institute Rabin Medical Center, Beilinson Hospital The IASLD semi-annual meeting-
More informationLipid and Bile Acids as NAFLD- Related Biomarkers
Lipid and Bile Acids as NAFLD- Related Biomarkers Puneet Puri, MBBS, MD Division of Gastroenterology, Hepatology and Nutrition Virginia Commonwealth University, Richmond, VA 1st International Workshop
More informationNICE guideline Published: 6 July 2016 nice.org.uk/guidance/ng49
Non-alcoholic fatty liver disease (NAFLD): assessment and management NICE guideline Published: 6 July 20 nice.org.uk/guidance/ng49 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationAssessment of Liver Stiffness by Transient Elastography in Diabetics with Fatty Liver A Single Center Cross Sectional observational Study
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 6 Ver. IV (June. 2017), PP 49-53 www.iosrjournals.org Assessment of Liver Stiffness by Transient
More informationPREVALENCE OF NAFLD & NASH
- - PREVALENCE OF & USA Prevalence in Middle Age Patients San Antonio, Texas (Williams et al., Gastroenterology 2011; 140:124-31) Dallas Heart Study Prevalence Numbers (Browning et al., Hepatology 2004;40:1387-95)
More informationPHC, Paris, 30th Jan 2017 PATHOLOGY OF NAFLD. Pierre Bedossa. Departement of Pathology Hôpital Beaujon University Paris-Diderot Paris - FRANCE
PHC, Paris, 30th Jan 2017 PATHOLOGY OF NAFLD Pierre Bedossa Departement of Pathology Hôpital Beaujon University Paris-Diderot Paris - FRANCE 1 PATHOLOGY OF NAFLD NAFLD: a chronic liver disease with a wide
More informationPreface: Nonalcoholic Fatty Liver Disease: An Expanding Health Care Epidemic
NASH and NAFLD Preface: Nonalcoholic Fatty Liver Disease: An Expanding Health Care Epidemic David E. Bernstein xiii Clinical and Economic Burden of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis
More informationFDA Introductory Remarks Stephanie O. Omokaro, MD
FDA Introductory Remarks Stephanie O. Omokaro, MD Division of Gastroenterology & Inborn Errors Products (DGIEP) Center for Drug Evaluation and Research Office of New Drugs Office of Drug Evaluation III
More informationNonalcoholic fatty liver disease (NAFLD) is the most common
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2008;6:1249 1254 Cytokeratin 18 Fragment Levels as a Noninvasive Biomarker for Nonalcoholic Steatohepatitis in Bariatric Surgery Patients DIMA L. DIAB,* LISA YERIAN,
More informationPrevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus patients in a tertiary care hospital of Bihar
Original Research Article Prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus patients in a tertiary care hospital of Bihar Naresh Kumar 1, Jyoti Kumar Dinkar 2*, Chandrakishore
More informationUsefulness of Magnetic Resonance Imaging for the Diagnosis of Hemochromatosis with Severe Hepatic Steatosis in Nonalcoholic Fatty Liver Disease
CASE REPORT Usefulness of Magnetic Resonance Imaging for the Diagnosis of Hemochromatosis with Severe Hepatic Steatosis in Nonalcoholic Fatty Liver Disease Yuichi Nozaki 1,NorikoSato 2, Tsuyoshi Tajima
More informationPathology of Fatty Liver Disease
1 Fatty Liver Disease - Causes Pathology of Fatty Liver Disease Role of Liver Biopsy in (Non-Alcoholic) Fatty Liver Disease Stefan Hübscher, Institute of Immunology & Immunotherapy, University of Birmingham
More informationA Modification of the Brunt System for Scoring Liver Histology of Patients with Non-Alcoholic Fatty Liver Disease
Arch Iran Med 2010; 13 (1): 38 44 Original Article A Modification of the Brunt System for Scoring Liver Histology of Patients with Non-Alcoholic Fatty Liver Disease Shahin Merat MD*, Farzaneh Khadem-Sameni
