PIERO LUIGI ALMASIO CATTEDRA DI GASTROENTEROLOGIA UNIVERSITA OF PALERMO

Size: px
Start display at page:

Download "PIERO LUIGI ALMASIO CATTEDRA DI GASTROENTEROLOGIA UNIVERSITA OF PALERMO"

Transcription

1 Steatosi e Steatoepatite PIERO LUIGI ALMASIO CATTEDRA DI GASTROENTEROLOGIA UNIVERSITA OF PALERMO

2 Alcoholic liver disease Liver damage resulting from long-term alcohol consumption Histological features: - Mallory bodies - inflammatory neutrophils infiltrate - macrovesicular and/or microvesicular steatosis - fibrosis (ranging from perivascular foci to fibrous septa and cirrhosis) Non-alcoholic Steatohepatitis (NASH) Named by Ludwig in 1980 to identify a disease of liver associated with the pathological features most commonly seen in alcoholic liver disease in patients who had negligible alcohol consumption.

3 Metabolic Pathway to Liver Disease NAFLD & NASH NASH No fat HCC Cirrhosis Fibrosis + Necroinflammation N A F Time Pure Fatty Liver L D

4 Factors Associated with NAFLD PRIMARY NAFLD Metabolic factors Obesity, Diabetes, Hyperglycemia, Hyperlipidemia Rapid weight loss, Acute starvation, i.v. Glucose, TPN SECONDARY NAFLD Surgical procedures Drugs Jejunal by-pass, Gastroplasty, Bilio-pancreatic diversion Extensive small bowel resection Amiodarone, Perhexiline maleate, Glucocorticoids Synthetic estrogens, Tamoxifen Miscellaneous factors Jejunal diverticolosis with bacterial overgrowth Partial lipodystrophy Abetalipoproteinemia

5 Problems in the Diagnosis of Metabolic Liver Disease 1. Diagnosis by exclusion (liver biopsy) 2. High prevalence of associated conditions 3. Frequent association with well-known etiologic agents 4. Slow course 5. Lack of therapeutic options

6 Worldwide Prevalence of Viral Hepatitis & Metabolic Diseases HBV 360 HCV Diabetes Obesity 500 HIV Millions

7 Prevalence of Elevated ALT Levels in US 15,676 adult US citizens (NHANES III) Total prevalence: 7.9% High alcohol consumption, hepatitis B and C infection, and high transferrin saturation were found in 31% The large majority was unexplained Unexplained ALT elevation was associated with high BMI, enlarged waist, increased triglycerides and insulin, low HDL-cholesterol (+ type 2 DM and hypertension in females) Alcohol HCV HFE HBV 2+ Clark et al, Am J Gastroenterol 2003

8 Risk Factors for Steatosis in Italy The prevalence of steatosis increases in heavy drinkers (46%) and obesity (76%), compared with controls (16%) All cases vs. Heavy Drinkers vs. Obesity 16% Controls Heavy Drinkers Obesity Obesity + Alcohol Steatosis was exceedingly common in heavy drinkers with obesity (94%) Obesity increased the risk compared with heavy drinkers, whereas alcohol further increased the risk when added to obesity Elevated ALT and triglycerides are marker of steatosis Bellentani et al, Ann Intern Med 2000

9 NAFLD in Obesity and Diabetes Steatosis NASH Lean Obese Diabetes Reviewed by Neuschwander & Caldwell, Hepatology 2003

10 HOMA-Insulin Resistance and BMI 7.0 Insulin Resistance (%) (Nonalcoholic fatty liver; r = 0.08) (Controls; r = 0.38) Body Mass Index (kg/m 2 ) Marchesini et al, Am J Med 1999

11 Non-alcoholic Steatohepatitis Criteria for diagnosis Rigorous exclusion of alcohol consumption - detailed personal history - interrogation of family members - biochemical markers (?) - GGT values, MCV, AST/ALT ratio - desialylated transferrin, mitochondrial isoenzyme of AST Absence of: - serologic evidence of HBV and/or HCV infection - clinical and/or laboratory features of autoimmune hepatitis and metabolic liver diseases.

12 Laboratory Mild elevation of AST and ALT (>1.5x) ALT > AST (if AST>ALT, then fibrosis or cirrhosis) Hyperglycemia (caused by DM present in 1/3 of cases) Hyperlipidemia (mainly raised triglycerides) in 20-25% 25% Abnormal iron indices (common, but do not indicate genetic Hemochromatosis) Neuschwander and Caldwell, Hepatology 2003

13 Criteria for diagnosis: histology Liver biopsy that shows - macrovesicular fatty degeneration (steatosis) - portal and/or lobular inflammation with or without - Mallory (hyaline) bodies - ballooning degeneration - fibrosis (grade 1-3) or cirrhosis

14

15

16

17

18

19

20

21

22 Non-alcoholic Steatohepatitis Therapeutic Options Weight loss Adequate diet for hyperlipidemia Drug treatment of hyperlipidemia Correct therapy of diabetes? Ursodeoxycholic acid? Anti-oxidants drugs Vitamin E Glutathione? Insulin-sensitizing sensitizing agents Metformin? Phlebothomy (iron overload)

Abnormal Liver Tests and Fatty Liver Disease

Abnormal Liver Tests and Fatty Liver Disease Abnormal Liver Tests and Fatty Liver Disease Michael D Voigt MD Medical Director Liver Failure and Transplantation, University of Iowa Hospital and Clinics Conflict of interest: I sadly have nothing to

More information

Management of Complications of NASH: When to Biopsy? How to Treat? Assistant Professor University of Pittsburgh Medical Center.

