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Fatty Liver Disease - Kuwait

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  • Table 7.1. Metabolic syndrome1</sup
  • Fig. 7.29. The same flow chart as Fig. 7.28 with emphasis on the concepts developed largely in animal models that the lesions associated with steatohepatitis are explained by pathogenetic models.
  • Fig. 7.28. A simplified flow chart of the cyclic pathogenic events that both lead to and result in steatosis and steatohepatitis.
  • Fig. 7.9. Most of the ballooned hepatocytes in this field contain intracytoplasmic ropy material consistent with Mallory’s hyaline. Satellitosis can be seen. H&E.
  • Fig. 7.11. The frequency of megamitochondria in NAFLD and NASH has not been rigorously evaluated. This example shows round intracytoplasmic inclusions that are characteristic of megamitochondria. Needle-shaped inclusions may also be seen. H&E (reproduced with permission from Kliener DE et al. Hepatology 2005; 41: 1313–1321 with permission).
  • Fig. 7.5. Portal inflammation in NASH is common, but usually mild. H&E.
  • Fig. 7.7. On this higher power view, the distinct pericellular, perisinusoidal location of collagen deposition can be seen. Masson trichrome.
  • Fig. 7.6. Collagen deposition can be appreciated in zone 3 in this low power photomicrograph. Masson trichrome.
  • Fig. 7.18. Paediatric NAFLD. A low power photomicrograph of a paediatric liver biopsy shows diffuse steatosis with prominent portal tracts. The latter is due to inflammation and slightly increased fibrosis. There was no ballooning or zone 3 perisinusoidal fibrosis. H&E. (Courtesy Dr Cynthia Behling)
  • Transcript

    • 1. Fatty Liver Disease Neil Theise, MD Depts of Pathology and Medicine (Digestive Diseases) Beth Israel Medical Center – Albert Einstein College of Medicine New York City
    • 2. Alcoholic And Non-alcoholic Fatty Liver Disease (NAFLD)
    • 3. Alcoholic And Non-alcoholic Fatty Liver Disease (NAFLD) NOT NASH!
    • 4. Non-alcoholic Fatty Liver Disease (NAFLD) Obesity Diabetes Mellitus Dyslipidemia syndromes Drug toxicities
    • 5. Non-alcoholic Fatty Liver Disease (NAFLD) Obesity Diabetes Mellitus Dyslipidemia syndromes Metabolic Syndrome!!!
    • 6.  
    • 7.  
    • 8.  
    • 9. Obesity Trends* Among U.S. Adults BRFSS, 1985 No Data <10% 10%–14%
    • 10. Obesity Trends* Among U.S. Adults BRFSS, 1986 No Data <10% 10%–14%
    • 11. Obesity Trends* Among U.S. Adults BRFSS, 1987 No Data <10% 10%–14%
    • 12. Obesity Trends* Among U.S. Adults BRFSS, 1988 No Data <10% 10%–14% No Data <10% 10%–14%
    • 13. Obesity Trends* Among U.S. Adults BRFSS, 1989 No Data <10% 10%–14%
    • 14. Obesity Trends* Among U.S. Adults BRFSS, 1990 No Data <10% 10%–14%
    • 15. Obesity Trends* Among U.S. Adults BRFSS, 1991 No Data <10% 10%–14% 15%–19%
    • 16. Obesity Trends* Among U.S. Adults BRFSS, 1992 No Data <10% 10%–14% 15%–19%
    • 17. Obesity Trends* Among U.S. Adults BRFSS, 1993 No Data <10% 10%–14% 15%–19%
    • 18. Obesity Trends* Among U.S. Adults BRFSS, 1994 No Data <10% 10%–14% 15%–19%
    • 19. Obesity Trends* Among U.S. Adults BRFSS, 1995 No Data <10% 10%–14% 15%–19%
    • 20. Obesity Trends* Among U.S. Adults BRFSS, 1996 No Data <10% 10%–14% 15%–19%
    • 21. Obesity Trends* Among U.S. Adults BRFSS, 1997 No Data <10% 10%–14% 15%–19% ≥20%
    • 22. Obesity Trends* Among U.S. Adults BRFSS, 1998 No Data <10% 10%–14% 15%–19% ≥20%
    • 23. Obesity Trends* Among U.S. Adults BRFSS, 1999 No Data <10% 10%–14% 15%–19% ≥20%
    • 24. Obesity Trends* Among U.S. Adults BRFSS, 2000 No Data <10% 10%–14% 15%–19% ≥20%
    • 25. Obesity Trends* Among U.S. Adults BRFSS, 2001 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
    • 26. Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
    • 27. Obesity Trends* Among U.S. Adults BRFSS, 2003 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
    • 28. Obesity Trends* Among U.S. Adults BRFSS, 2004 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
    • 29. Obesity Trends* Among U.S. Adults BRFSS, 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    • 30. Obesity Trends* Among U.S. Adults BRFSS, 2006 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    • 31. Obesity Trends* Among U.S. Adults BRFSS, 2007 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    • 32. Obesity Trends* Among U.S. Adults BRFSS, 2008 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    • 33.  
