Non-Alcoholic Fatty Liver Disease (NAFLD)

Transcription

1 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 at Community Regional Medical Center

2 FACTS: Hepatocellular Carcinoma (HCC) is the third leading cause of cancer death in the USA with steadily increasing incidence. NAFLD synergistically with other risk factors like diabetes and obesity is becoming the most common cause of HCC in developed countries. Relationships between steatosis, steatohepatitis, cirrhosis and HCC are not necessarily linear. Considerable numbers of NAFLD-associated HCC cases develop in non-cirrhotic livers. American Gastroenterological Association Technical Review on Nonalcoholic Fatty Liver Disease, states: physicians should actively check for the presence of NAFLD in those who are overweight and/or diabetic. Obesity Metabolic Syndrome Diabetic Mellitus Steatosis Steatohepatitis Cirrhosis NAFLD Hepatocellular Carcinoma (HCC) Modified from: Baffy G, Brunt EM, Caldwell SH. Hepatocellular carcinoma in nonalcoholic fatty liver disease: An emerging menace. Journal of hepatology 2012.

3 DIAGNOSIS: Laboratory Evaluation: Liver function tests, Fasting Serum Glucose, as well as Lipid panel should be checked. Mild to moderate elevation of serum levels of aminotransferases, alkaline phosphatase and g-glutamyl transpeptidase levels are most commonly found. Imaging: Steatosis of liver could be evaluated by multiple modalities such as Liver Ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) studies, especially the new techniques of MRI are more sensitive modalities for quantifying steatosis and inflammation. Liver Biopsy: Is the gold standard for determining the presence of steatosis, distinguishing steatosis from steatohepatitis, and assessing the degree of fibrosis

4 MANAGEMENT: 1. Weight Loss: A reasonable goal for many patients is to lose 1 to 2 lb/week. 2. Vaccination: Hepatitis A and B vaccinations should be given to patients without serologic evidence of immunity. 3. Antioxidants: Vitamin E is recommended (400 international units/day). 4. Insulin-Sensitizing Therapy in Diabetic patients: Metformin is associated with lower mortality in diabetic patients with early stage HCC. 5. Lipid-Lowering Drugs: Omega-3 Fatty acids are associated with improvement in hepatic steatosis. 6. Consult a liver expert, to determine the best diagnostic test, especially in case of abnormal liver function tests. HOW TO REFER Please call FOREGUT. From the time you call our office to the time of treatment, the process will take two weeks. 4

5 SUGGESTED READINGS: Angulo P: Nonalcoholic fatty liver disease. N Engl J Med 2002; 346: Musso G, Gambino R, Cassader M, Paganu G: A meta-analysis of randomized trials for the treatment of nonalcoholic fatty liver disease. Hepatology 2010; 52: Baffy G, Brunt EM, Caldwell SH: Hepatocellular carcinoma in non-alcoholic fatty liver disease: An emerging menace. Journal of hepatology 2012; 56: Sanyal AJ: American Gastroenterological Association: AGA technical review on nonalcoholic fatty liver disease (national guidelines). Gastroenterology 2002; 123: Loria P, Adinolfi LE, Bellentani S et al: Practice guidelines for the diagnosis and management of nonalcoholic fatty disease. Dig Liver Dis 2010; 42:

6 Babak Eghbalieh, M.D. Babak (Bobby) Eghbalieh, M.D., FACS is a board certified surgeon and specializes in General, Advanced Robotic and Laparoscopic (minimally invasive) surgery. He completed his General Surgery residency at the University of California, San Francisco, Fresno and his Pancreatic Surgery training at The Cleveland Clinic, Ohio. Dr. Eghbalieh s interests include Advanced Robotic and Laparoscopic General surgery, Oncologic surgery for the Pancreas, Gallbladder, Hepato-Biliary, Stomach and Foregut, Melanoma, and Retroperitoneal Sarcomas. He serves as the Cancer Liaison Physician (CLP) for the American College of Surgeons - Commission on Cancer for Community Medical Centers cancer program. He is also the Director of Robotic Surgery at Community Regional Medical Center. He is an avid musician, and enjoys traveling around the world. 6

7 Amir Fathi, M.D. Amir Fathi, M.D., is a board certified surgeon and specializes in Hepato- Pancreato-Biliary Surgery. Dr. Fathi completed his General Surgery residency at Case Western Reserve University and a Fellowship in Hepato- Pancreato-Biliary Surgery at the Medical College of Wisconsin. He is also certified in Robotic Surgery. Dr. Fathi s practice includes surgical treatment of the following: primary and metastatic tumors of the Liver, Pancreas, Gallbladder, biliary tree, Stomach and foregut, surgical management of acute and chronic pancreatitis, complex abdominal wall reconstruction, minimally invasive hernia repair as well as General Surgery. In his free time Dr. Fathi enjoys hiking, reading and swimming. Phone: AFathi@Fresno.UCSF.Edu To send SECURE (HIPPA complaint) , please type SECURE in subject line. Example Subject: SECURE Patient Question Subject: SECURE Jane Doe pt #

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