(17okt) fatty liver - dr. salman

8/18/2019 (17Okt) Fatty Liver - Dr. Salman

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dr. Salman Paris H. SpPDBagian Ilmu Penyakit Dalam RSUD Budhi Asih/ FK UPN V Jakarta


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NAFLD didefnisikan : ditemukannya steatosis(retensi lemak abnormal di dalam sel) dengan

pemeriksaan imaging atau dengan pemeriksaanhistologi, serta penyebab terjadinya akumulasilemak di hati tidak disebabkan oleh konsumsialkohol berlebihan, penggunaan obat

steatogenik, atau gangguan hereditas.NAFLD dikaitkan dengan aktor risiko metabolik,

seperti obesitas, diabetes, dan dislipidemia.

NAFLD dibagi menjadi ! katergori, yaitu NAFL

(nonal"oholi" atty li#er) dan NA$%(nonal"oholi" steatohepatitis).

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Prevalence &NAFLD is seen 'orld'ide andis the most "ommon li#er disorder in

estern industrialied "ountries, 'here themajor risk a"tors or NAFLD, "entralobesity, *ype ! D+, dyslipidemia, andmetaboli" are "ommon.

n the -$, studies report a pre#alen"e oNAFLD o /0123.

orld'ide, NAFLD has a reported

pre#alen"e o 20453.

67D6+8L89


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Time Period: Prevalence ofNAFLD:

;planation) "ould lead to mis"lassif"ation andlikely underestimated the true pre#alen"e o NAFLD, sin"e patients'ith NAFLD may ha#e normal serum aminotranserases.

7?6@AL6N6N%AN6$ DA*A


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8#er the same three time periods, the study also notedin"reases in the rates o other "omponents o the

metaboli" syndrome, in"luding obesity, *ype! D+ andsystemi" hypertension.

Obesity DM2

Systemic HTN;


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Patients wit NAFLD !"artic#larly tosewit NASH$ often ave one or morecom"onents of te metabolic syndrome:

8besity

$ystemi" hypertension

Dyslipidemia

nsulin resistan"e or o#ert diabetes

A$$8A*8N *% 8*%6?

D$8?D6?$


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Adipo"yte is an 6ndo"rine

8rgan

7


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*he *'o %* on"ept

8

st

%*

!nd

%*


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*he *'o %it on"ept

9

Fatty Liver

1st Hit

Damaged Liver

2nd Hit

Oxidative Stress

Toxins

InfammatoryMolecules

Susceptibility

Donnelly et al. J. Clin. Invest. 113: 1343, 2005; Day and James.astroenterol. 114: !42, 1""!

DietFFA

Fats urnt !"D"#T$

Saturated

%&nsaturated

Apoptosis


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*hese are a ontinuum

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@?isk

FA* B53 nCammation

$"arring DLD

? and+$

st %* !nd %*

? and+$


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Natural %istory o Fatty Li#er

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*he Ne' Defnition o +$

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Waist Circum ≥ 90 (M), 80 (F)

Triglycerides >150 mg

H! "#0 (M) " 50 (F)

ysglycemia F$% >100 &r M

Hy'ertesi& >10 &r 85

*+ -&r ay &- t.e a/&e c&diti&s

! o 5

!


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6a"h 7erpetuating the 8ther

1

NAFLD is teHe"atic com"onent

of MS


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hat is the impli"ation *hese are 8N6 'e fnd one &

look or the other

1#


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? Adipone"tin 8besity, 77A?0γ

7, , $,L6

715/ A,6

9lutathione

77A?0 α, γ

$?6E7a,",!

NA$%, @ ?isk

Free radi"als Antio>idants

uer ells

NF0κ E

8! stress,

nCmma.

Leptin,

IL-6 FFA, PC1

Rad, TNF-

NEFAs NO

TNF-

ATP

in oxidativestress

in oxidation

in DAG & TAG

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*he ?isk Fa"tors

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hat auses Fatty Li#er GAl"ohol

8besity,

*!D+

*rigly"erides

+edi"inesH, *7N

ilsonsIs Disease

α0 Anti0trypsin

A %epatitis%epatitis

nherited syndromes

17

H +*J, @A, A"etaminophen, *, *amo>ien,Nefdepine, Amiodarone, l1


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lini"al 7resentation

Asymptomati"

?outine blood tests

Li#er enymes

6nlarged Li#er (K4)?- periumb. 7ain

Fatigue. +alaise

Anore>ia, Nausea

B ;/3 are obese

-$9 eKo atty li#er

A"anthosisNigri"ans

D+, %*N, Lipid abn.