    • 34.  
    • 35. And now… … pathology!
    • 36. Independent of etiology, 3 features to assess:
    • 37. Independent of etiology, 3 features to assess: 1. Steatosis
    • 38.
      • Independent of etiology,
      • 3 features to assess:
      • Steatosis
      • Steatohepatitis
    • 39.
      • Independent of etiology,
      • 3 features to assess:
      • Steatosis
      • Steatohepatitis
      • Steatofibrosis
    • 40.
      • Steatosis
    • 41.
      • Steatosis
    • 42.
      • Steatosis
    • 43.  
    • 44.  
    • 45.
      • Steatosis
    • 46.
      • Steatosis
    • 47.
      • Steatosis
    • 48.
      • Steatosis
      MILD
    • 49.
      • Steatosis
      MODERATE
    • 50.
      • Steatosis
      SEVERE
    • 51.
      • Steatosis
    • 52. 2. Steatohepatitis
    • 53.  
    • 54.  
    • 55.
      • 2. Steatohepatitis
      • Hepatocyte ballooning
    • 56.  
    • 57.  
    • 58.
      • 2. Steatohepatitis
      • Hepatocyte ballooning
      • Mallory bodies
    • 59.  
    • 60.
      • Steatosis
    • 61.
      • 2. Steatohepatitis
      • Hepatocyte ballooning
      • Mallory bodies
      • Neutrophils
    • 62.  
    • 63.
      • Steatosis
    • 64. 2. Steatohepatitis Portal inflammation…?
    • 65.  
    • 66.
      • 3. Steatofibrosis
      • Perivenular fibrosis
    • 67.
      • 3. Steatofibrosis
      • Perivenular fibrosis
      • Pericellular fibrosis
    • 68.  
    • 69.
      • 3. Steatofibrosis
      • Perivenular fibrosis
      • with central hyaline sclerosis
    • 70.  
    • 71.  
    • 72.  
    • 73.
      • 3. Steatofibrosis
      • Perivenular fibrosis
      • Pericellular fibrosis
      • Central-portal linking
    • 74.  
    • 75.  
    • 76. CIRRHOSIS
      • 3. Steatofibrosis
      • Perivenular fibrosis
      • Pericellular fibrosis
      • Central-portal linking
    • 77. Active EtOH Use
    • 78. CIRRHOSIS
      • 3. Steatofibrosis
      • Perivenular fibrosis
      • Pericellular fibrosis
      • Central-portal linking
    • 79. and back again…?
      • 3. Steatofibrosis
      • Perivenular fibrosis
      • Pericellular fibrosis
      • Central-portal linking
    • 80. Active EtOH Use > 6 months abstinence
    • 81. Active EtOH Use > 6 months abstinence 4 years abstinence
    • 82. Sample Diagnoses
    • 83. LIVER: NEEDLE BIOPSY - STEATOSIS, MODERATE, WITH STEATOHEPATITIS AND STEATOFIBROSIS (CENTRAL-PORTAL SEPTA) c/w ALCOHOLIC LIVER DISEASE.
    • 84. LIVER: NEEDLE BIOPSY - STEATOSIS, SEVERE, WITH STEATOHEPATITIS AND STEATOFIBROSIS (CENTRAL-PORTAL SEPTA) c/w ALCOHOLIC LIVER DISEASE.
    • 85. LIVER: NEEDLE BIOPSY - STEATOSIS, MODERATE, INDICATIVE OF FATTY LIVER DISEASE, ? ALCOHOLIC VS. NON-ALCOHOLIC
    • 86. LIVER: NEEDLE BIOPSY - STEATOSIS, MODERATE, WITH STEATOHEPATITIS COMPATIBLE WITH OBESITY RELATED FATTY LIVER DISEASE.
    • 87. Special Case Fat!
    • 88. In children….
    • 89. Microvesicular Steatosis
    • 90. Microvesicular Steatosis 5ive Causes!
    • 91. Oil Red O stain
      • Diffuse microvesicular steatosis
      • Reye’s syndrome
      • Fatty liver of pregnancy
      • Tetracycline toxicity
      • Valproate toxicity
      • (HAART)
      • Vomiting sickness of Jamaica
      • ( from eating the unripened
      • fruit of the Ackee tree )
      Special Type of Fat!!!
    • 92. ?’s