Management of Complications of NASH: When to Biopsy? How to Treat? Assistant Professor University of Pittsburgh Medical Center. Management of Complications of NASH: When to Biopsy? How to Treat? Alison Jazwinski, MD, MHS Assistant Professor University of Pittsburgh Medical Center Clinical Case 31 yo female referred for evaluation

More information

Alcoholic and Non-Alcoholic Fatty Liver Disease

Alcoholic and Non-Alcoholic Fatty Liver Disease Alcoholic and Non-Alcoholic Fatty Liver Disease Thomas W. Faust, M.D., M.B.E. Professor of Clinical Medicine Division of Gastroenterology The University of Pennsylvania Alcoholic Liver Disease Additional

More information

Non-alcoholic Fatty Liver Disease. Christi Matteoni, MD GI Consultants

Non-alcoholic Fatty Liver Disease. Christi Matteoni, MD GI Consultants Non-alcoholic Fatty Liver Disease Christi Matteoni, MD GI Consultants Definition of NAFLD Evidence of hepatic steatosis by imaging or histology No causes for secondary hepatic fat accumulation Significant

More information

Learning Objectives. Non-alcoholic Fatty Liver Disease (NAFLD) (Fatty Liver) What is Fatty Liver (Non-Alcoholic Fatty Liver)? Fatty Liver (NAFLD)

Learning Objectives. Non-alcoholic Fatty Liver Disease (NAFLD) (Fatty Liver) What is Fatty Liver (Non-Alcoholic Fatty Liver)? Fatty Liver (NAFLD) Learning Objectives Non-alcoholic Fatty Liver Disease (NAFLD) (Fatty Liver) Smruti R. Mohanty, MD, MS Assistant Professor of Medicine Center for Liver Diseases Section of Gastroenterology University of

More information

Fatty Liver Disease Diagnostic Challenges & Updates

Fatty Liver Disease Diagnostic Challenges & Updates Definitions Fatty Liver Disease Diagnostic Challenges & Updates Ryan M. Gill Current Issues 2014 NAFLD Fat in the liver (imaging or histology) in a patient without secondary fat accumulation. NASH-NAFLD

More information

Treatment and Management of NAFLD. Amanda Camp Wieland Fellow in Gastroenterology May 11, 2013

Treatment and Management of NAFLD. Amanda Camp Wieland Fellow in Gastroenterology May 11, 2013 Treatment and Management of NAFLD Amanda Camp Wieland Fellow in Gastroenterology May 11, 2013 Learning Objectives: Summarize the current epidemiology and natural history of Nonalcoholic Fatty Liver Disease

More information

Fatty Liver Disease Diagnostic Challenges & Updates. Ryan M. Gill

Fatty Liver Disease Diagnostic Challenges & Updates. Ryan M. Gill Fatty Liver Disease Diagnostic Challenges & Updates Ryan M. Gill Current Issues 2014 Definitions NAFLD Fat in the liver (imaging or histology) in a patient without secondary fat accumulation. NASH NAFLD

More information

NASH: It is not JUST a Fatty Liver. Karen F. Murray, M.D. Director of Hepatobiliary Program Children s Hospital and Regional Medical Center

NASH: It is not JUST a Fatty Liver. Karen F. Murray, M.D. Director of Hepatobiliary Program Children s Hospital and Regional Medical Center NASH: It is not JUST a Fatty Liver Karen F. Murray, M.D. Director of Hepatobiliary Program Children s Hospital and Regional Medical Center Stages of Fatty Liver Disorders Fatty Liver 16-35% of Western

More information

Steatohepatitis Grading. Bile Duct Lesions

Steatohepatitis Grading. Bile Duct Lesions Common Problems in Hepatopathology Steatohepatitis Grading & Bile Duct Lesions Larry Burgart, MD Abbott NW Hospital, Minneapolis University of Minnesota Inflammatory Liver Disease Lawrence Burgart, M.D.

More information

Non-alcoholic Fatty liver disease in children. Dr.S.Venkatesh Karthik Consultant Paediatric Hepatologist KTP-NUCMI, NUH, Singapore

Non-alcoholic Fatty liver disease in children. Dr.S.Venkatesh Karthik Consultant Paediatric Hepatologist KTP-NUCMI, NUH, Singapore Non-alcoholic Fatty liver disease in children Dr.S.Venkatesh Karthik Consultant Paediatric Hepatologist KTP-NUCMI, NUH, Singapore Relevance Leading cause of chronic liver disease- both adults and children

More information

Approach to Identification and Treatment of Alcoholic & Non- Alcoholic Fatty Liver Disease

Approach to Identification and Treatment of Alcoholic & Non- Alcoholic Fatty Liver Disease Approach to Identification and Treatment of Alcoholic & Non- Alcoholic Fatty Liver Disease Kimberly A. Forde, MD Assistant Professor of Medicine Division of Gastroenterology and Hepatology University of

More information

Non Alcoholic Steato-Hepatitis (NASH)

Non Alcoholic Steato-Hepatitis (NASH) Non Alcoholic Steato-Hepatitis (NASH) DISCLAIMER NEITHER THE PUBLISHER NOR THE AUTHORS ASSUME ANY LIABILITY FOR ANY INJURY AND OR DAMAGE TO PERSONS OR PROPERTY ARISING FROM THIS WEBSITE AND ITS CONTENT.

