Non-alcoholic fatty liver disease classification: Difference between revisions

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Revision as of 17:30, 21 December 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Non-alcoholic fatty liver disease may be classified based on clinical presentation into non-alcoholic fatty liver and non-alcoholic steatohepatitis.

Classification

Non-alcoholic fatty liver disease may be classified based on clinical presentation into non-alcoholic fatty liver and non-alcoholic steatohepatitis.^[1]^[2]^[3]

Based on clinical presentation
Non-alcoholic fatty aliver	Non-alcoholic steatohepatitis
Benign	Aggressive
Non-progressive	Can progress to cirrhosis Rarely can give rise to hepatocellular carcinoma
Based on histopathology
Steatosis
Steatohepatitis Grade: depends on degree of steatosis and necroinflammatory activity Stage: depends on degree of fibrosis

Grading

NAFLD activity score is employed for grading steatohepatitis of NASH. NAS represents the sum of scores for steatosis, lobular inflammation, and ballooning.^[4]^[5]

Component	Range	Score
Steatosis	<5%	0
	5-33%	1
	34-66%	2
	>66%	3
Lobular Inflammation	None	0
	<2 focci	1
	2-4	2
	>4	3
Hepatocyte Balloning	None	0
	Few ballooned cells	1
	Many ballooned cells	2
Interpretation	0-2	Non-diagnostic
	3-4	Borderline
	5-8	Diagnostic

Staging

Staging
Stage 1	Zone 3 fibrosis Perisinusoidal fibrosis Portal/ periportal fibrosis
Stage 2	Perisinusoidal and portal/periportal fibrosis
Stage 3	Bridging fibrosis
Stage 4	Cirrhosis

References

↑ Hashimoto E, Tokushige K, Ludwig J (2015). "Diagnosis and classification of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: Current concepts and remaining challenges". Hepatol Res. 45 (1): 20–8. doi:10.1111/hepr.12333. PMID 24661406.
↑ Cobbina E, Akhlaghi F (2017). "Non-alcoholic fatty liver disease (NAFLD) - pathogenesis, classification, and effect on drug metabolizing enzymes and transporters". Drug Metab Rev. 49 (2): 197–211. doi:10.1080/03602532.2017.1293683. PMC 5576152. PMID 28303724.
↑ Monteiro JM, Monteiro GM, Caroli-Bottino A, Pannain VL (2014). "Nonalcoholic fatty liver disease: different classifications concordance and relationship between degrees of morphological features and spectrum of the disease". Anal Cell Pathol (Amst). 2014: 526979. doi:10.1155/2014/526979. PMC 4333905. PMID 25763333.
↑ Vizuete J, Camero A, Malakouti M, Garapati K, Gutierrez J (2017). "Perspectives on Nonalcoholic Fatty Liver Disease: An Overview of Present and Future Therapies". J Clin Transl Hepatol. 5 (1): 67–75. doi:10.14218/JCTH.2016.00061. PMC 5411359. PMID 28507929.
↑ "Transplant Pathology Internet Services".

Template:WS Template:WH

[pmid24661406-1] Hashimoto E, Tokushige K, Ludwig J (2015). "Diagnosis and classification of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis: Current concepts and remaining challenges". Hepatol Res. 45 (1): 20–8. doi:10.1111/hepr.12333. PMID 24661406.

[pmid28303724-2] Cobbina E, Akhlaghi F (2017). "Non-alcoholic fatty liver disease (NAFLD) - pathogenesis, classification, and effect on drug metabolizing enzymes and transporters". Drug Metab Rev. 49 (2): 197–211. doi:10.1080/03602532.2017.1293683. PMC 5576152. PMID 28303724.

[pmid25763333-3] Monteiro JM, Monteiro GM, Caroli-Bottino A, Pannain VL (2014). "Nonalcoholic fatty liver disease: different classifications concordance and relationship between degrees of morphological features and spectrum of the disease". Anal Cell Pathol (Amst). 2014: 526979. doi:10.1155/2014/526979. PMC 4333905. PMID 25763333.

[pmid28507929-4] Vizuete J, Camero A, Malakouti M, Garapati K, Gutierrez J (2017). "Perspectives on Nonalcoholic Fatty Liver Disease: An Overview of Present and Future Therapies". J Clin Transl Hepatol. 5 (1): 67–75. doi:10.14218/JCTH.2016.00061. PMC 5411359. PMID 28507929.

[urlTransplant_Pathology_Internet_Services-5] "Transplant Pathology Internet Services".

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@@ Line 38: / Line 38: @@
 ===Grading===
 NAFLD activity score is employed for grading steatohepatitis of NASH. NAS represents the sum of scores for [[steatosis]], lobular [[inflammation]], and ballooning.<ref name="pmid28507929">{{cite journal |vauthors=Vizuete J, Camero A, Malakouti M, Garapati K, Gutierrez J |title=Perspectives on Nonalcoholic Fatty Liver Disease: An Overview of Present and Future Therapies |journal=J Clin Transl Hepatol |volume=5 |issue=1 |pages=67–75 |year=2017 |pmid=28507929 |pmc=5411359 |doi=10.14218/JCTH.2016.00061 |url=}}</ref><ref name="urlTransplant Pathology Internet Services">{{cite web |url=http://tpis.upmc.com/changebody.cfm?url=/tpis/schema/NAFLD2006.jsp |title=Transplant Pathology Internet Services |format= |work= |accessdate=}}</ref>
-{|border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable"
+{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable"
-!style="background:#efefef;" |Component
+! style="background:#efefef;" |Component
-!style="background:#efefef;" |Range
+! style="background:#efefef;" |Range
-!style="background:#efefef;" |Score
+! style="background:#efefef;" |Score
 |-
 | rowspan="4" |Steatosis
@@ Line 80: / Line 80: @@
 |-
 | rowspan="3" style="background:#efefef;" |Interpretation
-|style="background:#efefef;" |0-2
+| style="background:#efefef;" |0-2
-|style="background:#efefef;" |Non-diagnostic
+| style="background:#efefef;" |Non-diagnostic
 |-
-|style="background:#efefef;" |3-4
+| style="background:#efefef;" |3-4
-|style="background:#efefef;" |Borderline
+| style="background:#efefef;" |Borderline
 |-
-|style="background:#efefef;" |5-8
+| style="background:#efefef;" |5-8
-|style="background:#efefef;" |Diagnostic
+| style="background:#efefef;" |Diagnostic
 |}
 ===Staging===
+{| class="wikitable"
+! colspan="2" |Staging
+|-
+|Stage 1
+|Zone 3 fibrosis
+Perisinusoidal fibrosis
+Portal/ periportal fibrosis
+|-
+|Stage 2
+|Perisinusoidal and portal/periportal fibrosis
+|-
+|Stage 3
+|Bridging fibrosis
+|-
+|Stage 4
+|Cirrhosis
+|}
 ==References==