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Once hydrated and glucose 5% of hepatocytes NAFL without hepatocyte damage NASH with hepatocyte damage Strong associations has been found with: obesity, diabetes, metabolic syndrome, PCOS, prolonged TPN, certain drugs Excess energy intake cause fat formation as vesicles inside hepatic cells that lead to steatosis Complications Fibrosis (3040%) Cirrhosis (10%) Hepatocellular carcinoma (HCC) Clinical Features -Mostly asymptomatic -RUQ pain, acanthosis nigricans -End-stage cirrhosis symptoms -Elevated LFT (25x), Ferritin (up to 60% cases) Diagnosis -Imaging: Ultrasonography, Ultrasonic elastography, MRE, Fibroscan - Liver biopsy for unexplained prolonged LFT elevation --- Treatment Strategies Lifestyle modification (510% weight loss) Caffeinated drip coffee fibrosis & HCC risk Omega-3 fatty acids intake Thiazolidinediones ( insulin sensitivity, inappropriate lipolysis) Vitamin E (not recommended more than 400Unites/day in diabetes) Bariatric surgery (effective in morbid obesity) Last resort: Liver transplant To view or add a comment, sign in Berberine ameliorates diabetic nephropathy by inhibiting TLR4/NF-B pathway Liping Zhu 1, Jiakai Han 1, Rongrong Yuan 1, Lei Xue 1, Wuyan Pang 2 Affiliations Expand PMID: 29604956 PMCID: PMC5878418 DOI: 10.1186/s40659-018-0157-8 Abstract Background: Diabetic nephropathy (DN) is the leading cause of end-stage renal failure, contributing to severe morbidity and mortality in diabetic patients

doi:10.1046/j.1524-475x.2003.11105.x