More information

Assessment of Fat in the Liver. Gia L. Tyson, MD, MPH Transplant Hepatologist Ochsner Health System New Orleans and Baton Rouge

Assessment of Fat in the Liver. Gia L. Tyson, MD, MPH Transplant Hepatologist Ochsner Health System New Orleans and Baton Rouge Assessment of Fat in the Liver Gia L. Tyson, MD, MPH Transplant Hepatologist Ochsner Health System New Orleans and Baton Rouge Agenda Epidemiology Liver biopsy Laboratory tests Indirect Direct Imaging

More information

Dr Lee Yin Mei Senior Consultant Gastroenterology NUHS

Dr Lee Yin Mei Senior Consultant Gastroenterology NUHS Dr Lee Yin Mei Senior Consultant Gastroenterology NUHS Simple steatosis (SS), through steatohepatitis Put picture of spectrum Prevalence of NASH 3-25% NASH Progression only occurs in NASH: 27% develop

More information

Session Outline 8/11/2015. Fatty Liver Disease. Conflict of Interest Disclosure

Session Outline 8/11/2015. Fatty Liver Disease. Conflict of Interest Disclosure Fatty Liver Disease Donald Gardenier, DNP, FNP-BC, FAANP, FAAN Assistant Professor and Clinical Program Director Icahn School of Medicine at Mount Sinai New York, NY Conflict of Interest Disclosure Having

More information

Fatty Liver What to do? michael herman d.o. Borland-groover clinic Jacksonville, florida

Fatty Liver What to do? michael herman d.o. Borland-groover clinic Jacksonville, florida Fatty Liver What to do? michael herman d.o. Borland-groover clinic Jacksonville, florida Liver Enzymes Liver enzymes are not liver function tests! True liver function tests Albumin INR Bilirubin The patient

More information

Non-alcoholic fatty liver disease: Prognosis and Treatment

Non-alcoholic fatty liver disease: Prognosis and Treatment Non-alcoholic fatty liver disease: Prognosis and Treatment Zachary Henry, M.D. Assistant Professor UVA Gastroenterology & Hepatology October 28, 2015 Overview Case Presentation Prognosis Effects of fibrosis

More information

Patient information: Nonalcoholic steatohepatitis (NASH)

Patient information: Nonalcoholic steatohepatitis (NASH) Official reprint from UpToDate www.uptodate.com 2011 UpToDate The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek

More information

Fatty Liver Disease. Donald Gardenier, DNP, FNP-BC, FAANP, FAAN Assistant Professor and Clinical Program Director

Fatty Liver Disease. Donald Gardenier, DNP, FNP-BC, FAANP, FAAN Assistant Professor and Clinical Program Director Fatty Liver Disease Donald Gardenier, DNP, FNP-BC, FAANP, FAAN Assistant Professor and Clinical Program Director Icahn School of Medicine at Mount Sinai New York, NY Conflict of Interest Disclosure Having

More information

NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) Joel M. Andres, M.D. University of Florida

NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) Joel M. Andres, M.D. University of Florida NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) Joel M. Andres, M.D. University of Florida OBJECTIVES To understand the pathophysiology of nonalcoholic fatty liver disease (NAFLD) - The link between NAFLD and

More information

NAFLD/NASH and HCC Awaiting a Rise in HCC

NAFLD/NASH and HCC Awaiting a Rise in HCC NAFLD/NASH and HCC Awaiting a Rise in HCC Hossein Poustchi MD PhD Digestive Disease Research Institute Epidemiology of HCC Causes of HCC Cryptogenic cirrhosis and HCC MS, NAFLD, NASH and HCC Studies related

More information

Pharmacologic treatment of NAFLD Yes!

Pharmacologic treatment of NAFLD Yes! Pharmacologic treatment of NAFLD Yes! Jian-Gao FAN M.D, Ph.D Department of Gastroenterology Xinhua Hospital Shanghai Jiao Tong University School of Medicine 2014.9.14 Management of NAFLD What is NAFLD?

More information

Patterns of abnormal LFTs and their differential diagnosis

Patterns of abnormal LFTs and their differential diagnosis Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Summary liver function / liver function

More information

Treatment of non-alcoholic

Treatment of non-alcoholic Earn 3 CPD Points online Treatment of non-alcoholic fatty liver disease (NAFLD) Dr Aslam Amod Endocrinologist Durban Introduction Non-alcoholic steatohepatitis (NASH) or non-alcoholic fatty liver disease

More information

WHAT IS A NORMAL VALUE FOR SERUM ALT ACTIVITY?

WHAT IS A NORMAL VALUE FOR SERUM ALT ACTIVITY? WHAT IS A NORMAL VALUE FOR SERUM ALT ACTIVITY? D. Robert Dufour, MD, FACB, FCAP Consultant Pathologist Attending, Liver Clinic VAMC, Washington DC Emeritus Professor of Pathology DISCLOSURE I have no conflicts

More information

Non-alcoholic fatty liver disease (NAFLD): assessment and management

Non-alcoholic fatty liver disease (NAFLD): assessment and management Non-alcoholic fatty liver disease (NAFLD): assessment and management NICE guideline: short version Draft for consultation, December 0 This guideline covers assessing and managing non-alcoholic fatty liver

More information

Mastiha treatment for Healthy obese with NAFLD diagnosis MAST4HEALTH

Mastiha treatment for Healthy obese with NAFLD diagnosis MAST4HEALTH Marie Skłodowska-Curie Actions Research and Innovation Staff Exchange (RISE) Call: H2020-MSCA-RISE-2015 Mastiha treatment for Healthy obese with NAFLD diagnosis MAST4HEALTH Sophie Visvikis-Siest Head of

More information

Nonalcoholic Steatohepatitis

Nonalcoholic Steatohepatitis Nonalcoholic Steatohepatitis National Digestive Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH Nonalcoholic steatohepatitis

