Post on 07-May-2015
Fatty Liver Disease
Neil Theise, MDDepts of Pathology and Medicine (Digestive Diseases)
Beth Israel Medical Center – Albert Einstein College of MedicineNew York City
AlcoholicAnd
Non-alcoholic Fatty Liver Disease
(NAFLD)
AlcoholicAnd
Non-alcoholic Fatty Liver Disease
(NAFLD)
NOT NASH!
Non-alcoholic Fatty Liver Disease
(NAFLD)Obesity
Diabetes MellitusDyslipidemia syndromes
Drug toxicities
Non-alcoholic Fatty Liver Disease
(NAFLD)Obesity
Diabetes MellitusDyslipidemia syndromes
Metabolic Syndrome!!!Metabolic Syndrome!!!
Obesity Trends* Among U.S. AdultsBRFSS, 1985
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1986
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1987
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1988
No Data <10% 10%–14%No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1989
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1990
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1991
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1992
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1993
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1994
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1995
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1996
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1997
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 1998
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 1999
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 2000
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 2001
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2002
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2003
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2004
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2005
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. AdultsBRFSS, 2006
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. AdultsBRFSS, 2007
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity Trends* Among U.S. AdultsBRFSS, 2008
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
And now……pathology!
Independent of etiology,3 features to assess:
Independent of etiology,3 features to assess:
1. Steatosis
Independent of etiology,3 features to assess:
1. Steatosis2. Steatohepatitis
Independent of etiology,3 features to assess:
1. Steatosis2. Steatohepatitis3. Steatofibrosis
1. Steatosis
1. Steatosis
1. Steatosis
1. Steatosis
1. Steatosis
1. Steatosis
1. SteatosisMILD
1. Steatosis MODERATE
1. Steatosis
SEVERE
1. Steatosis
2. Steatohepatitis
2. Steatohepatitis• Hepatocyte ballooning
2. Steatohepatitis• Hepatocyte ballooning
• Mallory bodies
1. Steatosis
2. Steatohepatitis• Hepatocyte ballooning
• Mallory bodies• Neutrophils
1. Steatosis
2. Steatohepatitis
Portal inflammation…?
3. Steatofibrosis• Perivenular fibrosis
3. Steatofibrosis• Perivenular fibrosis• Pericellular fibrosis
3. Steatofibrosis• Perivenular fibrosis
with central hyaline sclerosis
3. Steatofibrosis• Perivenular fibrosis• Pericellular fibrosis
• Central-portal linking
CIRRHOSIS
3. Steatofibrosis• Perivenular fibrosis• Pericellular fibrosis
• Central-portal linking
ActiveEtOH Use
CIRRHOSIS
3. Steatofibrosis• Perivenular fibrosis• Pericellular fibrosis
• Central-portal linking
and back again…?
3. Steatofibrosis• Perivenular fibrosis• Pericellular fibrosis
• Central-portal linking
ActiveEtOH Use
> 6 monthsabstinence
ActiveEtOH Use
> 6 monthsabstinence
4 yearsabstinence
Sample Diagnoses
LIVER: NEEDLE BIOPSY - STEATOSIS, MODERATE, WITH STEATOHEPATITIS AND STEATOFIBROSIS (CENTRAL-PORTAL SEPTA) c/w ALCOHOLIC LIVER DISEASE.
LIVER: NEEDLE BIOPSY - STEATOSIS, SEVERE, WITH STEATOHEPATITIS AND STEATOFIBROSIS (CENTRAL-PORTAL SEPTA) c/w ALCOHOLIC LIVER DISEASE.
LIVER: NEEDLE BIOPSY - STEATOSIS, MODERATE, INDICATIVE OF FATTY LIVER DISEASE, ? ALCOHOLIC VS. NON-ALCOHOLIC
LIVER: NEEDLE BIOPSY - STEATOSIS, MODERATE, WITH STEATOHEPATITIS COMPATIBLE WITH OBESITY RELATED FATTY LIVER DISEASE.
Special Case Fat!
In children….
MicrovesicularSteatosis
MicrovesicularSteatosis
5ive Causes!
Oil Red O stain
Diffuse microvesicular steatosis
• Reye’s syndrome• Fatty liver of pregnancy• Tetracycline toxicity• Valproate toxicity• (HAART)• Vomiting sickness of Jamaica (from eating the unripened fruit of the Ackee tree)
Special Type of Fat!!!
?’s