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ID:18894558
大小:1.55 MB
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、020NaturalHistoryofFLDfattyliversteatohepatitissteatohepatitis+fibrosissteatohepatitis+cirrhosiscryptogeniccirrhosisMortalityrisk: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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