Fatty Acid Metabolism Fatty liver, No Alcohol

1
Fatty Acid MetabolismFatty liver, No Alcohol

• Nathaniel Bellissimo
• Eri Kamura
• Kathleen Krenzel

2
Backround

• Patient
• 43 year old woman
• Has abnormal liver functions
• Has a number of medical problems
• No history of diabetes, viral hepatitis,
  gallbladder disease, or alcohol use
• Takes a multivitamin and ibuprofen

3
Family History Of Obesity

• Married to obese husband with two children
• Both overweight
• Works at home
• Father deceased, 61 secondary complications due
  to diabetes
• Mother, 64, has hypertension and coronary artery
  disease
• Brother, 36, hypertensive
• Sister, 40, adult onset diabetes

4
Physical Examination

• Weighs 248 pounds at 52
• Body mass index 45.8
• Blood pressure 144/88 mmHg
• Resting heart rate is 84 bpm (average is 65-70)
• Besides obese heart sounds normal
• Tenderness to liver

5
Laboratory Evaluations

• Normal electrolytes
• Blood sugar 96 mg/dl
• Slightly anemia
• Elevated lipids
• Cholesterol 238 mg/dl
• Triglycerides 452 mg/dl
• HDL 49 mg/dl, LDL 158 mg/dl
• NO thyroid issues
• Many liver problems

6
Biopsy of Liver

• CT scan of the abdomen
• Showed hypodense regions in liver consistent with
  steatosis (fatty infiltration of the liver)
• Biopsy supported findings
• Fatty infiltration with sinusodial and
  pericellular fibrosis with ballooning
  degeneration of hepatocytes and Mallory hyaline

7
Diagnosis and Treatment

• Nonalcoholic steatohepatitis
• Calorie- restricted diet
• Hyperlipidemia treated with HMG-CoA reductase
  inhibitors
• Started on ursodeoxycholic acid

8
Liver Issues
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Nonalcoholic Steatohepatitis

• Pathogenesis is unclear
• insulin resistance
• release of toxic inflammatory proteins by fat
  cells (cytokines)
• oxidative stress (deterioration of cells) inside
  liver cells
• Indistinguishable liver biopsies as patients with
  alcoholic hepatitis

10
Biopsy of Liver
11
Pathway
12
References

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• http//images.google.com/imgres?imgurlhttp//dige
  stive.niddk.nih.gov/ddiseases/pubs/nash/images/bil
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  ih.gov/ddiseases/pubs/nash/h216w415sz29hle
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