Non-alcoholic fatty liver disease – basic information and exemplary cases

Non-alcoholic fatty liver disease (NAFLD) is one of the most common diseases of this organ.

Persons with type 2 diabetes, overweight and obesity, metabolic syndrome, as well as at age > 50 years are particularly vulnerable to the development of NAFLD. The disease, especially in its more advanced form – NASH (non-alcoholic steatohepatitis), is one of the most common causes of the increase of liver enzymes.

Pathogenesis is associated with insulin resistance and abnormal lipid metabolism. Initial diagnosis is based on imaging techniques, especially easily accessible ultrasonography and laboratory studies. The final diagnosis is based on pathomorphological assessment of liver specimens; however, it is necessary only in some cases. NAFLD is the risk factor of liver cirrhosis and hepatocellular carcinoma. The treatment consists of proper diet, physical exercise, loss of weight, and pharmacotherapy. The medicines improving the laboratory results and particularly also pathomorphological scores are ursodeoxycholic acid (UDCA), vitamin E in big dose and glitazons.

Two exemplary cases are presented in this article. The first one is the woman at the middle age with the minor ailments in the abdominal cavity, obesity, insulin-independent diabetes and arterial hypertension. On the base of anamnesis and physical examination, US and laboratory tests, the diagnosis of simple liver steatosis was made. UDCA at a dose of 750 mg/day and the low-caloric diet was applied. The partial regression of the disease after 6 months was achieved. The second case is the 45 years old man with obesity and hyperlipidaemia in which on the base of overall clinical state as well as US and laboratory tests, NASH was suspected. The final diagnosis of NASH was based on pathomorphological assessment of liver biopsy specimens. UDCA at a dose of 750 mg per day together with vitamin E at a dose of 400 mg per day were applied with improvement of laboratory results observed after 3 months of treatment.