More information

NP/PA Clinical Hepatology Fellowship Summary of Year-Long Curriculum

NP/PA Clinical Hepatology Fellowship Summary of Year-Long Curriculum OVERVIEW OF THE FELLOWSHIP The goal of the AASLD NP/PA Fellowship is to provide a 1-year postgraduate hepatology training program for nurse practitioners and physician assistants in a clinical outpatient

More information

Nonalcoholic Fatty Liver Disease: Where Do We Stand In 2016

Nonalcoholic Fatty Liver Disease: Where Do We Stand In 2016 Nonalcoholic Fatty Liver Disease: Where Do We Stand In 2016 K.Rajender Reddy MD Ruimy Family President s Distinguished Professor of Medicine Director of Hepatology Director, Viral Hepatitis Center Medical

More information

HCC: Risk factors, surveillance and the importance of a multidisciplinary team

HCC: Risk factors, surveillance and the importance of a multidisciplinary team HCC: Risk factors, surveillance and the importance of a multidisciplinary team Anjana Pillai MD Assistant Professor of Medicine Director, Emory University Hospital Liver Tumor Clinic Division of Digestive

More information

Pathogenesis and Management of Non-Alcoholic Fatty Liver Disease

Pathogenesis and Management of Non-Alcoholic Fatty Liver Disease Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/lipid-luminations/pathogenesis-management-non-alcoholic-fatty-liverdisease/8155/

More information

脂肪肝的西醫藥治療 Western medicine treatment on fatty liver. Vincent Wong 黃煒燊 Institute of Digestive Disease 消化疾病研究所

脂肪肝的西醫藥治療 Western medicine treatment on fatty liver. Vincent Wong 黃煒燊 Institute of Digestive Disease 消化疾病研究所 脂肪肝的西醫藥治療 Western medicine treatment on fatty liver Vincent Wong 黃煒燊 Institute of Digestive Disease 消化疾病研究所 Disclosures Advisory board member: AbbVie, Gilead, Janssen, Otsuka, Roche Consultancy: Merck,

More information

Non-alcoholic Fatty Liver Disease (NAFLD) Nissa Erickson, MD June 13, 2014

Non-alcoholic Fatty Liver Disease (NAFLD) Nissa Erickson, MD June 13, 2014 Non-alcoholic Fatty Liver Disease (NAFLD) Nissa Erickson, MD June 13, 2014 I have no financial relationships to disclose Case 12 yo hispanic male presents to clinic after incidental finding of increased

More information

ORIGINAL ARTICLE EVALUATION OF CARDIOVASCULAR RISK BY CAROTID INTIMA MEDIA THICKNESS IN NON ALCOHOLIC FATTY LIVER DISEASE

ORIGINAL ARTICLE EVALUATION OF CARDIOVASCULAR RISK BY CAROTID INTIMA MEDIA THICKNESS IN NON ALCOHOLIC FATTY LIVER DISEASE EVALUATION OF CARDIOVASCULAR RISK BY CAROTID INTIMA MEDIA THICKNESS IN NON ALCOHOLIC FATTY LIVER DISEASE Mandeep Kaur 1, S B Nayyar 2, Jagdeep Singh 3 HOW TO CITE THIS ARTICLE: Mandeep Kaur, SB Nayyar,

More information

Gli aspetti terapeutici La steatoepatite: a sfavore

Gli aspetti terapeutici La steatoepatite: a sfavore UNIGASTRO COORDINAMENTO NAZIONALE DOCENTI UNIVERSITARI DI GASTROENTEROLOGIA Corso residenziale di formazione per specializzandi in Gastroenterologia IL FEGATO COME CENTRALE METABOLICA E I FATTORI DI DANNO

More information

BACKGROUND MEDIA INFORMATION Fast facts about liver disease

BACKGROUND MEDIA INFORMATION Fast facts about liver disease BACKGROUND MEDIA INFORMATION Fast facts about liver disease Liver, or hepatic, disease comprises a wide range of complex conditions that affect the liver. Liver diseases are extremely costly in terms of

More information

Hepatology Guidelines for Primary Care November 2011

Hepatology Guidelines for Primary Care November 2011 Common requests for hepatology opinion/advice 1. Abnormal LFTs (is this fatty liver?) 2. Fatty Liver Disease (is this serious liver disease?) 3. Abnormal liver ultrasound 4. Alcohol related liver disease

More information

Abnormal Liver Function. Dr William Alazawi MA(Cantab) PhD MRCP Senior Lecturer and Consultant in Hepatology Queen Mary, University of London

Abnormal Liver Function. Dr William Alazawi MA(Cantab) PhD MRCP Senior Lecturer and Consultant in Hepatology Queen Mary, University of London Abnormal Liver Function Dr William Alazawi MA(Cantab) PhD MRCP Senior Lecturer and Consultant in Hepatology Queen Mary, University of London Does Liver Disease Matter? Mortality in England & Wales Liver-related

More information

Fatty Liver Disease Diagnosis & Implications. Dr Matthew Foxton Consultant Hepatologist Chelsea & Westminster Hospital / Kings College Hospital

Fatty Liver Disease Diagnosis & Implications. Dr Matthew Foxton Consultant Hepatologist Chelsea & Westminster Hospital / Kings College Hospital Fatty Liver Disease Diagnosis & Implications Dr Matthew Foxton Consultant Hepatologist Chelsea & Westminster Hospital / Kings College Hospital Intellectuals solve problems Geniuses prevent them The potential

