• Descriptions
  • NAFLD: non-alcohol related accumulation of fat in the liver cells
  • NASH: NAFLD with chronic inflammation and damage of liver cells
• Epidemiology: very widespread
• Etiology
  • Obesity and/or type 2 diabetes (metabolic syndrome)
    • Due to excess supply of nutrients in the liver
• Pathophysiology: ↑ Insulin resistance
  • ↑ Hepatic uptake of fatty acids
    • Essentially, insulin resistance creates a situation where fat storage in the designated areas (fat cells) is impaired, causing the liver to take on an excess burden of processing these fatty acids.
  • ↑ Triglyceride synthesis
  • ↑ Peripheral lipolysis
• Clinical features
  • Often asymptomatic
  • Hepatomegaly
  • May progress to cirrhosis
• Diagnostics
  • ↑ Transaminases (AST/ALT ratio < 1): The reversal of the AST/ALT ratio to values > 1 may indicate progression to cirrhosis.
  • Rule out other causes of chronic hepatitis (e.g., heavy alcohol use, hepatitis B, hepatitis C, Wilson disease, autoimmune hepatitis, hemochromatosis, α1-antitrypsin deficiency)

Mnemonic

There is more ALT than AST (AST/ALT < 1) if the Liver is infiltrated with Lipids.

• Pathology
  • Hepatocellular lipid accumulation, mostly macrovesicular