Non-alcoholic fatty liver disease (or NAFLD) is a liver disease that is not related to ethanol use,
that involves hepatic fatty infiltration. In this lesson, we're going to talk about
why this happens, what are some of the risk factors, and we're also going to talk about
the signs and symptoms of this condition, and what we can do to manage and treat it. So again,
it's a liver disease that involves hepatic fatty infiltration that is not related to alcohol. It is
a spectrum of macrovesicular hepatic steatosis that eventually leads to inflammation and eventual
fibrosis. So essentially, the liver starts to build up fatty deposits - eventually it leads
to inflammation of the liver - and this infiltration and inflammation over long long periods of
time can lead to scar tissue or fibrosis. The etiology of non-alcoholic fatty liver disease
is essentially insulin resistance. So I'm going to talk briefly about insulin resistance and why this
happens in the liver. So here is a cell that has an insulin receptor and there is glucose that needs
to enter the cell we need insulin to activate the insulin receptor and allow the glucose to enter
the cell. But in a state of insulin resistance that doesn't work, the insulin receptor doesn't
work properly. We can't get the glucose in the cell like we need it to - what happens is
glucose starts to increase, insulin starts to increase, and we become hyperinsulinemic and these
cause a couple of different things to happen. The hyperinsulinemic state actually leads to activated
or increased lipogenesis (fat production) in the liver. Essentially, the liver will take that higher level of glucose
and essentially convert it into fat and because this is happening at a higher level the fat is
essentially abnormal, that fat making process becomes aberrant, and it leads to fatty deposits in
the liver. This is how we actually get this disease in a simple way of describing it. The risk factors
all are associated with insulin resistance The risk factors for non-alcoholic fatty liver disease
include the following: 1) metabolic syndrome, 2) type 2 diabetes (so something with insulin resistance),
both of those have insulin resistance, 3) hypertension is also associated, 4) dislipidemia - you can imagine
if there's lots of higher levels of fats in the blood you can assume that the liver is making
them and there's an associated risk due to that. And what is interesting is that rapid
changes in weight including weight gain or weight loss can lead to this condition as well. We're
going to discuss this later in the lesson as well. So what is the pathogenesis and progression of
non-alcoholic fatty liver disease. So if we have a normal liver over time with insulin resistance
if it's brewing it really hasn't come to the attention of a clinician we can see there's
some minimal fatty infiltrate and it leads to some acute hepatitis A hepatitis is itis means
inflammation and hep at or hep paddle means liver it's inflammation of the liver so it's an acute
inflammation of the liver due to something getting inside the liver that really isn't supposed to be
there so we see this low level inflammation of the liver if this continues to go on over time the fat
can continue to accumulate and it can continue to infiltrate into the fat or into the liver tissue
and this essentially can have a prolonged and chronic level of liver inflammation and that's
not good because what happens is over time if this can go on for years and years and years in
a long long time that information can lead to scar tissue in the liver and essentially scar tissue in
the liver is cirrhosis so this is a simplistic look at the progression of non-alcoholic fatty
liver disease but it's important to understand because it can lead to some significant morbidity
later on in life like cirrhosis so what are some of the signs and symptoms of non-alcoholic fatty
liver disease what can we do to maybe come to the attention of our clinicians or have started some
treatment for it well unfortunately a lot of times this is a mostly asymptomatic condition so a lot
of times people just go on with their lives and don't realize that they have this when there are
symptoms there are often vague and that doesn't help either we a lot of times can see malaise so
people can feel very tired very fatigued they can have right upper quadrant discomfort so what we
describe as a gnawing or aching kind of sensation and that can be something that can clue you into
this condition so again most of the time it's asymptomatic so it's not easy to pick up just
simply by the symptoms but when there are symptoms they can be vague it so that can be difficult to
detect as well it can be just some fatigue some ways but what can really kind of maybe clue you
in on this is the right upper quadrant discomfort or the gnawing or aching sensation that they get
in the right upper quadrant so what are some of the investigations of non-alcoholic fatty liver
disease the laboratory investigations include hypertriglyceridemia hypercholesterolemia so
essentially the liver is making a lot of fats you're gonna see that in the blood that dis
lipid ii mean that we talked about before so you can can see that in the blood you may also
see some indications of insulin resistance we did talk that the main cause of non-alcoholic
fatty liver disease is insulin resistance so you might see an elevated a1c you might see
elevated fasting glucose so different parameters of insulin resistance might be aberrant as well
you may also see liver enzymes being elevated if there is hepatitis you can start to see some
elevated ast and alt and generally speaking that ratio if you were to take ast to alt
ratio that's gonna be less than one so it's a very mild underlying inflammation of the liver and you
might also see elevated IgM as well so these are some of the laboratory investigations you may see
with an individual with non-alcoholic fatty liver disease they may have dis lemme they may have some
insulin resistance they might have some elevated liver enzymes and elevated IgM so this may help
you clue in on non-alcoholic fatty liver disease as well what's really gonna help you is imaging
and it's a right upper quadrant ultrasound that you want to do and what you're gonna see in a
right upper quadrant ultrasound is a hyper echoed genic liver so i would encourage you to look on
the internet look at images of a normal liver and a hyper echogenic fatty liver and you can see the
differences there so essentially a hyper echogenic liver is going to be essentially echogenic more
there's any more echogenicity on a right upper quadrant ultrasound so for the treatment of
non-alcoholic fatty liver disease if we can say you know what this patient does have non-alcoholic
fatty liver disease we've seen it on imaging we've seen the laboratory investigations what can we
do to treat it treatment involves weight loss and this makes sense because a lot of the risk factors
in etiology the insulin resistance can all have to do with obesity and diabetes and this is something
we can target specifically and we want to do what we call a gradual weight loss we want to lose
0.5 to 1 kilogram per week that is the goal for treatment for non-alcoholic fatty liver disease
because a rapid weight loss can actually worsen Nanako fatty liver disease remember that was one
of the risk factors rapid changes in weight can actually make this worse can actually increase
your risk for this condition in the goal for treatment of this condition is you want to lose at
least 10% of your body weight in another thing is you want to refrain from ethanol use because there
is an underlying inflammation of the liver already you don't want to add any problems to it and there
are other treatments as well that shows some evidence of benefit this includes vitamin D so
taking a vitamin D supplement can also may be of some help in treating or reducing the progression
of non alcohol fatty liver disease vitamin E 800 units has been shown especially if there
is hepatic inflammation involved and even coffee drinking so drinking three cups of coffee per day
can actually help treat or reduce the progression of this condition so very interesting that gradual
weight loss is the treatment you don't want to lose too much weight too quickly and you want to
lose at least 10% of your body weight but what's even more interesting is that you can use vitamin
D you can use vitamin E and you can even drink more coffee to help you with this condition as
well so a lot of this lesson has been on why this condition occurs and how we can detect
it it can be difficult to detect sometimes but when we do detect it we can use these
lifestyle modification type of treatments gradual weight loss and refraining from alcohol and some
supplements vitamin D vitamin E and we can even drink some more coffee that can help as well so
if you want to learn more about other conditions please check out my other lessons as well and
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help support the channel and as always thanks so much for watching and I hope to see you next time