More information

Non-alcoholic fatty liver: a practical approach. Mark Thursz Division of Digestive Diseases Imperial College

Non-alcoholic fatty liver: a practical approach. Mark Thursz Division of Digestive Diseases Imperial College Non-alcoholic fatty liver: a practical approach Mark Thursz Division of Digestive Diseases Imperial College 42%of abnormal ALT was attributable to coinfection with HBV or HCV 28% of those scanned had fatty

More information

7/13/2016. Non Alcoholic Fatty Liver Disease (NAFLD) Definitions. Other Causes of hepatic steatosis. NAFLD Spectrum

7/13/2016. Non Alcoholic Fatty Liver Disease (NAFLD) Definitions. Other Causes of hepatic steatosis. NAFLD Spectrum Beyond Obesity, The Spectrum of Nonalcoholic Fatty Liver Disease Normal Liver NAFLD Spectrum Fatty liver (Steatosis) Jamie Wolosin, MD Division of Gastroenterology Sharp Rees Stealy Medical Group Financial

More information

THE BURDEN OF NASH IN PATHOLOGY. HOW TO RECOGNIZE AND HOW TO SCORE?

THE BURDEN OF NASH IN PATHOLOGY. HOW TO RECOGNIZE AND HOW TO SCORE? THE BURDEN OF NASH IN PATHOLOGY. HOW TO RECOGNIZE AND HOW TO SCORE? Pierre Bedossa Departement of Pathology, Imaging and Nuclear Medicine Hôpital Beaujon University Paris-Diderot Paris FRANCE 1 THE BURDEN

More information

The Skinny On Non Alcoholic Fatty Liver Disease

The 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 May 20 th, 2015 Non Alcoholic Fatty Liver Disease: Outline Pathogenesis

More information

Anatomy of Liver Normal Liver 6/21/2007

Anatomy of Liver Normal Liver 6/21/2007 Objective Prevention of Liver Cancer Smruti R. Mohanty, MD, MS Assistant Professor of Medicine Center for Liver Diseases Section of Gastroenterology University of Chicago September 6, 2006 Anatomy of Liver

More information

HIGHLIGHTS FROM THE AASLD MEETING. Rob Goldin. Imperial College Faculty of Medicine at St Mary s r.goldin@imperial.ac.uk

HIGHLIGHTS FROM THE AASLD MEETING. Rob Goldin. Imperial College Faculty of Medicine at St Mary s r.goldin@imperial.ac.uk HIGHLIGHTS FROM THE AASLD MEETING Rob Goldin Imperial College Faculty of Medicine at St Mary s r.goldin@imperial.ac.uk What was on at the meeting? 1. Postgraduate Course 2. Oral Presentations 3. Poster

More information

Fatty liver: A risk factor for chronic liver disease and new strategy for its management Rashid MH, Haque MA, Alam MS, Sarker MK, Hossain MMI

Fatty liver: A risk factor for chronic liver disease and new strategy for its management Rashid MH, Haque MA, Alam MS, Sarker MK, Hossain MMI Fatty liver: A risk factor for chronic liver disease and new strategy for its management Rashid MH, Haque MA, Alam MS, Sarker MK, Hossain MMI The ORION Medical Journal 2007 Jan; 26:427-430 Introduction

More information

Identify presence of elevated liver enzymes in otherwise healthy patients in outpatient medicine

Identify presence of elevated liver enzymes in otherwise healthy patients in outpatient medicine Patrick Louis Brine September 27 th Associate Program Director SEHC IM Residency Assistant Professor Northeast Ohio Medical University Clinical Adjunct Professor Lake Erie College of Osteopathic Medicine

More information

NAFLD/NASH: Criteri diagnostici e prognostici

NAFLD/NASH: Criteri diagnostici e prognostici Monotematica AISF Personalizzazione della Cura in Epatologia NAFLD/NASH: Criteri diagnostici e prognostici Pisa 17-19 ottobre 2013 Elisabetta Bugianesi MD, PhD Division of Gastro-Hepatology, University

More information

disease going forward for the next 10 years and I'm sure all of you will see more and more of these

disease going forward for the next 10 years and I'm sure all of you will see more and more of these MANAGEMENT, JAIDEEP BEHARI, MD 1 So moving on from the viral hepatitis in the morning to what I think will be the most important liver disease going forward for the next 10 years and I'm sure all of you

More information

What to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic

What to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic What to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic Introduction Elevated liver enzymes is often not a clinical problem by itself. However it is a warning

More information

NAFLD Risk Factors. Classifications of Fatty Liver. Non Alcoholic Fatty Liver Disease (NAFLD) Definitions. Other Causes of hepatic steatosis 8/14/2016

NAFLD Risk Factors. Classifications of Fatty Liver. Non Alcoholic Fatty Liver Disease (NAFLD) Definitions. Other Causes of hepatic steatosis 8/14/2016 Beyond Obesity: The Spectrum of Nonalcoholic Fatty Liver Disease Normal Liver NAFLD Spectrum Fatty liver (Steatosis) Jamie Wolosin, MD Division of Gastroenterology Sharp Rees Stealy Medical Group Financial

More information

Updates in Fatty Liver Disease

Updates in Fatty Liver Disease Updates in Fatty Liver Disease Blaire E Burman, MD Virginia Mason Gastroenterology & Hepatology Talk Outline Definitions Burden of obesity and NAFLD Complications and natural history Diagnosis Blood work

