TAILIEUCHUNG - Fatty Liver Disease : Nash and Related Disorders - part 8

1 steatohepatitis không nhi nghiện rượu (NASH) là một hình thức toàn cầu và ngày càng phổ biến của bệnh gan mạn tính được tìm thấy chủ yếu trong kháng insulin béo phì trước khi thanh thiếu niên và thanh thiếu niên | 19 Fatty Liver Disease NASH and Related Disorders Edited by Geoffrey C. Farrell Jacob George Pauline de la M. Hall Arthur J. McCullough Copyright 2005 Blackwell Publishing Ltd NAFLD NASH in children Joel E. Lavine Jeffrey B. Schwimmer Key learning points 1 Paediatric non-alcoholic steatohepatitis NASH is a global and increasingly prevalent form of chronic liver disease found mainly in obese insulin-resistant pre-adolescents and adolescents. 2 Paediatric NASH differs histologically from that found in adults with respect to the extent of fat and the location of fibrosis and inflammation. 3 Vigorous exercise diet change and weight loss is the most desirable therapy. If this is unsuccessful either oral vitamin E or metformin may be beneficial. Confirmation of efficacy is required in controlled randomized masked trials with clinically relevant end-points. Abstract Non-alcoholic steatohepatitis NASH is an increasingly prevalent and global problem in both children and adults. NASH is a subset of non-alcoholic fatty liver disease NAFLD likely to be the most common chronic liver condition in industialized nations. The diagnosis is predicated on the finding of macrovesicular steatosis with accompanying inflammation hepatocellular injury and fibrosis. Important differences exist between adult and paediatric NASH in terms of the extent quality and location of the inflammatory and fibrotic process. Conditions such as Wilson s disease alcoholic steatohepatitis or hepatitis C virus infection may mimic these findings and need to be excluded. All paediatric clinical series report that NASH is more frequently found in boys than girls and that the usual age at presentation is approximately 12 years. The vast majority of patients are obese and usually present incidentally with elevated serum aminotransferases. Physical examination often reveals hepatomegaly and acanthosis nigricans. Clin ical evaluation usually reveals modest elevation of serum alanine aminotransferase ALT greater .

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