More informationNAFLD: US GUIDELINES. US Guidelines for NAFLD
NAFLD: US GUIDELINES Arun J Sanyal M.D. Charles Caravati Professor of Medicine Virginia Commonwealth University School of Medicine US Guidelines for NAFLD Represents consensus amongst AGA, AASLD and ACG
More informationPostmenopausal women are at an increased risk
AMERICAN ASSOCIATION FOR THE STUDY OFLIVERD I S E ASES HEPATOLOGY, VOL. 64, NO. 1, 2016 A Longer Duration of Estrogen Deficiency Increases Fibrosis Risk Among Postmenopausal Women With Nonalcoholic Fatty
More information2 nd International Workshop on NASH Biomarkers, Washington DC, May 5-6, 2017
Hepatic Proton Density Fat Fraction Correlates With Histologic Measures of Steatosis and Is Responsive to Changes in Those Measures in a Multi-center Nonalcoholic Steatohepatitis Clinical Trial Michael
More informationEffect of lifetime alcohol consumption on the histological severity of non-alcoholic fatty liver disease
Liver International ISSN 1478-3223 METABOLIC AND STEATOHEPATITIS Effect of lifetime alcohol consumption on the histological severity of non-alcoholic fatty liver disease Hellan K. Kwon 1, Joel K. Greenson
More informationNAFLD: evidence-based management. Curso de residentes AEEH Salvador Augustin, MD Liver Unit Vall d Hebron Hospital Barcelona, Spain
NAFLD: evidence-based management Curso de residentes AEEH 2017 Salvador Augustin, MD Liver Unit Vall d Hebron Hospital Barcelona, Spain Clinical case - 55 yo female - Sent for incidental steatosis at abdominal
More informationCirrhosis Secondary to Nonalcoholic Fatty Liver Disease
Proceedings of UCLA Healthcare -VOLUME 19 (2015)- CLINICAL VIGNETTE Cirrhosis Secondary to Nonalcoholic Fatty Liver Disease Amruti Borad, D.O., and Michelle Sangalang, M.D. Introduction Primary care physicians
More informationThe role of ARFI and APRI in diagnosis of liver fibrosis on patients with common chronic liver diseases
RESEARCH ARTICLE The role of ARFI and APRI in diagnosis of liver fibrosis on patients with common chronic liver diseases Objective: This study aimed to investigate the value of liver fibrosis assessment
More informationThe Skinny On Non Alcoholic Fatty Liver Disease
The Skinny On Non Alcoholic Fatty Liver Disease UCSF Advances in Internal Medicine Monika Sarkar, MD, MAS UCSF Division of GI/Hepatology June 24th, 2015 Non Alcoholic Fatty Liver Disease: Outline Pathogenesis
More informationM30 Apoptosense ELISA. A biomarker assay for detection and screening of NASH
M30 Apoptosense ELISA A biomarker assay for detection and screening of NASH NASH A Global Disease In the Western countries, Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common liver disease, strongly
More informationPathology of Non-Alcoholic Fatty Liver Disease
The Hong Kong College of Pathologists, Incorporated in Hong Kong with Limited Liability Volume 10, Issue 1 January 2015 Editorial note: Non-alcoholic fatty liver disease (NAFLD) is the commonest metabolic
More informationNonalcoholic Fatty Liver Disease: Pros and Cons of Histologic Systems of Evaluation
International Journal of Molecular Sciences Review Nonalcoholic Fatty Liver Disease: Pros and Cons of Histologic Systems of Evaluation Elizabeth M. Brunt Received: 15 December 2015; Accepted: 7 January
More informationEFFECT OF ORAL SUPPLEMENTATION OF WHEY PROTEIN ISOLATE ON NON-ALCOHOLIC STEATOHEPATITIS PATIENTS
42 EFFECT OF ORAL SUPPLEMENTATION OF WHEY PROTEIN ISOLATE ON NON-ALCOHOLIC STEATOHEPATITIS PATIENTS Prasong Tienboon MD, PhD. 1, Taned Chitapanarux MD. 2, Suwalee Pojchamarnwiputh MD. 3, Donrawee Leelarungrayub