More information

Two Cases of Non-Alcoholic Steato-Hepatitis Developing from Simple Fatty Liver

Two Cases of Non-Alcoholic Steato-Hepatitis Developing from Simple Fatty Liver case series Two Cases of Non-Alcoholic Steato-Hepatitis Developing from Simple Fatty Liver Soo Ryang Kim, Taisuke Nakajima, Kenji Ando, Keiji Mita, Katsumi Fukuda Department of Gastroenterology, Kobe Asahi

More information

Primary Care Guidance Program: Non-Alcohol related Fatty Liver Disease (NAFLD) Guidance on Management in Primary Care

Primary Care Guidance Program: Non-Alcohol related Fatty Liver Disease (NAFLD) Guidance on Management in Primary Care Primary Care Guidance Program: Non-Alcohol related Fatty Liver Disease (NAFLD) Guidance on Management in Primary Care This advice has been developed to help GPs with shared care of patients with Non- Alcohol

More information

Noninvasive Assessment of Nonalcoholic Fatty Liver Disease in Type 2 Diabetes Patients

Noninvasive Assessment of Nonalcoholic Fatty Liver Disease in Type 2 Diabetes Patients FACULTEIT GENEESKUNDE EN FARMACIE Noninvasive Assessment of Nonalcoholic Fatty Liver Disease in Type 2 Diabetes Patients Dissertation presented in the programme of Master of Medicine in Medicine Lynn Debels

More information

Profile of Non Alcoholic Fatty Liver Disease (NAFLD) In Healthy Young Adults.

Profile of Non Alcoholic Fatty Liver Disease (NAFLD) In Healthy Young Adults. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 10 Ver. III (October. 2016), PP 114-121 www.iosrjournals.org Profile of Non Alcoholic Fatty

More information

Nonalcoholic Fatty Liver Disease

Nonalcoholic Fatty Liver Disease Clinical Review Article Nonalcoholic Fatty Liver Disease Mark W. Russo, MD, MPH Ira M. Jacobson, MD Nonalcoholic fatty liver disease (NAFLD) comprises a spectrum of conditions, ranging from steatosis without

More information

Evaluation and Staging of Liver Fibrosis

Evaluation and Staging of Liver Fibrosis Evaluation and Staging of Liver Fibrosis Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco Recorded on April

More information

Alcoholic Liver Disease

Alcoholic Liver Disease Alcoholic Hepatitis Paul Y. Kwo, MD Professor of Medicine i Medical Director, Liver Transplantation Gastroenterology/Hepatology Division Indiana University School of Medicine 975 W. Walnut, IB 327 Indianapolis,

More information

Alcoholic liver disease

Alcoholic liver disease Maladie alcoolique et non alcoolique du foie La place des facteurs génétiques et environnementaux Alcoholic liver disease Healty liver Fatty liver Cirrhosis HCC 13 ème Journée d automne d actualités en

More information

NICE guideline Published: 6 July 2016 nice.org.uk/guidance/ng49

NICE guideline Published: 6 July 2016 nice.org.uk/guidance/ng49 Non-alcoholic fatty liver disease (NAFLD): assessment and management NICE guideline Published: 6 July 2016 nice.org.uk/guidance/ng49 NICE 2016. All rights reserved. Your responsibility The recommendations

More information

Liver Pathology Questions. Matthew M. Yeh, MD, PhD. 1. Which of the following statements is true regarding hepatitis B?

Liver Pathology Questions. Matthew M. Yeh, MD, PhD. 1. Which of the following statements is true regarding hepatitis B? Liver Pathology Questions 2012 Matthew M. Yeh, MD, PhD 1. Which of the following statements is true regarding hepatitis B? A. Cirrhosis is not a prerequisite for the development of hepatocellular carcinoma.

More information

NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) IN MEN WITH TYPE 2 DIABETES

NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) IN MEN WITH TYPE 2 DIABETES NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) IN MEN WITH TYPE 2 DIABETES D. Bakalov 1, M. Boyanov 1, G. Sheinkova 1, L. Vezenkova 1, G. Prodanova 2, V. Christov 1 1 Endocrinology Clinic 2 Sonography unit

More information

Differential Diagnosis of NAFLD- A Short Summary:

Differential Diagnosis of NAFLD- A Short Summary: Differential Diagnosis of NAFLD- A Short Summary: Almost a fifth of our general pediatric population is now classified as overweight in the United States. When such children present with elevated liver

More information

Management of NAFLD - Clinical case

Management of NAFLD - Clinical case Management of NAFLD - Clinical case 9th PHC January 12th 2016 Vlad Ratziu, Université Pierre et Marie Curie, Hôpital Pité Salpêtrière, Paris, France Woman, age 39, increased LFT and steatosis Family history:

More information

Evaluation of abnormal LFT in the asymptomatic patient. Son Do, M.D. Advanced Gastroenterology Vancouver, WA

Evaluation of abnormal LFT in the asymptomatic patient. Son Do, M.D. Advanced Gastroenterology Vancouver, WA Evaluation of abnormal LFT in the asymptomatic patient Son Do, M.D. Advanced Gastroenterology Vancouver, WA Definition of chronic, abnormally elevated LFT Elevation of one or more of the following for

More information

Alanine aminotransferase (serum, plasma)

Alanine aminotransferase (serum, plasma) Alanine aminotransferase (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Alanine aminotransferase (ALT) 1.2 Alternative names Systematic name L alanine:2 oxoglutarate aminotransferase

More information

Laura T. Acampado, MD, FPCP, FPSEDM. Clinical Associate Professor, UP College of Medicine Chief, Section of Endocrinology, UP- PGH

Laura T. Acampado, MD, FPCP, FPSEDM. Clinical Associate Professor, UP College of Medicine Chief, Section of Endocrinology, UP- PGH Laura T. Acampado, MD, FPCP, FPSEDM Clinical Associate Professor, UP College of Medicine Chief, Section of Endocrinology, UP- PGH OUTLINE I. Introduction II. Definitions III. Clinical Presentation IV.