8$A$, $noring

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Laboratory Abnormalities

! 0 1 old 97* M98*

$98*: $97* ?atio

A7 slight in K4Dyslipidemia 0 *9FE9 and 77E9 E-N M reatinine 0 N

Normal Albumin. 7*Lo' ANA O in

4!/

$erum Ferritin ron saturation$98*: $97* ?atio B

i irrhosis sets in

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7otential Drugs or NAFLDnsulin $ensitiing Agents

9litaonesP +etormin

Lipid0Lo'ering Agents

lofbrateP 9emfbroilFuture 7otential

*reatments

Anti0fbroti"sP 7robioti"s

$ilymarinP $elenium

+embrane0$tabiliing

-rso deo>y "holi" A"id

Eetaine ($A+)

Anti08>idants@itamin 6P @itamin

Le"ithinP β 0arotene

@itamin E omple>

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-rso deo>y "holi" A"id 0 -DA

6#iden"e o eQ"a"y in NA$%KNAFLD is eRui#o"al

4// mg bid or / mgKkg in t'o di#ided doses 78

9i#en up to ! to !1 months 0 depends on response

holestasis, 7E, 7$, A"ute #iral hepatitis, %E@, %@

hroni" hepatitis, Al"oholi" li#er disease

Dissolution o "holesterol mi"roliths K gallstones

lass 6 drug in pregnan"y (not to be used in 87)

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*here is No 6e"ti#e Drug ?>.NAFLD and NA$% may resol#e 'ith 'eight lossLi#er at "ontent P No ee"t on fbrosis M nCam.

Diet and e>er"ise impro#e insulin sensiti#ity,

in"rease o>idati#e "apa"ity and utiliation o FFAs

eight loss has "lear benefts or @ risk M *!D+

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%erit adala bebera"a re&omendasi#nt#& tatala&sana dari "en'obatan NAFLD:

. 7enurunan berat badan dapa mengurangisteatosis hepatik, akan tetapi diperlukan penurunanberat badan paling sedikit /3 untuk memperbaiki

ne"roinCammation.!. 7asien dengan NAFLD tidak disarankan untukmengkonsumsi alkohol dalam jumlah yang banyak.4. 7emberian #itamin 6 (a0to"opherol)


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%erit adala bebera"a re&omendasi#nt#& tatala&sana dari "en'obatan

NAFLD:

1. 8mega04 dapat dipertimbangkan sebagai terapi linipertama pada pasien NAFLD denganhipertrigliseridemia.

5. +etormin tidak direkomendasikan sebagai terapispesik untuk penyakit hati pada de'asa dengan NA$%.2. 7ioglitaone dapat digunakan sebagai terapisteatohepatitis pada pasien dengan NA$% yang telahdibuktikan dengan biopsi, akan tetapi data keamanan

dan efkasi jangka panjang belum diketahui.=. $tatin dapat digunakan sebagai terapi dislipidemiapada pasien dengan NAFLD dan NA$%, akan tetapitidak direkomendasikan pada pasien dengan spesifkNA$%.(+A?)

2#


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*6?+AA$%

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*ake %ome 7oints

t is the main "ause o li#er enymesP snIt that

benign

$pe"trum o disease & NAFLD & NA$% & irrhosis 0 %

nsulin resistan"e, +$ are the key pathogeni" eaturesD+, *9, Non atty abdominal obesity, in"reasing age

Al'ays look or D+, *9, @D i you see atty li#er

7resently, the management is to impro#e ?, *9, D+

t is a marker o @ ?isk. ?>. impro#e insulin sensiti#ity

+odiy underlying metaboli" risk a"tors & diet, e>er"ise

-se +ayo s"oring to predi"t NA$% (fbrosis). No biopsy

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(17okt) fatty liver - dr. salman

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