More informationNON-ALCOHOLIC FATTY LIVER DISEASE:
NON-ALCOHOLIC FATTY LIVER DISEASE: ROLE OF THE PRIMARY PROVIDER Archita P. Desai, MD Assistant Professor of Medicine University of Arizona 25 th Annual Southwestern Conference on Medicine Outline Pathophysiology
More informationNon-Alcoholic Fatty Liver Disease (NAFLD)
HEPATO-PANCREATO-BILIARY STOMACH CANCER PROGRAM Non-Alcoholic Fatty Liver Disease (NAFLD) Steatosis and Non-Alcoholic Steatohepatitis (NASH) Management Recommendations UCSF Fresno Department of Surgery
More informationLiver disease is a major cause of mortality and morbidity
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2011;9:524 530 Changes in the Prevalence of the Most Common Causes of Chronic Liver Diseases in the United States From 1988 to 2008 ZOBAIR M. YOUNOSSI,*, MARIA
More informationFATTY LIVER DISEASE (NAFLD) (NASH) A GROWING
NON ALCOHOLIC FATTY LIVER DISEASE () & NON ALCOHOLIC S T E ATO H E PAT I T I S () ADDRESSING A GROWING SILENT EPIDEMIC Prevalence of & USA Prevalence in Middle Age Patients San Antonio, Texas (Williams
More informationThe classical metabolic work-up, approved by the Ethics Committee of the Antwerp
SUPPLEMENTARY MATERIALS METHODS Metabolic work-up The classical metabolic work-up, approved by the Ethics Committee of the Antwerp University Hospital and requiring written informed consent, included a
More informationNASH PROGRESS IN THE LAST DECADE
PROGRESS IN THE LAST DECADE Mitchell L. Shiffman, MD, FACG Director Health System Richmond and Newport News, VA Medical Group Good Help to Those in Need A GLOBAL HEALTH PROBLEM Nigeria Australia Spain
More informationNew Discriminant Method for Identifying the Aggressive Disease Phenotype of Non-alcoholic Fatty Liver Disease
ORIGINAL ARTICLE New Discriminant Method for Identifying the Aggressive Disease Phenotype of Non-alcoholic Fatty Liver Disease Yusuke Kawamura 1,2, Kenji Ikeda 1,2, Yasuji Arase 1,2, Shunichiro Fujiyama
More informationFatty liver disease: What do we know?
Fatty liver disease: What do we know? Prof. Dr. Claus Niederau Katholische Kliniken Oberhausen ggmbh St. Josef-Hospital Academic Teaching Hospital University of Duisburg-Essen NAFLD Non-Alcoholic Fatty
More informationWORLDWIDE EPIDEMIOLOGY OF NASH
WORLDWIDE EPIDEMIOLOGY OF NASH Stefano Bellentani, M.D., Ph.D. Chief of Gastroenterology and Hepatology Service Clinica Santa Chiara Locarno Switzerland & Fondazione Italiana Fegato (FIF), Bassovizza (Trieste),
More informationNon-Alcoholic Fatty Liver Disease
Non-Alcoholic Fatty Liver Disease None Disclosures Arslan Kahloon M.D Chief, Division of Gastroenterology and Hepatology University of Tennessee College of Medicine Chattanooga Objectives Understand the
More informationFREQUENCY OF NON ALCOHOLIC FATTY LIVER DISEASE (NAFLD) AND ITS BIOCHEMICAL DERANGEMENTS IN TYPE II DIABETIC PATIENTS
FREQUENCY OF NON ALCOHOLIC FATTY LIVER DISEASE (NAFLD) AND ITS BIOCHEMICAL DERANGEMENTS IN TYPE II DIABETIC PATIENTS DR. ABDUL JABBAR, MBBS DR. ABDUL BASIT, MBBS DR. HAFIZ MUHAMMAD HANNAN AKBAR, MBBS ABSTRACT
More informationNon-alcoholic fatty liver disease
Non-alcoholic fatty liver disease Link to this article online for CPD/CME credits Naveed Sattar, 1 Ewan Forrest, 2 David Preiss 1 1 BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow
More informationEVALUATION OF ABNORMAL LIVER TESTS
EVALUATION OF ABNORMAL LIVER TESTS MIA MANABAT DO PGY6 MOA 119 TH ANNUAL SPRING SCIENTIFIC CONVENTION MAY 19, 2018 EVALUATION OF ABNORMAL LIVER TESTS Review of liver enzymes vs liver function tests Clinical
More informationWhat to do about the high ALT picked up at the annual review. Dr Michael Yee Consultant in Diabetes and Endocrinology
