2.What are the Typesof Fatty Liver Diseases?

fatty Liver Disease

1. 1.Only Steatosis 2. Steato Hepatitis NASH (7-15%) (ASH)  Cirrhosis NAFLD  MASLD 2/8/2011 1 Dr.P.N.Karamchand.MD(Hom) FLD -Types

2. 2/8/2011 2 Dr.P.N.Karamchand.MD(Hom) Steatosis is the collection of excessive amounts of TGL and other fats inside liver cells (>5% ) without any liver injury

3. 3 Dr.P.N.Karamchand.MD( Hom ) ASH / NASH

4. In NASH There is inflammation within the liver, and, as a result, the liver cells are damaged, they die, and are replaced by scar tissue. 40% of NASH & Fibrosis  CIRRHOSIS 8% --> Cirrhosis--> HCA . 2/8/2011 4 Dr.P.N.Karamchand.MD(Hom) NASH ( N on A lcoholic S teato H epatitis)

5. Increased lipolysis  Increased fatty acid synthesis ↑TGL but Decreased Triglyceride utilization Decreased fatty acid oxidation  ketone bodies & 2/8/2011 5 Dr.P.N.Karamchand.MD(Hom) What happens In chronic alcoholism ??- AS H

6. 2/8/2011 6 Dr.P.N.Karamchand.MD(Hom)

7. NAFLD  MASLD Kerala is the World Capital of MASLD 2/8/2011 7 Dr.P.N.Karamchand.MD(Hom)

8. MASLD M etabolic defects A ssociated S teatotic L iver D s. (Kerala a is considered as World Capital of MASLD ) 2/8/2011 8 Dr.P.N.Karamchand.MD(Hom)

9. in which alcohol has been excluded as a cause. NAFLD is a manifestation of an abnormality of metabolism within the liver. Is Mainly due to over usage of food which contain Saturated fatty acid & Sugar / Sweeteners, 2/8/2011 9 Dr.P.N.Karamchand.MD(Hom) NAFLD (Non Alcoholic Fatty Liver Disease) ( BMI >30)

10. 10 Dr.P.N.Karamchand.MD( Hom ) OBESITY

11. When large amounts of fat are present as they are seen in obesity, the fat becomes metabolically active ( actually inflamed ) and gives rise to the Production of many Hormones and Proteins that are released into the blood and have effects on cells throughout the body  Insulin Resistance . 2/8/2011 11 Dr.P.N.Karamchand.MD(Hom) EFECT OF OBESITY

12. ↑Fatty acids, results in an increase in the blood levels of TGL /fatty acids. Large amounts of certain types of fatty acids are very toxic to cells also. 2/8/2011 12 Dr.P.N.Karamchand.MD(Hom) EFECT OF OBESITY - 2

13. WORLD WIDE 30-50% OF PEOPLE HAD MAFLD ( 16% in Lean Personalities) 5:1 in Children In which 70%- DM pts 90%- Obese 60%- DL & ↑ TGL RISK 10% WITH NASH 40% NASH --> FIBROSIS --> CIRRHOSIS CIRRHOSIS -- > 8% HCCA OBESE CHILDREN HAD MAFLD -52% 2/8/2011 13 Dr.P.N.Karamchand.MD(Hom) MAFLD- NOT ONLY AFFECTS THE LIVER ….

14. Risk ? MAFLD --> MI / PDM / DM/CVA/PCOD (Unwanted energy--> Adiposity -->Hormonal Resistance) 2/8/2011 14 Dr.P.N.Karamchand.MD(Hom) NAFLD/MAFLD (Non Alcoholic Fatty Liver Disease) ( BMI >30)

15. 58%-DM In Tvm 34% ( DM +MAFLD) (22% DM +Fibroid) CVS;- MAFLD --> IHD / MI ( 2Times ) NASH--. IHD RISK 2 TIMES FIBROSIS --> 2% CIRRHOSIS -->3% IHD RISK 2/8/2011 15 Dr.P.N.Karamchand.MD(Hom) Extra Hepatic effect of MAFLD ( in India- 23%) ( 51% in Kerala)

16. Muscle wasting- 20% --> MAFLD 40-70% --> Cirrhosis Sleep Apnea- MAFLD 18-24% 2/8/2011 16 Dr.P.N.Karamchand.MD(Hom) Extra Hepatic effect of MAFLD ( in India- 23%) ( 51% in Kerala)

17. In children ;- MAFLD--> Obesity (52%) Lean 46% PCOD risk 2-3times In MAFLD In pregnant ladies , MAFLD -->DM, HTN, CS, PD 2/8/2011 17 Dr.P.N.Karamchand.MD(Hom) Extra Hepatic effect of MAFLD ( in India- 23%) ( 51% in Kerala)

18. 2/8/2011 18 Dr.P.N.Karamchand.MD(Hom) NAFLD

19. 2/8/2011 19 Dr.P.N.Karamchand.MD(Hom)

20. Clinical correlations + Elevated SGOT/SGPT SGOT/SGPT Ratio<1 ALP/GGT Levels may be elevated S. Bil : Alb, pt are usually normal Abnormal Ferritin Fibro scan , US, MRI-PDFF 2/8/2011 20 Dr.P.N.Karamchand.MD(Hom) DIAGNOSIS OF FLD

21. 5-35% of Fatty Tissue in Liver = Gr.1 35-65% ‘’ ‘’ = Gr. II More than 65% ‘’ = Gr.III 2/8/2011 21 Dr.P.N.Karamchand.MD(Hom) Grading of FLD-

22. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 22

23. Gr.1- Too bright Gr. II- poorly visulise Gr. III 2/8/2011 23 Dr.P.N.Karamchand.MD(Hom) Grading of FLD-

24. Degree of Fibrosis, Steatosis , Stiffness Fibro Scan Score :-( CAP SCORE) F0-F1= NORMAL F2= 7-10 F3= 10-14 F4 =14 --> Cirrhosis 2/8/2011 24 Dr.P.N.Karamchand.MD(Hom) FIBROSCAN - TRANSCIENT ELASOGRAPHY

25. 2/8/2011 25 Dr.P.N.Karamchand.MD(Hom) Weight Loss Hypocaloric Diet Increased Physical Activity Bariatric Surgery of Pt with Morbid Obesity Loss of body wt-3-5%-in Steatosis & 7-10% in NASH is must Resistance Exercise 45-60 mts at least 3-5 times/ wk improve intra hepatic TGL as well as Insulin Resistance

26. 2/8/2011 26 Dr.P.N.Karamchand.MD(Hom)