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Fatty liver disorders - Coggle Diagram

- - - - Associated with diabetes type 2 and obesity (metabolic syndrome)
        
        insulin resistance is a prerequisite for NAFLD
        
        Fatty infiltration is a reactive pathological response
      - NAFLD/MAFLD
      - Appears similar to AFLD
      - A small number of patients have normal BMI
        
        These patients have genetic predisposition
      - Steatohepatitis
        
        Condition by which the fat in the liver causes inflammation
      - progression of NAFLD
        
        NAFLD
        
        Non-alcoholic steatohepatitis
        
        Cirrhosis
        
        HCC (Hepatocellular cancer)
      - Clinical features
        
        Can be asymptomatic
        
        Abnormal liver biochemistry
        
        RUQ abdominal pain, fatigue
        
        Hepatomegaly
        
        Acanthosis nigricans (Children)
        
        Deposition of a pigment at the back of the neck
        
        Obesity
        
        Stigmata of CLD (Rare)
      - Diagnosis
        
        Chronic elevation of serum aminotransferases
        
        Exclusion of other liver diseases
        
        Imaging studies
        
        Fatty changes detected if over 1/3 of liver is involved
        
        Perform liver biopsy if in doubt
        
        Biochemistry
        
        Increased ALT/AST
        
        Increased GGT
        
        Increased Alkaline phosphatase
        
        Increased glucose and HOMA-IR
        
        Increased Ferritin and transferrin
        
        Histological features
        
        Degree of steatosis
        
        Necroinflammatory activity
        
        Hepatocyte ballooning
        
        Necrosis
  - - - People with conditions meaning they cant feed through digestive system
  - - - Called Mallory's hyaline bodies
        
        Intermediate keratin filament proteins
    - - High alcohol consumption
        
        Ratio of NADH to NAD increases hepatic glycerol-3-phosphate enhancing the esterification of fatty acids
        
        Enhances lipolysis releasing free fatty acids
        
        Increase in free radical oxygen species action leading to mitochondrial dysfunction
        
        Oxidation of fatty acids inhibited so they accumulate
        
        Triglyceride production is increased in the liver and VLDL released in the blood
        
        End result is steatosis
        
        large droplets of fat accumulate in hepatocytes
        
        Metabolised in the liver to an aldehyde
        
        via alcohol dehydrogenase action
        
        Then metabolised to acetate
        
        Via aldehyde dehydrogenase action
        
        End product acetyl-CoA
    - - Presence of acetalhydrate due to chronic ethanol intake
        
        Causes NADH production and lipid peroxidation
        
        Together causes oxidative stress which results in hepatocyte damage
        
        Stellate cells are then activated due to the damage and form fibrous tissue
        
        Produce and deposit collagen in the liver causing fibrosis eventually leading to cirrhosis
- - - - Muscle and adipose tissue
  - - - This promotes lipolysis and accumulation of free fatty acids leading to impaired insulin signalling
        
        Liver lipogenesis is also promoted
- - - - Leptin is raised in NAFLD and correlated with the degree of steatosis
  - - - Insulin sensitiser and adipoR2 is in NAFL