Beware of fatty liver
1. Fatty liver is present in up to 30% of population, up to 60 % in patients who are at risk for heart disease and in up to 90 % of obese persons.
2. Nonalcoholic fatty liver disease (NAFLD) means presence of hepatic steatosis (fatty liver) when no other causes for secondary hepatic fat accumulation (heavy alcohol consumption) are present. NAFLD if not treated may progress to cirrhosis and is likely an important cause of cryptogenic cirrhosis.
3. NAFLD is subdivided into: Nonalcoholic fatty liver (NAFL) or simple fatty liver with no liver inflammation and Nonalcoholic steatohepatitis (NASH) or fatty liver with liver inflammation
4. Patients with NAFLD may have mild or moderate elevations in the SGOT and SGPT levels (liver enzymes). Normal SGOT and SGPT levels however do not exclude NAFLD. When elevated, the SGOT and SGPT levels are typically two to five times the upper limit of normal.
5. SGOT/SGPT ratio is less than one (unlike alcoholic fatty liver disease, which typically has a ratio greater than two)
6. The degree of SGOT and SGPT elevation does not predict the degree of liver inflammation or fibrosis, and a normal SGOT, SGPT levels does not exclude clinically important histologic injury.
7. The alkaline phosphatase may be elevated to two to three times the upper limit of normal.
8. Serum albumin and bilirubin levels are typically within the normal range, but may be abnormal in patients who have developed cirrhosis. When cirrhosis sets in one may have prolonged prothrombin time and cytopenias.
9. A serum ferritin greater than 1.5 times the upper limit of normal in patients with NAFLD may mean presence of inflammation.
10. SGOT > SGPT is seen in alcoholic liver disease, NASH, hepatitis C cirrhosis, dengue, acute muscle injury, H1N1 flu, Wilson’s disease.
11. SGOT/SGPT > 2 times and
Persistently high SGOT and SGPT more than 2 times normal require liver biopsy
Elevated γ-GT with otherwise normal liver test require no further workup.
SGOT, SGPT < 8 times are seen in hepatocellular or cholestatic liver disease SGOT SGPT > 25 times seen primarily in hepatocellular diseases.
Patients with jaundice from cirrhosis may have normal or only slight elevations of the liver enzymes.
12. A person with a history of viral hepatitis after age 10 is permanently deferred from giving blood. A person who has received a blood transfusion cannot donate blood for the next 12 months.
Fatty liver can develop within hours after a single large binge. Binge alcohol means consuming 150 ml in one hour or more than 160 ml inn one day.
Dr K K Aggarwal
Honorary Secretary general IMA and President Heart Care Foundation of India
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