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How is non alcoholic fatty liver disease diagnosed?

Liver disease is also called hepatic disease. This is in terms of group of single number of diseases affecting the liver.

Non-alcoholic fatty liver disease is a liver disease.
- This is one cause of a fatty liver.
- This occurrs when fat is deposited (steatosis) in the liver.
- It is not due to excessive alcohol use.
- It is related to insulin resistance and the metabolic syndrome.
- This is involved with symptoms such as weight loss, metformin and thiazolidinediones.
- Non-alcoholic steatohepatitis (NASH) is the most extreme form of NAFLD.
- This is regarded as a major cause of cirrhosis of the liver of unknown cause.

Causes of Non Alcoholic Fatty Liver Disease
- Fatigue
- Malaise
- Dull right-upper-quadrant abdominal discomfort
- Mild jaundice
- Abnormal liver function tests
- Alcohol consumption of over 20 g/day
- Insulin resistance
- Metabolic syndrome
- Obesity
- Combined hyperlipidemia
- Diabetes mellitus (type II)
- High blood pressure

Secondary Causes
NAFLD can also be caused by some medications.
- Amiodarone
- Antiviral drugs (nucleoside analogues)
- Aspirin rarely as part of Reye’s syndrome in children
- Corticosteroids
- Methotrexate
- Tamoxifen
- Tetracycline

Diagnosis of Non Alcoholic Fatty Liver Disease
- Elevated liver enzymes
- A liver ultrasound showing steatosis.
- An ultrasound may also be used to exclude gallstone problems (cholelithiasis).
- Computed Tomography (CT) —a method of body imaging in which a thin X-ray beam rotates around the patient which provides a detailed view of the liver.
- A biopsy (tissue examination) of the liver is the only test widely accepted.
- FibroTest that estimates liver fibrosis.
- SteatoTest that estimates steatosis.
- Apoptosis has been shown to be the mechanism of hepatocyte destruction and caspase-cleaved cytokeratin 18 (M30-Apoptosense ELISA) in serum/plasma.

Relevant Blood Tests
- Erythrocyte sedimentation rate
- Glucose
- Albumin
- Renal function
- Coagulation related studies
- The INR (international normalized ratio)

Blood tests (serology) are usually used to rule out:
- Viral hepatitis (hepatitis A, B, C, EBV, CMV andherpes viruses),
- Rubella,
- Autoimmune related diseases
- Hypothyroidism

Diagnosis
- Abdominal Ultrasound
- AMA Test
- ERCP (Endoscopic Retrograde Cholangiopancreatography)
- Liver Biopsy
- Liver Panel
- Manifestations of Liver Disease
- Needle Biopsy

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What is Cirrhosis and what are causes of Cirrhosis?

Cirrhosis is a chronic (ongoing, long-term) disease of the liver. It means damage to the normal liver tissue.
- This tissue is the reason that keeps this important organ from working as it should.
- The liver gradually loses its ability to carry out its normal functions.
- This is called liver failure, which is also referred to as end-stage liver disease.
- The liver is the largest organ in the body and one of the most essential.

Causes of Cirrhosis

Cirrhosis can be caused by a number of conditions and sometimes there is no cause found too. This includes:
- Long-standing inflammation
- Poisons
- Infections
- Heart disease
- Chronic alcoholism
- Chronic hepatitis

Chronic Alcoholism
- Alcohol can poison all living cells.
- This causes liver cells to become inflamed and die.
- The death of liver cells leads your body to form scar tissue around veins of your liver.
- Healing liver cells form nodules, which also press on the liver veins.
- This scarring process occurs in 10-20 percent of alcoholics
- The most common form of cirrhosis in the United States.
- The severity of the process depends on how much you drink.
- How long you have been abusing alcohol.
- The amount of alcohol needed to injure the liver varies widely from individual to individual.
- Some families are more susceptible to cirrhosis than others.

Hepatitis
- Hepatitis means inflammation of the liver from any cause.
- It usually refers to a viral infection of the liver.
- Over many years the inflammation damages liver cells and leads to scarring.
- Hepatitis B , hepatitis C, and hepatitis D all can cause cirrhosis.
- Hepatitis B is the most common cause of cirrhosis.

