18/12/2024
If you have .
Ask your Doctor ❓❓❓❓❓
is it or
Or
Advanced Or .
If your liver enzymes are coming down to normal with some Booti 🌿 or 💊 Don't think your liver is improving.
This is
WRONG NUMBER in FATTY LIVER DISEASE.
Non Alcoholic Fatty liver disease ( NAFLD) is a spectrum at the one end there is
and
on the other end we have CIRRHOSIS.
This topic is very complex but let me quickly write down some basic practical points for patients and physicians especially working at periphery.
The of NAFLD is:
(a) . Means more than 5
percent of liver cells have fat.
Grade 1 means 5 to 30 percent.
Grade 2 means 30 to 60 and
Grade 3 means more than 60 percent
(b) (NASH) :
It means Simple fatty liver of any above mentioned grade Plus liver cell inflammation and injury. This injury is usually seen on biopsy as ballooning of liver cells some degree of fibrosis may or may not be there.
( c) :
presence of Fibrotic tissue in between liver cells or replacing replacing liver cells by Fibrotic tissue. Advanced fibrosis is usually associated with cirrhosis of liver.
( d) :
This stage means liver cells have been destroyed with formation of nodules and advanced fibrosis.
We have to search for Fatty liver 🧐.
patient has Diabetes. Obesity. Abnormal lipid profile. Hypothyridism. Polycystic ovaries, Sleep apnea,Psoriasis, Hypo Pitutitarism , hypogonadism,
Metabolic syndrome ( Fatty Belly , High TG, Low
HDL, High BP, High Sugar).
Look for the above disorders in a patient who comes to us with ultrasound showing fatty liver 🏃
NOW You have a person with FATTY LIVER :
First see are there other causes which have lead to fatty liver : Alcohol, hepatitis C, Iron overload, Copper overload, Drugs,Lipodystrophy, inborn errors of metabolism ( when suspicion )
What NEXT👉
Decide at which stage of the this person's liver is🤔. Obviously simple fatty liver is clear from Imaging( USG. CT. MRI).
Tough Job 😠
Is to decide is LIVER AT Steatohepatatis stage or Advanced fibrosis stage or Cirrhosis.
DO💪.
💉 NAFLD - Fibrosis Score( NFS) : ( Age, BMI, sugar,
platelet count, albumin level and
SGOT/SGPT ratio.
💉FIB-4 Index: An algorithm based on
( platelet count, age, SGOT, SGOT).
💉ELF Panel: ( Hyaluronic acid, TIMP1, Nterminal
peptide of pro collagen 111)
VCTE ( Fibroscan) : We all know. 😍.
These investigation modalities will tell us if a simple fatty liver patient has fibrosis, advanced fibrosis or cirrhosis.
Liver Biopsy : This will be decided by an Expert.
WHOM TO TREAT AND HOW 👨🔧.
Goal of treatment ⚽:
( 1) Remove fat from liver, make it non fatty:
Not possible with any medicine💊.
(2) Reduce amount of fat from liver from
grade 111 to Grade 1 :
Yes 👋👋
possible with Life style modification.
Weigh loss by taking less calories and increased physical activity.
Common Mistake 😱:
Liver enzymes coming down to normal mean liver is improving. NO it is not True.
Role of medicine💊 :
To reverse advanced fibrosis back to Steatohepatatis and Steatohepatatis back to simple fatty liver{ improvement in liver histology}
Before starting Medicine💊
Must to know where our liver is in this spectrum🙆♂️
Simple fatty liver: NO Medicine.
Steatohepatatis : Medicine.
Fibrosis even Advanced : Medicine.
Cirrhosis : it is a different story. Refer to an expert
Drugs:
: Does not change liver histology so STEATOHEPATATIS WON'T go back to simple fatty liver. It will decrease liver enzymes.
:
Improves liver histology. Will change your liver from fibrosis back to Steatohepatatis and then Steatohepatatis back to Simple fatty liver.
:
Many side effects especially cardiac, risk of prostate cancer.
Don't give it unless we have proven by liver biopsy that there is Steatohepatatis or fibrosis.
: Apna :
It will decrease your liver enzymes to normal and you will go and kiss 😘 your doctor.
Wait. ⛔
It won't improve your Liver histology.
Means fibrosis will not go back to Steatohepatatis and Steatohepatatis will not move back to simple fatty liver.
Doctors don't think I left nothing for you
in fatty liver
👀
Don't worry😥
There is much to DO.
If you see a fatty liver patient:
Diagnose and manage His/ Her
Diabetes, Hypertension, Hypothyroidism, Metabolic Syndrome, Polycystic ovaries, Obstructive Sleep apnea, Dyslipidemia, Hyperuricemia, Hepatitis C, Hepatitis B, Hemochromatosis, Wilson's Disease, Autoimmune hepatitis, Lipodystrophy, Abetalipoproteinemia, Ryes syndrome, Acute Fatty liver of pregnancy, Inborn errors of metabolism, Hypo Pitutitarism, Hypo gonadism, Psoriasis.
For the sake of Almighty
Don't be after LIVER ENZYMES. and Don't Give them a false Hope that LIVER ENZYMES coming down to NORMAL means improvement and CURE.
:
The ideal goal is to make fatty liver non fatty.😍
Second important goal is to change
Steatohepatatis in liver back to fatty liver
stage. 😌
Minimum goal is to reverse advanced fibrosis in liver back to Steatohepatatis😚
