1. What is FATTY LIVER Liver Disease? FLD

Fatty liver disease

1. 2/8/2011 1 Dr.P.N.Karamchand.MD(Hom) LIVER

2. 2 Dr.P.N.Karamchand.MD(Hom) LIVER

3. FATTY LIVER When the Excess amount of nutrients ( particularly fat ) entering the liver , exceeds its ability to Use it up, fat accumulates in the liver.

4. When the liver contains an excessive amount of fat and the normal healthy liver tissue is partly replaced with areas of Unhealthy fats. FATTY LIVER Dr.P.N.Karamchand.MD(Hom)

5. Silent Killer… 2/8/2011 5 Dr.P.N.Karamchand.MD(Hom)

6. Global Fatty Liver Day- June 13 th Already 50% Keralytes had affected by FLD World wide-30% In reality Fatty liver is not the disease- its only an association. FATTY LIVER DISEASES = F L D Dr.P.N.Karamchand.MD(Hom)

7. Risk Factors- (In general) Obesity (70%)- BMI >25, w:h >1 Alcohol-30-35% ( 2Peg/day) C / Viral- B/C Auto-Immune Cu / Fe Consuming excess Carb; Fruits / Sugar Metabolic- Syndrome X - DL, PDM / DM (Type 2 ) 10-15% Cryptogenic 2/8/2011 7 Dr.P.N.Karamchand.MD(Hom)

8. Certain medications,-------  as well as impaired gut health. 2/8/2011 8 Dr.P.N.Karamchand.MD(Hom) Risk Factors Tamoxyfen Amioderon methotrexate Steroids Estrogen

9. 2/8/2011 9 Dr.P.N.Karamchand.MD(Hom)

10. Genetic - PNPL A3 Gene Sedentary Life style Insulin resistance Hypothyroidism Renal failure Poor diet 2/8/2011 10 Dr.P.N.Karamchand.MD(Hom) High R isk Group

11. Sudden High level entry of Glucose in liver ( High Glycemic Index ) --> Fatty Acid Synthesis Insulin Resistance favors accumulation of Fatty acids in Liver Daily intake of high quantity fatty food ( Extra calories will be stored in the body as TGL., Trans fat --> High LDL & Low HDL 2/8/2011 11 Dr.P.N.Karamchand.MD(Hom) Root course of FLD

12. P/C Of your Pt with Obesity – In (M) > 90—102 cm F > 80 – 88 cm TGL - > 150 mg % HDL - < 40 in males, < 50 in females. BP – Systolic > 130 mm of Hg. Diastolic > 85 mm of Hg. FBS - > 100 mg% If your Pt is having any of these 3---  It CONSTITUTE Metabolic X syndrome Commonly Presented as Heart attack (50%) & Stroke (80%)

13. THE SYNDROME X

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15. Decreased mitochondrial fatty acid beta-oxidation  ( ↑TGL ) Increased endogenous fatty acid synthesis or enhanced delivery of fatty acids to the liver. Deficient incorporation or export of TGL as VLDL 2/8/2011 15 Dr.P.N.Karamchand.MD(Hom) Pathophysiology

16. A/c- CBC, WBC< PLT LFT, -GGT,PLT, PT Synthetic function- Alb Serological Markers Auto Immune Markers US, CT, MRI Fibro scan / Elasto scan Endoscopy-GEV 2/8/2011 16 Dr.P.N.Karamchand.MD(Hom) Investigation

17. 2/8/2011 17 Dr.P.N.Karamchand.MD(Hom) F L D  fibrosis / Cirrhosis