What to do about the high ALT picked up at the annual review Dr Michael Yee Consultant in Diabetes and Endocrinology Mrs DC HPC PMH Type 2 Diabetes (decades) Regular retinal screening No foot complications/neuropathy
More informationPITFALLS IN THE DIAGNOSIS OF MEDICAL LIVER DISEASE WITH TWO CONCURRENT ETIOLOGIES I HAVE NOTHING TO DISCLOSE CURRENT ISSUES IN ANATOMIC PATHOLOGY 2017
CURRENT ISSUES IN ANATOMIC PATHOLOGY 2017 I HAVE NOTHING TO DISCLOSE Linda Ferrell PITFALLS IN THE DIAGNOSIS OF MEDICAL LIVER DISEASE WITH TWO CONCURRENT ETIOLOGIES Linda Ferrell, MD, UCSF THE PROBLEM
More informationSAF score and mortality in NAFLD after up to 41 years of follow-up
SAF score and mortality in NAFLD after up to 41 years of follow-up Hannes Hagström, Patrik Nasr, Mattias Ekstedt, Stergios Kechagias, Per Stal, Pierre Bedossa and Rolf Hultcrantz Journal Article N.B.:
More information/ FIB4 Index , simple steatosis. FIB4 Index. FIB4 Index. FIB4 Index FIB4 Index. Sterling FIB4 Index. FIB4 Index AST AST ALT
原 著 29 34-41, 2014 FIB4 Index 1 1 1 1 2 1 1 FIB4 Index FIB4 Index cut off 2.67 2.67 12,059 FIB4 IndexFIB4 Index 2.67 / FIB4 Index AST ALT FIB4 Index 2.67 161 1.3% FIB4 Index 5 FIB4 Index 1.1 5 1.6 FIB4
More informationFirst European NAFLD-NASH Summit European Parliament, Brussels, May 31 st NAFLD/NASH : an expanding burden on liver health
First European NAFLD-NASH Summit European Parliament, Brussels, May 31 st 2017 NAFLD/NASH : an expanding burden on liver health Vlad Ratziu, Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière,
More informationEnd Stage Liver Disease & Disease Specific Indications for Liver Transplant. Susan Kang, RN, MSN, ANP-BC
End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP-BC Introduction (https://www.srtr.org) What does the liver do? STORAGE METABOLIC DETOXIFICATION SYNTHETIC
More informationEnd Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC
End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC Introduction (https://www.srtr.org) 1 What does the liver do? STORAGE METABOLIC DETOXIFICATION SYNTHETIC
More informationLIVER PATHOLOGY. Thursday 28 th November 2013
LIVER PATHOLOGY Thursday 28 th November 2013 Liver biopsy assessment of steatosis Amar Paul Dhillon Royal Free Hospital RIBA, London Thursday 28th November 2013 NAFLD didn t exist before 2001 and liver
More informationSerum Levels of CK18 M30 and Leptin Are Useful Predictors of Steatohepatitis and Fibrosis in Paediatric NAFLD
ORIGINAL ARTICLE: HEPATOLOGY AND NUTRITION Serum Levels of CK18 M30 and Leptin Are Useful Predictors of Steatohepatitis and Fibrosis in Paediatric NAFLD Emer Fitzpatrick, y Ragai R. Mitry, y Alberto Quaglia,
More informationPrognosis of NASH VII Workshop Intenracional de Actualizaçao em Hepatologia, Aug 29th 2014
Prognosis of NASH VII Workshop Intenracional de Actualizaçao em Hepatologia, Aug 29th 2014 Vlad Ratziu, Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France NASH : a severe hepatic
More informationPancreatic exocrine insufficiency: a rare cause of nonalcoholic steatohepatitis
Pancreatic exocrine insufficiency: a rare cause of nonalcoholic steatohepatitis Naoki Tanaka 1, Akira Horiuchi 2, Takahide Yokoyama 3, Shigeyuki Kawa 1, and Kendo Kiyosawa 1 1 Department of Gastroenterology,
More informationTreatment of NASH: What Helps Beyond Weight Loss?
THE RED SECTION 821 see related editorial on page x Treatment of NASH: What Helps Beyond Weight Loss? Bubu A. Banini, MD, PhD1 and Arun J. Sanyal, MBBS, MD1 Am J Gastroenterol 2017; 112:821 824; doi: 10.1038/ajg.2017.83;
More information