Alcoholic And Nonalcoholic Fatty Liver Disease

1. Alcoholic And Nonalcoholic Fatty Liver Disease
The subject: Clinical Pathology II
Subject professor: Dr. Nino Javakhishvili
By: Juma Awar
UG: 1802018

2. Liver Function
1. Production of bile
2. Production of certain proteins for blood plasma
3. Production of cholesterol and special proteins to
help carry fats through the body
4. Conversion of excess glucose into glycogen for
storage
5. Regulation of blood levels of amino acids, which
form the building blocks of proteins
6. Conversion of poisonous ammonia to urea
7. Clearing the blood of drugs and other poisonous
substances
8. Regulating blood clotting
9. Resisting infections by making immune factors
and removing bacteria from the bloodstream
10. Clearance of bilirubin

3. Alcoholic Liver Disease
Alcoholic liver disease (ALD) has 3 stages of
liver damage:
1. Fatty liver (steatosis),
2. Alcoholic hepatitis (inflammation and
necrosis)
3. Alcoholic liver cirrhosis
All are caused by chronic heavy alcohol
ingestion, about 40 to 80 g/day in men and 20
to 40 g/day in women for 10 to 12 years is
sufficient to cause liver damage in the absence
of other liver diseases.

4. The Pathogenesis

5. Morphology
A mix of small and large fat droplets
Clustered inflammatory cells & A Mallory-Denk body Ballooned hepatocytes & clusters of inflammatory cells

6. Clinical Features
• Clinical features depends on the stage of the disease
• Most patients present with:
• malaise, anorexia, weight loss, upper abdominal discomfort,
tender hepatomegaly, and fever
• As liver function worsens, clinical features may include:
• Edema in the legs and abdomen (ascites)
• Jaundice
• Redness on the palms of the hands
• Easy bruising and abnormal bleeding
• Confusion or problems thinking
• Pale or clay-colored stools
• spider angioma

7. Typical findings
Typical findings include:
• Hyperbilirubinemia
• Elevated serum alkaline
phosphatase levels, and neutrophilic
leukocytosis
• Serum alanine and aspartate
aminotransferases are elevated but
usually remain below 500 U/mL

8. Nonalcoholic Fatty Liver Disease
NAFLD is a common condition in which fatty liver
disease develops in individuals who do not drink
alcohol.
NAFLD is consistently associated with insulin
resistance and the metabolic syndrome
Other commonly associated abnormalities are:
• Type 2 diabetes
• Obesity
• Dyslipidemia
the features of steatohepatitis (such as hepatocyte
ballooning, Mallory-Denk bodies, and neutrophilic
infiltration) often are less prominent than they are in
alcohol related injury

9. The Pathogenesis

10. Clinical Features
• Most individuals with steatosis are
asymptomatic
• Some may have:
• Fatigue
• Malaise
• right upper-quadrant discomfort
• Liver biopsy is required to identify NASH
• Lifestyle modifications that lead to
weight loss (diet and exercise) appear to be
the most effective form of treatment.

11. Thank YOU