Non-alcoholic fatty liver disease other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Liver biopsy may be helpful in the diagnosis of non-alcoholic fatty liver disease. Findings on biopsy include macrovesicular steatosis, inflammation, ballooning degeneration, zone 3 perivenular/periportal/perisinusoidal fibrosis and, finally, mallory bodies.

Other Diagnostic Studies

  • Liver biopsy is considered as a gold-standard for diagnosing, grading, and staging NAFLD.

Complications

  • Requires dexterity and skill
  • Invasive test
  • Associated with significant bleeding risk in patients with clotting abnormalities due to hepatic disease.

Complications

Complications of liver biopsy are rare but include

  • Pain
  • Hypotension
  • Peritonitis
  • Intraperitoneal hemorrhage
  • Biliary injury

Findings

Classically, biopsy reveals:[1][2]

  • Macrovesicular steatosis
  • Inflammatory cells
  • Ballooning degeneration
  • Zone 3 perivenular/periportal/perisinusoidal fibrosis
  • Mallory bodies

Interpretation

  • Histologic changes in NAFLD are very similar to those in alcoholic hepatitis and may also mimic those seen in chronic HCV infection
  • The spectrum of abnormalities varies from simple bland steatosis to NASH, in which steatosis is associated with mixed inflammatory cell infiltration, mostly lobular, and liver injury.
  • Cell injury is manifested by hepatocyte ballooning as well as by Mallory hyaline and acidophilic bodies.
  • Fibrosis is classically perisinusoidal/perivenular and may lead to bridging fibrosis and cirrhosis.
  • Although portal tracts are relatively spared in adult NAFLD, children with this condition may have a predominance of portal inflammation and fibrosis as opposed to lobular involvement.
  • Compared with alcoholic hepatitis, NASH is associated with a higher prevalence of nuclear vacuoles and steatosis, while alcoholic hepatitis tends to produce periportal and pericellular fibrosis.
  • Alcoholic hepatitis presents with identical histology but patient history and/or biochemistry will indicate prolonged, excessive alcohol intake.[3]

References

  1. Angula P. Nonalcoholic Fatty Liver Disease. NEJM. 2002 346(16):1221-31
  2. Brunt EM, Janney CG, Di Bisceglie AM et al. Nonalcoholic steatohepatitis: A proposal for grading and staging the histological lesions. Am. J. Gastroenterol. 1999; 94(9):2467-2474
  3. Skelly et al. Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. J Hepatol 2001;35:195-9

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