TASL practice guidance on the clinical assessment and management of patients with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease and is significantly associated with obesity, insulin resistance, type 2 diabetes mellitus, metabolic syndrome, and cardiovascular disease. NAFLD has become the most prevalent chronic liver disease in Western countries, and the proportion of NAFLD-related cirrhosis among patients on liver transplantation waiting lists has increased. In light of the accumulated data about NAFLD, and to provide a common approach with multi-disciplines dealing with the subject, it has become necessary to create new guidance for diagnosing and treating NAFLD. This guidance was prepared following an interdisciplinary study under the leadership of the Turkish Association for the Study of the Liver (TASL), Fatty Liver Special Interest Group. This new TASL Guidance is a practical application guide on NAFLD and was prepared to standardize the clinical approach to diagnosing and treating NAFLD patients. This guidance reflects many advances in the field of NAFLD. The proposals in this guidance are meant to aid decision-making in clinical practice. The guidance is primar-ily intended for gastroenterology, endocrinology, metabolism diseases, cardi-ology, internal medicine, pediatric specialists, and family medicine specialists

A Case Report: Delta Superinfection and Pregnancy

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

Mallory-Denk Bodies in chronic hepatitis

Mallory-Denk Bodies (MDB) are important as investigators, suggesting MDB as an indicator of the histologic severity of chronic hepatitis, causes of which include hepatitis C, primary biliary cirrhosis (PBC), and nonalcoholic fatty liver disease (NAFLD). Matteoni et al scored MDB in patients with NAFLD as none, rare and many, and reported that MDB plays a prominent role in this classification scheme in an earlier classification system. In this study, we evaluated 258 patients with chronic hepatitis due to metabolic, autoimmune and viral etiologies. Liver biopsy samples were evaluated with hematoxylin and eosin, periodic acid-Schiff-diastase, Gordon and Sweet's reticulin, Masson's trichrome, and iron stains. Both staging and grading were performed. Additionally, MDB were evaluated and discussed for each disease. We examined patients with nonalcoholic steatohepatitis (NASH; 50 patients), alcoholic hepatitis (10 patients), PBC (50 patients), Wilson disease (WD; 20 patients), hepatitis B (50 patients), hepatitis C (50 patients) and hepatocellular carcinoma (HCC; 30 patients). Frequency of MDB was as follows; NASH: 10 patients with mild in 60% and moderate in 40% and observed in every stage of the disease and frequently seen in zone 3. PBC: 11 patients with mild in 10%, moderate in 70%, and cirrhosis in 20%, and frequently seen in zone 1. WD: 16 patients with moderate and severe in 60% and cirrhosis in 40% and frequently seen in zone 1. Hep B: 3 patients with mild in 66% and severe in 34%. Hep C: 7 patients with mild in 40% and moderate in 60% and observed in every stage. HCC: 3 patients with hep B in 2 patients. We found that there is no relationship between MDB and any form of chronic hepatitis regarding histologic severity such as alcoholic steatohepatitis and NAFLD and variable zone distribution by etiology. (C) 2011 Baishideng. All rights reserved

Mallory-Denk Bodies in chronic hepatitis

Mallory-Denk Bodies (MDB) are important as investigators, suggesting MDB as an indicator of the histologic severity of chronic hepatitis, causes of which include hepatitis C, primary biliary cirrhosis (PBC), and nonalcoholic fatty liver disease (NAFLD). Matteoni et al scored MDB in patients with NAFLD as none, rare and many, and reported that MDB plays a prominent role in this classification scheme in an earlier classification system. In this study, we evaluated 258 patients with chronic hepatitis due to metabolic, autoimmune and viral etiologies. Liver biopsy samples were evaluated with hematoxylin and eosin, periodic acid-Schiff-diastase, Gordon and Sweet’s reticulin, Masson’s trichrome, and iron stains. Both staging and grading were performed. Additionally, MDB were evaluated and discussed for each disease. We examined patients with nonalcoholic steatohepatitis (NASH; 50 patients), alcoholic hepatitis (10 patients), PBC (50 patients), Wilson disease (WD; 20 patients), hepatitis B (50 patients), hepatitis C (50 patients) and hepatocellular carcinoma (HCC; 30 patients). Frequency of MDB was as follows; NASH: 10 patients with mild in 60% and moderate in 40% and observed in every stage of the disease and frequently seen in zone 3. PBC: 11 patients with mild in 10%, moderate in 70%, and cirrhosis in 20%, and frequently seen in zone 1. WD: 16 patients with moderate and severe in 60% and cirrhosis in 40% and frequently seen in zone 1. Hep B: 3 patients with mild in 66% and severe in 34%. Hep C: 7 patients with mild in 40% and moderate in 60% and observed in every stage. HCC: 3 patients with hep B in 2 patients. We found that there is no relationship between MDB and any form of chronic hepatitis regarding histologic severity such as alcoholic steatohepatitis and NAFLD and variable zone distribution by etiology

Understanding mechanisms of the pathogenesis of nonalcoholic fatty liver disease

A central issue in the understanding of the pathogenesis of nonalcoholic fatty liver disease is the problem of the underlying mechanisms which are not fully understood. In the setting of excessive central adiposity, insulin resistance is the major underlying cause of fat accumulation in hepatocytes. Because of the difficulties with human trials, several animal models have been developed for this purpose mainly characterized as follows: genetically disturbed or murine fatty liver, methionine-choline deficient diet fed or murine steatohepatitis, and high-fat or sucrose diet fed models. Although these animal models have provided useful information, none of them accurately reflect genetic, metabolic and biochemical characteristics of the human disease