Biliary Cirrhosis:
- Bile is a substance produced by the liver to help the body digest fats.
- Bile is carried from the liver to the gallbladder
- It is eventually into the intestines by small tubes called bile ducts.
- If these ducts become blocked, the bile backs up and can damage the liver.
- The liver becomes inflamed, starting the long process of cell damage that leads to cirrhosis.
- In adults, gallstones are a common cause of bile duct blockage.
- Surgery to remove the gallbladder also blocks the bile ducts.
- Children may be born with a condition that blocks the bile ducts called biliary atresia.
- This disease usually affects women aged 35-60 years.

Autoimmune Cirrhosis
- The body’s immune system defends against “invaders” such as bacteria, viruses, or allergens.
- Autoimmune diseases occur when the immune system begins to fight healthy body tissues and organs instead of the disease.
- In autoimmune hepatitis, the body’s immune system attacks the liver.
- This causes cell damage that leads to cirrhosis.

Non alcoholic fatty liver
This is a condition in which fat builds up in the liver that eventually causes scar tissue to form. This kind of cirrhosis is linked to:
- Diabetes
- Obesity
- Coronary artery disease
- Protein malnutrition
- Treatment with corticosteroids such as prednisone.
- It is sometimes called “steatohepatitis.”

Inherited Diseases
- A variety of genetic diseases can damage the liver.
- These are diseases that interfere with the metabolism of different substances by the liver.
They include:
- Wilson’s disease
- Cystic fibrosis
- Alpha-1 antitrypsin deficiency
- Hemochromatosis
- Galactosemia
- Glycogen storage disease

Drugs, Toxins and Infections
- Various substances and germs can cause damage to the liver.
- Certain medications (for example, acetaminophen [Tylenol]), poisons, and environmental toxins can lead to cirrhosis.
- Reactions to certain drugs can damage the liver. This is rare.
- Long-term infections with various bacteria or parasites can damage the liver and cause cirrhosis.

Cardiac Cirrhosis
- When your heart doesn’t pump well, blood “backs up” into the liver.
- This congestion causes damage to your liver.
- It may become swollen and painful.
- Later it becomes hard and less painful.

The cause of the heart failure may be:
- A heart valve problem
- Smoking
- Infection of the heart muscle
- Infection of the sac around the heart

Hyperthyroidism or active thyroid – Causes, Symptoms and Treatment

Thyroid is a butterfly shaped gland at the base of your neck and below Adam’s Apple and close to the collar bones. The wings are connected in the middle and spread on each side of wind pipe. Thyroid gland controls the rate at which every cell, tissue and organ in the body functions from your muscles, bones and skin to your digestive tract, brain, heart and more.

Thyroid secretes hormones T3 which is called thyroxine and T4 which is called triidothyronine. They control how fast and efficiently cells convert nutrients into energy. Thyroid gland is controlled by pituitary gland and it produces a thyroid stimulating hormone (TSH) and it pushes the thyroid gland to produce thyroid hormones in balancing quantities.

Hyperthyroidism or active thyroid is the result from excess production of thyroid hormones particularly T3. The increased level of T3 pushes up the body’s metabolism which is the main reason for losing weight despite eating well.

Symptoms of Hyperthyroidism
- Anxiety
- Fast heart rate
- Nervousness
- Irritability
- Muscle weakness
- Weight loss
- Hair loss
- Trembling hands
- Moist warm skin
- Heart intolerance
- Frequency of bowel movements increase
- Less or decreases menstrual flow
- Painful enlarged thyroid gland

Causes of Hyperthyroidism
- Hyperactive thyroid nodules
- Graves disease affecting people between age 30 and 50.
- Thyroiditis which is the inflammation of thyroid gland releasing excessive hormones and it is caused by virus.
- Over stimulated pituitary gland which produces too much TSH.
- Excessive iodine in the form of iodised salt, sea food, dairy products.
- Thyrotoxicosis is taking too much thyroid hormone while treating for hyperthyroidism.

Treatment for Hyperthyroidism
- Anti thyroid drugs interfere with gland’s ability to make T3 and T4 but they are accompanied by side effects like rash, itching, fever and very rarely liver inflammation and deficiency of white blood cells.
- Beta blockers to prevent symptoms of palpitations and tremors.
- Radioactive iodine treatment is done to damage and kill thyroid cells. The only side effect is the destruction of thyroid tissues.
- Surgery of land or nodules.