Liver and Biliary Disorders
Liver and Biliary disorders are the conditions that affect the liver, gallbladder, and pancreas.
Examples include fatty liver disease and cirrhosis, liver cancer & inherited diseases, such as hemochromatosis & Wilson disease.
Most are amenable to effective treatment. Treatment of chronic hepatitis may prevent subsequent conditions such as cirrhosis and liver cancer.
Non-alcoholic fatty liver disease (NAFLD) is seen worldwide and is the most common liver disorder in Western industrialized countries, where the major risk factors for NAFLD, central obesity, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome are common. Worldwide, NAFLD has a reported prevalence of 6 to 35 percent (median 20 percent). Most patients are diagnosed with NAFLD in their 40s or 50s.
Non- alcoholic fatty Liver disease is a condition that is characterized by large deposit of fat in the liver (steatosis) caused by factors other than excessive alcohol use. The causes are generally traceable to genetics, drugs, and diet.
After some intensive studies, it was found that there are some genetic mutations that are susceptible to the condition. Most individuals who suffer NAFLD do not experience major symptoms. They may experience such abnormalities as undue fatigue, mild jaundice, and abdominal discomfort.
Diagnosis of the condition is possible through liver ultrasound. Treatment options for the condition include nutrition, exercise, some medications and weight loss surgeries.
Insulin resistance is considered as the key mechanism leading to hepatic steatosis, and perhaps also to steatohepatitis. Patients with NAFLD may have mild or moderate elevations in liver enzymes, although normal levels do not exclude NAFLD
Finding increased echogenicity on ultrasound most often makes the diagnosis of fatty liver. Other radiologic imaging methods can also be used to diagnose fatty liver.
The diagnosis of nonalcoholic fatty liver disease (NAFLD) requires all of the following:
Demonstration of hepatic steatosis by imaging or biopsy
Exclusion of significant alcohol consumption
Exclusion of other causes of hepatic steatosis
Which Patients to Biopsy — There is no clear consensus about which patients require a liver biopsy
Significant alcohol consumption — Several definitions have been proposed for what constitutes significant alcohol consumption. We define significant alcohol consumption as an average consumption of >210 grams of alcohol per week in men or >140 grams of alcohol per week in women over at least a two-year period.
A standard drink in South Africa is 340 mL of beer, 150 mL of wine, and 45 mL of spirits, containing approximately 14 grams of alcohol, so the limits above roughly translate to >15 drinks per week for men and >10 drinks per week for women.
Weight loss for patients who are overweight or obese.
Treatment of risk factors for cardiovascular disease.
We suggest that patients with NAFLD avoid all alcohol consumption.
Vit E 400u/day and insulin sensitizing agents e.g. metformin, may be recommended by your physician.
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© Dr. H Schneider, Registered Gastroenterologist, GI Doc Johannesburg
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