Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

1054 Nonalcoholic Fatty Liver Disease

■simple fatty liver: found in 70% of patients >10% over ideal body

weight

■steatosis present in 1/3 of type II diabetics

Signs and Symptoms

■usually asymptomatic

■if symptoms present: constitutional and nonspecific, such as fatigue,

weakness and malaise; hepatomegaly common on physical exami-

nation.

tests

Basic Studies: Blood

■increased AST and ALT and occasionally alkaline phosphatase

Other Tests

■exclusion of viral, autoimmune and genetic liver diseases

Imaging

■fatty liver by ultrasound, CT or MRI

■liver biopsy

➣diagnosis of NASH requires liver biopsy, showing characteristic

findings of fatty change, lobular inflammation, hepatocellular

injury and Mallory’s hyaline, with or without fibrosis

➣histologic features of NASH and alcoholic hepatitis overlap

➣simple fatty liver characterized by hepatic steatosis without

inflammation, necrosis or fibrosis

➣role of liver biopsy in diagnosis of NASH in routine clinical prac-

tice debated, with most clinicians not recommending biopsy,

unless needed to exclude suspected alternative liver diseases

differential diagnosis

■Alcoholic hepatitis

■Hemochromatosis

■Chronic hepatitis C

management

What to Do First

■Exclude alcohol abuse by collateral history if required

■Exclude viral, autoimmune, and genetic liver diseases by specific

laboratory tests