Fatty Liver Disease Neil Theise, MD Depts of Pathology and Medicine (Digestive Diseases) Beth Israel Medical Center – Albe...
Alcoholic And Non-alcoholic  Fatty Liver Disease (NAFLD)
Alcoholic And Non-alcoholic  Fatty Liver Disease (NAFLD) NOT NASH!
Non-alcoholic  Fatty Liver Disease (NAFLD) Obesity Diabetes Mellitus Dyslipidemia syndromes Drug toxicities
Non-alcoholic  Fatty Liver Disease (NAFLD) Obesity Diabetes Mellitus Dyslipidemia syndromes Metabolic Syndrome!!!
 
 
 
Obesity Trends* Among U.S. Adults BRFSS, 1985 No Data  <10%  10%–14%
Obesity Trends* Among U.S. Adults BRFSS, 1986 No Data  <10%  10%–14%
Obesity Trends* Among U.S. Adults BRFSS, 1987 No Data  <10%  10%–14%
Obesity Trends* Among U.S. Adults BRFSS, 1988 No Data  <10%  10%–14% No Data  <10%  10%–14%
Obesity Trends* Among U.S. Adults BRFSS, 1989 No Data  <10%  10%–14%
Obesity Trends* Among U.S. Adults BRFSS, 1990 No Data  <10%  10%–14%
Obesity Trends* Among U.S. Adults BRFSS, 1991 No Data  <10%  10%–14%   15%–19%
Obesity Trends* Among U.S. Adults BRFSS, 1992 No Data  <10%  10%–14%   15%–19%
Obesity Trends* Among U.S. Adults BRFSS, 1993 No Data  <10%  10%–14%   15%–19%
Obesity Trends* Among U.S. Adults BRFSS, 1994 No Data  <10%  10%–14%   15%–19%
Obesity Trends* Among U.S. Adults BRFSS, 1995 No Data  <10%  10%–14%   15%–19%
Obesity Trends* Among U.S. Adults BRFSS, 1996 No Data  <10%  10%–14%   15%–19%
Obesity Trends* Among U.S. Adults BRFSS, 1997 No Data  <10%  10%–14%   15%–19%  ≥20%
Obesity Trends* Among U.S. Adults BRFSS, 1998 No Data  <10%  10%–14%   15%–19%  ≥20%
Obesity Trends* Among U.S. Adults BRFSS, 1999 No Data  <10%  10%–14%   15%–19%  ≥20%
Obesity Trends* Among U.S. Adults BRFSS, 2000 No Data  <10%  10%–14%   15%–19%  ≥20%
Obesity Trends* Among U.S. Adults BRFSS, 2001 No Data  <10%  10%–14%   15%–19%  20%–24%  ≥25%
Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data  <10%  10%–14%   15%–19%  20%–24%  ≥25%
Obesity Trends* Among U.S. Adults BRFSS, 2003 No Data  <10%  10%–14%   15%–19%  20%–24%  ≥25%
Obesity Trends* Among U.S. Adults BRFSS, 2004 No Data  <10%  10%–14%   15%–19%  20%–24%  ≥25%
Obesity Trends* Among U.S. Adults BRFSS, 2005 No Data  <10%  10%–14%   15%–19%  20%–24%  25%–29%  ≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2006 No Data  <10%  10%–14%   15%–19%  20%–24%  25%–29%  ≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2007 No Data  <10%  10%–14%   15%–19%  20%–24%  25%–29%  ≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2008 No Data  <10%  10%–14%   15%–19%  20%–24%  25%–29%  ≥30%
 
 
And now… … pathology!
Independent of etiology, 3 features to assess:
Independent of etiology, 3 features to assess: 1. Steatosis
<ul><li>Independent of etiology, </li></ul><ul><li>3 features to assess: </li></ul><ul><li>Steatosis </li></ul><ul><li>Ste...
<ul><li>Independent of etiology, </li></ul><ul><li>3 features to assess: </li></ul><ul><li>Steatosis </li></ul><ul><li>Ste...
<ul><li>Steatosis </li></ul>
<ul><li>Steatosis </li></ul>
<ul><li>Steatosis </li></ul>
 