More information

Fatty Liver in 2016 Update for Primary Physicians. Dr Raymond Kwok Gastroenterologist KTPH

Fatty Liver in 2016 Update for Primary Physicians. Dr Raymond Kwok Gastroenterologist KTPH Fatty Liver in 2016 Update for Primary Physicians Dr Raymond Kwok Gastroenterologist KTPH Lack of awareness in patients Patients in an outpatient diabetes clinic had 70% rate of NAFLD Only 18% of patients

More information

Fish Oil & Fatty Liver. Kittie Wyne, MD, PhD, FACE, FNLA SWLA Spring Clinical Update March 16, 2014

Fish Oil & Fatty Liver. Kittie Wyne, MD, PhD, FACE, FNLA SWLA Spring Clinical Update March 16, 2014 Fish Oil & Fatty Liver Kittie Wyne, MD, PhD, FACE, FNLA SWLA Spring Clinical Update March 16, 2014 Disclosures Speaker s Bureau: NovoNordisk, AZ Diabetes, Janssen Case 52 y/o WF is referred to you for

More information

HBV & HCV induced. Liver Cirrhosis Iradj Maleki MD Gut & Liver Research Center Mazandaran University of Medical Sciences

HBV & HCV induced. Liver Cirrhosis Iradj Maleki MD Gut & Liver Research Center Mazandaran University of Medical Sciences HBV & HCV induced Liver Cirrhosis Iradj Maleki MD Gut & Liver Research Center Mazandaran University of Medical Sciences Definition of Cirrhosis Final pathway for a wide variety of chronic liver diseases

More information

HYPERFERRITINAEMIA IS A RISK FAKTOR FOR STEATOSIS IN CHRONIC LIVER DISEASE

HYPERFERRITINAEMIA IS A RISK FAKTOR FOR STEATOSIS IN CHRONIC LIVER DISEASE Trakia Journal of Sciences, Vol. 8, Suppl. 2, pp 180-185, 2010 Copyright 2009 Trakia University Available online at: http://www.uni-sz.bg ISSN 1313-7050 (print) ISSN 1313-3551 (online) HYPERFERRITINAEMIA

More information

Need for Biomarker Development in Non-Alcoholic Fatty Liver Disease. Éric Lefebvre, MD Chief Medical Officer Tobira Therapeutics, Inc.

Need for Biomarker Development in Non-Alcoholic Fatty Liver Disease. Éric Lefebvre, MD Chief Medical Officer Tobira Therapeutics, Inc. International Workshop on NASH Biomarkers Need for Biomarker Development in Non-Alcoholic Fatty Liver Disease Éric Lefebvre, MD Chief Medical Officer Tobira Therapeutics, Inc. Disclosure International

More information

STUDY OF BIOCHEMICAL MARKERS IN NON ALCOHOLIC FATTY LIVER DISEASE

STUDY OF BIOCHEMICAL MARKERS IN NON ALCOHOLIC FATTY LIVER DISEASE Page1 IJPBS Volume 2 Issue 2 APRIL-JUNE 2012 01-07 STUDY OF BIOCHEMICAL MARKERS IN NON ALCOHOLIC FATTY LIVER DISEASE Babu Rao R *, Sampath Kumar V **, Rama Rao J *, Ambica Devi K * *Department of Biochemistry,

More information

An update on nonalcoholic fatty liver disease Daniel M. Provencher, BMS, PA-C

An update on nonalcoholic fatty liver disease Daniel M. Provencher, BMS, PA-C An update on nonalcoholic fatty liver disease Daniel M. Provencher, BMS, PA-C ABSTRACT Non alcoholic fatty liver disease (NAFLD) is the accumulation of fat (steatosis) in the liver for reasons other than

More information

La steatoepatite: curarla? come? Antonino Picciotto Dipartimento di Medicina Interna e Specialità Mediche Università di Genova

La steatoepatite: curarla? come? Antonino Picciotto Dipartimento di Medicina Interna e Specialità Mediche Università di Genova La steatoepatite: curarla? come? Antonino Picciotto Dipartimento di Medicina Interna e Specialità Mediche Università di Genova Non Alcoholic Fatty Liver Disease Steatosis Inflammation NASH Inflammation

More information

Clinica Chimica Acta

Clinica Chimica Acta Clinica Chimica Acta 422 (2013) 29 39 Contents lists available at SciVerse ScienceDirect Clinica Chimica Acta journal homepage: www.elsevier.com/locate/clinchim Invited critical review Upper limit of normal

More information

Worldwide Causes of HCC

Worldwide Causes of HCC Approach to HCV Treatment in Patients with HCC JORGE L. HERRERA, MD, MACG UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE Worldwide Causes of HCC 60% 50% 40% 54% 30% 20% 10% 31% 15% 0% Hepatitis B Hepatitis

More information

IS VITAMIN E SAFE TO USE?

