Kuliah Perlemakan Hati 2012

8/18/2019 Kuliah Perlemakan Hati 2012

1/17

FATTY LIVER


2/17

NAFLD

• Clinico-pathologic syndrome encompassing of fatty liver

disease in the absence of significant alcohol intake

• The hepatic manifestation of eta!olic "yndrome

• "trongly associated #ith meta!olic determinants

$o!esity% T&'% hypertriglyceridemia% ins(lin resistance)

• *AFL' is pro!a!ly the +rd CL' ca(se after ,V and ,CV


3/17

*AFL' .revalence in Asia

• China / 0 1 &23

• India / 0 1 &43

• Indonesia / 5 +63• 7apan / 8 1 +63

• alaysia / 90 1 9:3

•;estern Co(ntries /


4/17

*at(ral ,istory of Fatty

Liver

4


5/17

;hat Ca(ses Fatty Liver =

• Alcohol

• >!esity

• T&'

• Triglycerides

• edicines?% T.*

• ;ilsons@s 'isease

• -9 Anti-trypsin

• AI ,epatitis

• ,epatitis C

• Inherited syndromes

* MTX, VA, Acetaminophen, Tamoxifen,Nefidepine, Amiodarone, CCl4

5


6/17

The T#o ,IT Concept

1st

HIT

2nd

HIT

6

Gut Derived endotoxin

ER Stress

3rd HIT

?


7/17

These are a Contin((m

CVRisk

FAT !" #nflammation $carrin% C&'

#R andM$

(st )#T

nd)#T

#R and

M$

7


8/17

Clinical .resentation

• As+mptomatic

• Rotine -lood tests

• &i.er en/+mes

• 0nlar%ed &i.er 1(23

• R56 perim-7 8ain

• Fati%e7 Malaise

• Anorexia, Nasea

• 9:" are o-ese

• 5$; e2o fatt+ li.er

• Acanthosis Ni%ricans

• 'M, )TN, &ipid a-n7

• $norin%

8


9/17

A


10/17

La!oratory A!normalities

• < 4 fold ;8T = ;>T

•$;>T? $;8T Ratio @ (• A&8 sli%ht in (23

• '+slipidemia < T;

• F; and 88;

• 5N = Creatinine < N

• Normal Al-min7 8T

• &oB ANA @ ( in 3:

• $erm Ferritin

• #ron satration

• $;>T? $;8T Ratio (

if Cirrhosis sets in

12

Unexplained AST or ALT elevation later on proved of NAFLD as the cause


11/17

"er(m !iomarker

• A"TALT ratio

• "er(m hyal(ronic acid

• ,>A score

• .lasma homocysteine

• Triglyceride

• Adiponectin

• "teatotest $score)

• Fi!rotest$score)

A&&ur&, "s

se-do+ ove 75)

82

(nnot sustitute

-iver io0s,

Gu# et - Gut 226 Sestin et - G 226


12/17

,o# #ere *AFL' recogniBed=

o ostly !y (ltraso(nd $")/ D!right livero " can only detect moderate to severe degree

of steatosis

o .atients #ith mild degree steatosis can not !edetected !y "CTRI

o "-defined *AFL' prevalence #ere mostlikely (nderestimate calc(lation


13/17

*AFL' Treatment

Main goals:

Primar : to reduce ! reverse fi"rosis progressionSecondar : to prevent hepatic cirrhosis

Limitation# Lac$ of positi%e &ar'e sca&e C) *ost st+ies -ere open&abe& / pi&ot

#nitial treatment shold -e directed at impro.in% co<

mor-idities of meta-olic s+ndrome


14/17

Insulin resistance

↑ Fatty acids

Steatosis

Lipid peroxidation

NAS#First Hit

Second Hit

NAFLD Treatment

Multi-hit process

Insulin

SensitizerAnti-hyperlipidemics

Antioxidants

$toprotectants

%eight LossDiet ! &xercise

Normal


15/17


16/17

Lifestyle odification

• 'ietary change / decr Calory

decr sat(rate fat• Ecerise / red(ce IR

$+ #) red(ce viseral fat

increase adiponectin


17/17

.otential 'r(gs for *AFL'

#nslin $ensiti/in% A%ents

• ;lita/onesD Metformin

&ipid

Documents

Kuliah Perlemakan Hati 2012