 
<ul><li>Steatosis </li></ul>
<ul><li>Steatosis </li></ul>
<ul><li>Steatosis </li></ul>
<ul><li>Steatosis </li></ul>MILD
<ul><li>Steatosis </li></ul>MODERATE
<ul><li>Steatosis </li></ul>SEVERE
<ul><li>Steatosis </li></ul>
2. Steatohepatitis
 
 
<ul><li>2. Steatohepatitis </li></ul><ul><li>Hepatocyte ballooning </li></ul>
 
 
<ul><li>2. Steatohepatitis </li></ul><ul><li>Hepatocyte ballooning </li></ul><ul><li>Mallory bodies </li></ul>
 
<ul><li>Steatosis </li></ul>
<ul><li>2. Steatohepatitis </li></ul><ul><li>Hepatocyte ballooning </li></ul><ul><li>Mallory bodies </li></ul><ul><li>Neut...
 
<ul><li>Steatosis </li></ul>
2. Steatohepatitis Portal inflammation…?
 
<ul><li>3. Steatofibrosis </li></ul><ul><li>Perivenular fibrosis </li></ul>
<ul><li>3. Steatofibrosis </li></ul><ul><li>Perivenular fibrosis </li></ul><ul><li>Pericellular fibrosis </li></ul>
 
<ul><li>3. Steatofibrosis </li></ul><ul><li>Perivenular fibrosis </li></ul><ul><li>with central hyaline sclerosis </li></ul>
 
 
 
<ul><li>3. Steatofibrosis </li></ul><ul><li>Perivenular fibrosis </li></ul><ul><li>Pericellular fibrosis </li></ul><ul><li...
 
 
CIRRHOSIS <ul><li>3. Steatofibrosis </li></ul><ul><li>Perivenular fibrosis </li></ul><ul><li>Pericellular fibrosis </li></...
Active EtOH Use
CIRRHOSIS <ul><li>3. Steatofibrosis </li></ul><ul><li>Perivenular fibrosis </li></ul><ul><li>Pericellular fibrosis </li></...
and back again…? <ul><li>3. Steatofibrosis </li></ul><ul><li>Perivenular fibrosis </li></ul><ul><li>Pericellular fibrosis ...
Active EtOH Use >  6 months abstinence
Active EtOH Use >  6 months abstinence 4 years abstinence
Sample Diagnoses
LIVER: NEEDLE BIOPSY - STEATOSIS, MODERATE, WITH STEATOHEPATITIS AND STEATOFIBROSIS (CENTRAL-PORTAL SEPTA) c/w ALCOHOLIC L...
LIVER: NEEDLE BIOPSY - STEATOSIS, SEVERE, WITH STEATOHEPATITIS AND STEATOFIBROSIS (CENTRAL-PORTAL SEPTA) c/w ALCOHOLIC LIV...
LIVER: NEEDLE BIOPSY - STEATOSIS, MODERATE, INDICATIVE OF FATTY LIVER DISEASE, ? ALCOHOLIC VS. NON-ALCOHOLIC
LIVER: NEEDLE BIOPSY - STEATOSIS, MODERATE, WITH STEATOHEPATITIS COMPATIBLE WITH OBESITY RELATED FATTY LIVER DISEASE.
Special Case Fat!
In children….
Microvesicular Steatosis
Microvesicular Steatosis 5ive Causes!
Oil Red O stain <ul><li>Diffuse microvesicular steatosis </li></ul><ul><li>Reye’s syndrome </li></ul><ul><li>Fatty liver o...
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Fatty Liver Disease - Kuwait

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Fatty Liver Disease - Kuwait

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

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