Non-alcoholic fatty liver disease

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Non-alcoholic fatty liver disease (NAFLD) is accumulation of lipid within hepatocytes. Associated with obesity. Liver enzymes will be deranged, usually mildly. If associated with inflammation (or strictly speaking, ballooning degeneration), it is termed non-alcoholic steatohepatitis (NASH). Untreated, repeated inflammation and scarring can ultimately cirrhosis; indeed, some cases previously labelled as 'cryptogenic cirrhosis' are likely to have been due to NASH/NAFLD. Although the proportion of cases that progression from NAFLD to NASH to cirrhosis and ultimately to hepatocellular carcinoma (HCC) is relatively small, obesity is at epidemic levels in many Western and Middle Eastern countries, and a rise in the cases of HCC is predicted in several years.[1]

The exact mechanisms of how obesity and lipid accumulation result in inflammation and damage is less clear, but it is thought that obesity results in changes in adipocyte function, which releases hormones, cytokines and other mediators that promote inflammation, or conversely, anti-inflammatory mediators are lowered, e.g. adiponectin levels with associated loss of its protective effect.

Histological Scoring

Several histological scoring systems exist. The Brunt-Kleiner score assesses steatosis, lobular inflammation and ballooning degeneration (with a separate fibrosis score).[2] PTEN immunostaining is decreased compared to normal and alcoholic cirrhosis[3]