IS VITAMIN E SAFE TO USE? Vitamin E & Fatty Liver IS VITAMIN E SAFE TO USE? Nonalcoholic Fatty Liver Disease (NAFLD) & Nonalcoholic Steatohepatitis (NASH) Prevalence: 5.7-16.5% 57 5 in US Usually diagnosed in 40-60 y/o s Non-significant

More information

Boehringer Ingelheim- sponsored Satellite Symposium. HCV Beyond the Liver

Boehringer Ingelheim- sponsored Satellite Symposium. HCV Beyond the Liver Boehringer Ingelheim- sponsored Satellite Symposium HCV Beyond the Liver HCV AS A METABOLIC MODIFIER: STEATOSIS AND INSULIN RESISTANCE Francesco Negro University Hospital of Geneva Switzerland Clinical

More information

Non-Alcoholic Fatty Liver Disease

Non-Alcoholic Fatty Liver Disease Non-Alcoholic Fatty Liver Disease Information for patients and families UHN Read this information to learn: what non-alcoholic fatty liver disease is what causes it how it s treated how to prevent it where

More information

Non-alcoholic Fatty Liver Disease (NAFLD): Does Anything Help?

Non-alcoholic Fatty Liver Disease (NAFLD): Does Anything Help? Non-alcoholic Fatty Liver Disease (NAFLD): Does Anything Stephen Caldwell, MD Director of Hepatology University of Virginia Case: 36 yo F, T2 DM, abn liver enzymes, mother died of cryptogenic cirrhosis

More information

LIVER FUNCTION TESTS AND STATINS

LIVER FUNCTION TESTS AND STATINS LIVER FUNCTION TESTS AND STATINS Philippe J. Zamor and Mark W. Russo Current Opinion in Cardiology 2011,26:338 341 SUMMARY Purpose of review: To discuss recent data on statins in patients with elevated

More information

KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease

KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease pissn 2287-2728 eissn 2287-285X Review Clinical and Molecular Hepatology 2013;19:325-348 KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease The Korean Association for the

More information

The Normal Liver. Acinar/lobular architecture Portal tracts Hepatic plates & sinusoids Central veins

The Normal Liver. Acinar/lobular architecture Portal tracts Hepatic plates & sinusoids Central veins Harvard-MIT Division of Health Sciences and Technology HST.121: Gastroenterology, Fall 2005 Instructors: Dr. Jonathan Glickman The Normal Liver Acinar/lobular architecture Portal tracts Hepatic plates

More information

Nonalcoholic fatty liver disease in asymptomatic obese women (a)

Nonalcoholic fatty liver disease in asymptomatic obese women (a) 144 Rodriguez-Hernandez H, et al., 2010; 9 (2): 144-149 ORIGINAL ARTICLE April-June, Vol. 9 No.2, 2010: 144-149 Nonalcoholic fatty liver disease in asymptomatic obese women (a) Heriberto Rodriguez-Hernandez,*,,

More information

Autoimmune Hepatitis. Hili N. Morillas, MD November 1, 2004 Morning Report

Autoimmune Hepatitis. Hili N. Morillas, MD November 1, 2004 Morning Report Autoimmune Hepatitis Hili N. Morillas, MD November 1, 2004 Morning Report Definition! An unresolving inflammation of unknown cause.! Characterized by the presence of interface hepatitis and portal plasma

More information

Liver, Gallbladder and Pancreas diseases. Premed 2 Pathophysiology

Liver, Gallbladder and Pancreas diseases. Premed 2 Pathophysiology Liver, Gallbladder and Pancreas diseases Premed 2 Pathophysiology Pancreas Pancreatitis Acute Pancreatitis Autodigestion of the pancreas due to activation of the enzymes Hemorrhagic fat necrosis, calcium

More information

MECHANISMS OF HUMAN DISEASE: LABORATORY SESSION LIVER (HEPATOBILIARY) PATHOLOGY LAB January 24, :00 pm 2:30 pm Faculty Copy

MECHANISMS OF HUMAN DISEASE: LABORATORY SESSION LIVER (HEPATOBILIARY) PATHOLOGY LAB January 24, :00 pm 2:30 pm Faculty Copy MECHANISMS OF HUMAN DISEASE: LABORATORY SESSION LIVER (HEPATOBILIARY) PATHOLOGY LAB January 24, 2013 1:00 pm 2:30 pm Faculty Copy GOAL: 1. Describe the basic morphologic and pathophysiologic changes which

More information

Evaluation of Liver Function tests in Primary Care. Abid Suddle Institute of Liver Studies, KCH

Evaluation of Liver Function tests in Primary Care. Abid Suddle Institute of Liver Studies, KCH Evaluation of Liver Function tests in Primary Care Abid Suddle Institute of Liver Studies, KCH Liver Function tests Markers of hepatocellular damage Cholestasis Liver synthetic function Markers of Hepatocellular

More information

Subproject 4: Specification and Documentation of Metabolic and Neoplastic Diseases

Subproject 4: Specification and Documentation of Metabolic and Neoplastic Diseases Subproject 4: Specification and Documentation of Metabolic and Neoplastic Diseases M. Trauner, Division of Gastroenterology and Hepatology, Department of Internal Medicine, MUG Co- Investigator: H. Samonigg,

More information

Revised Newcastle, North Tyneside and Northumberland Guidelines for the Management of Adults with Asymptomatic Liver Function Abnormalities.

Revised Newcastle, North Tyneside and Northumberland Guidelines for the Management of Adults with Asymptomatic Liver Function Abnormalities. Clinical Guidelines Revised Newcastle, North Tyneside and Northumberland Guidelines for the Management of Adults with Asymptomatic Liver Function Abnormalities. August 2014 Dr Mark Hudson Dr Stuart McPherson

More information

Diffuse Liver Disease

Diffuse Liver Disease Erasmus Course Abdominal MRI Leiden MRI of diffuse liver disease Christoph J Zech Institute of Clinical Radiology Chair: Prof. Dr. Dr. M. Reiser Klinikum der LMU München - Grosshadern Diffuse Liver Disease

More information