liver disease脂肪肝课件

liver disease脂肪肝课件

ID:18894558

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页数:63页

时间:2018-09-22

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1、FattyLiverDiseaseJamieBlazek,MPH,APRN,FNP-CLiverTransplantDepartmentOchsnerHealthSystemsNewOrleans,LaDisclosuresNoneObjectivesIdentifyriskfactorsforfattyliverdiseaseOrderappropriatescreeningtestsDiagnoseandtreatfattyliverdiseaseInitiateappropriatereferralsTerminologyALD:AlcoholicLiverDiseaseS

2、ignificantalcoholconsumption*>21drinks/weekformales>14drinks/weeksforfemalesNAFLD:Non-AlcoholicFattyLiverDiseasesteatosiswithouthepatocyteinjuryNASH:Non-AlcoholicSteatohepatitissteatosiswithinflammation,hepatocyteinjurywithorwithoutfibrosis*Sanyal,etalHepatology2011FattyliverNormalliverStatis

3、ticsAlcoholicliverdisease15millionpeopleabuse/overuseETOHinUSA90%ofthosewilldevelopfattyliversModerateusewithanotherriskfactorNon-alcoholicliverdiseaseMostcommonchronicliverdiseaseinUSA4thmostcommonreasonforlivertransplantProjectedtobethemostcommonin10-20yrsUpto20-40%adults6millionchildrenBy2

4、020NaturalHistoryofFLD fattyliversteatohepatitis steatohepatitis+fibrosis steatohepatitis+cirrhosis cryptogeniccirrhosisMortalityrisk: CirrhoticswithNAFLDvshepatitisCSanyal,etalHepatology2006:NAFLDhadlowerrateofmortalityYatsuji,etalGastroenterologyandHepatology2009:NodifferenceBothshowedp

5、tswithNAFLDatlowerriskforHCCthanHepatitisCpts.NAFLD:riskfactorsMiddleageFemalegenderOver-weightorobeseViralhepatitisIronoverloadMedicationsRapidweightlossStarvation/refeedingsyndromeReye’ssyndromeAuto-immunediseaseMalnutritionAbetalipoproteinemiaOvergrowthofbacteriainsmallintestinesTPNAcutefa

6、ttyliverofpregnancyHELLPsyndromeHispanicethnicityHereditaryRiskfactors:EstablishedassociationObesityType2DM:insulinresistance(IR)DyslipidemiaMetabolicsyndrome(MS)Riskfactors:EmergingassociationPolycysticovarysyndromeHypothyroidismObstructivesleepapneaHypopituitarismHypogonadismPancreatic-duod

7、enalresectionRiskfactor:MedicationsAmiodaroneMethotrexateTamoxifenCorticosteroidsDiltiazemValproicacidHighlyactiveantiretroviraltherapyRiskfactor:BacteriaovergrowthGrieco,etal.Hepatology200935ptswithNAFLDbxconfirmed27ptswithceliacdisease24hea

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