الفهرس 
Aim of The WorkOnly 14 pages are availabe for public view
 |  | from | 98 |  |  |
| | | from | 98 | | |
Abstract
Nonalcoholic fatty liver disease is an increasingly common global entity that encompasses a spectrum of histological liver changes ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) with/without fibrosis, “cryptogenic” cirrhosis, and hepatocellular carcinoma (HCC) occurring in the absence of excessive alcohol consumption and other competing etiologies of chronic liver disease . The studies estimated that the overall global prevalence of NAFLD diagnosed by imaging is around 25.24% .The highest prevalence of NAFLD is reported from the Middle East (31.79% ) increasing prevalence of NAFLD is associated with major risk factors such as obesity, dyslipidemia, type 2 diabetes mellitus (T2DM) ,hypertention, genetic variations as ( PNPLA3), And the metabolic syndrome. Extrahepatic manifestations of NAFLD : as Cardiovascular disease ,Type 2 DM , Osteoporosis, Obstructive Sleep Apnea ,psoriasis and NAFLD can accelerate the development and progression of CKD.
Diagnosis of NAFLD is established when > 5% of the hepatocytes show steatosis in the absence of causes for secondary steatosis, such as excessive alcohol consumption . NAFLD fibrosis score (NFS) used to predict the severity of liver involvement is the most validated non-invasive tool to assess the disease. NFS is based on age, body mass index, aspartate transaminase (AST), ALT, platelets, albumin, and presence or absence of impaired fasting glucose. Ultrasonography, CT and MRI of the liver are the standard imaging modalities used in clinical practice for diagnosis of NAFLD .
Transient elastography (TE) is an ultrasound-based imaging technique to detect the degree of fibrosis in patients with NAFLD and NASH. Liver biopsy is the only tool available for assessing the degree of inflammation and cell injury and to stage for the degree of fibrosis.
Summary
59
Management of NAFLD:
Lifestyle modification consisting of diet, exercise, and weight loss has been advocated to treat patients with NAFLD in all guidelines .
There are various pharmacological agents available for the management of NAFLD. Many of them have been found to be ineffective and some of them have high risk-benefit ratio .
- Antioxidants : Currently, vitamin E 800 units per day is recommended in nondiabetic individuals with biopsy-proven NASH.
- Insulin sensitizing agents :as Pioglitazone ,metformin and (GLP-1) although several studies have shown an improvement in serum aminotransferases and insulin resistance, but does not significantly improve liver histology.
- Statins decrease hepatic transaminases and hepatic fat but have no effect on hepatic fibrosis.
- Bariatric surgery improves or eliminates comorbid disease in most patients and improves long-term survival and death from cardiovascular disease (CVD) and malignancy, the two most common causes of death in NAFLD.
Nonalcoholic fatty liver disease and hepatocellular cancer :
Patients with NAFLD are at increased risk for developing HCC, however this risk is typically limited (but not exclusive) to those with advanced fibrosis or cirrhosis.
The risk Factors for NAFLD-HCC is metabolic syndrome, fibrosis,
diabetes mellitus, obesity and hepatic iron accumulation .
- Features of patients with HCC due to NASH differs from the features of patients with HCC due to other etiologies. patients with NAFLD-HCC tend to be male, older, and have one or more features of
Summary
60
metabolic syndrome comorbidities like heart diseases, diabetes, arterial hypertension and other diseases linked to metabolic syndrome.
- The treatment options of HCC in a NAFLD patients is the same for HCC due to other aetiologies.
- NAFLD and Extrahepatic cancers :
Accumulating evidence suggested that NAFLD was associated with an increased risk of various cancers, including extrahepatocellular cancers as esophageal, gastric, colorectal, Pancreatic breast, and prostate cancer.
- Colorectal cancer : NAFLD and colorectal tumours share many metabolic risk factors (mainly type 2 diabetes and obesity) and proinflammatory and profibrotic molecular pathways .NAFLD patients should undergo a closer surveillance for CRC risk according to screening guidelines .
- Esophageal and gastric cancer : NAFLD is independently associated with increased risk of erosive oesophagitis, which may be complicated by oesophageal ulcers, peptic stricture, Barrett’s esophagus and oesophageal adenocarcinoma.
pancreatic cancer : A new studies show that NAFLD is associated with an increased risk of pancreatic cancer.
- breast cancer : The association between breast cancer risk in postmenopausal women and components of Metabolic syndrome has been provided by several large studies .
- cholangiocarcinoma : Recent data suggested that NAFLD might increase the risk of CCA, particularly the iCCA subtype.
- Prostate Cancer : an important study show that prostate cancer developed in 12.6% of NAFLD compared to 3.5% in HCV patients. And the incidence of prostate cancer in NAFLD was higher than in the general population.