HEPATOBILIARY
SYSTEM
DR SREELEKSHMI S R
2.
Non-Alcoholic Fatty
Liver Disease (NAFLD)
DEFINITION
● Non-Alcoholic Fatty Liver Disease (NAFLD) is a
spectrum of liver disorders characterized by fat
accumulation (≥5% of hepatocytes) in individuals who
consume little to no alcohol. It includes:
• Non-Alcoholic Fatty Liver (NAFL): Fat accumulation
without inflammation or fibrosis.
• Non-Alcoholic Steatohepatitis (NASH): Fat
accumulation with inflammation, which can progress to
fibrosis, cirrhosis, and hepatocellular carcinoma (HCC)
ETIOLOGY AND RISK FACTORS
● NAFLD is commonly associated with metabolic syndrome
and insulin resistance.
• Metabolic Risk Factors:
• Obesity (especially central obesity)
• Type 2 diabetes mellitus (T2DM)
• Dyslipidemia (high triglycerides, low HDL)
• Hypertension
• Polycystic ovary syndrome (PCOS)
ETIOLOGY AND RISK FACTORS
● Genetic & Environmental Factors:
○ Family history of NAFLD
○ Sedentary lifestyle, high-calorie diet
○ Sleep apnea
● Drugs Associated with NAFLD:
○ Corticosteroids
PATHOPHYSIOLOGY OF NAFLD
● 1. Insulin Resistance → Increased Lipolysis → Excess Free
Fatty Acids (FFA) in Liver
● Insulin resistance (IR) in peripheral tissues (especially adipose tissue) leads to
increased lipolysis (breakdown of stored fat). This results in an excess of
free fatty acids (FFA) being delivered to the liver.
● 2. Hepatic Steatosis (Fat Accumulation) Due to Impaired
Oxidation and Increased Synthesis
● The excess FFAs are converted into triglycerides (TG) and stored in
hepatocytes, leading to hepatic steatosis (fatty liver).
● Accumulated fat in hepatocytes, produces reactive oxygen species
(ROS) and leading to oxidative stress.
● Inflammation is triggered due to the activation of Kupffer cells. This
results in hepatocyte injury, ballooning degeneration , and
infiltration of inflammatory cells , progressing to Non-alcoholic
steatohepatitis (NASH).
● Chronic inflammation leads to activation of hepatic stellate cells
(HSCs), which promote [Link] time, fibrosis progresses to
cirrhosis, where liver architecture is permanently damaged, leading to loss
of function.
● Cirrhosis increases the risk of developing hepatocellular carcinoma
(HCC)
Clinical Features
•Mostly asymptomatic (incidental finding on ultrasound or LFTs)
If symptomatic:
•Mild RUQ discomfort
•Fatigue, malaise
•Hepatomegaly (in advanced cases)
Signs of advanced disease:
•Jaundice (late stage)
•Ascites, splenomegaly (if cirrhosis develops)
Diagnosis
● There is no single diagnostic test; diagnosis is based on exclusion of
alcohol-related liver disease and other causes.
• Blood Tests:
• Elevated ALT & AST (ALT > AST, mild elevation)
• Normal to mildly increased ALP & GGT
• Normal bilirubin (except in cirrhosis)
• Fasting glucose & lipid profile (to assess metabolic syndrome)
Imaging Studies:
•Ultrasound Abdomen (First-line investigation) →
•Shows bright liver (hyperechogenicity)
•Transient Elastography (FibroScan) →
•Assesses liver stiffness for fibrosis
•MRI/CT (if needed) →
•Quantifies fat content
•Liver Biopsy (Gold Standard, but rarely needed)
•Differentiates NAFL from NASH
•Shows steatosis, ballooning degeneration, and fibrosis in
NASH
Staging of NAFLD
● Based on the presence and severity of steatosis,
inflammation, and fibrosis:
• Stage 1: Simple steatosis (fat accumulation, no
inflammation)
• Stage 2: NASH (inflammation & hepatocyte damage)
• Stage 3: Fibrosis
• Stage 4: Cirrhosis
Management
● Lifestyle Modification (First-line treatment for all stages)
• Weight loss (Target: 7-10% of body weight reduction)
• Dietary changes:
• Reduce saturated fats, refined carbs, and sugar
• Increase fiber, lean protein, and unsaturated fats
Homeopathic Therapeutics for
NAFLD
● 🔸 A. Acute/Recent NAFLD (Mild Fatty Liver, No Inflammation)
• Chelidonium Majus – Right upper quadrant (RUQ) pain, sluggish liver,
yellow-coated tongue, craving for hot drinks
• Chionanthus Virginica – Liver congestion, fatty liver with indigestion,
sluggish bile flow
• Taraxacum Officinale – Liver detox, bloating, jaundice, bitter taste in the
mouth
• Nux Vomica – Liver congestion from overeating, sedentary lifestyle,
alcoholism
● 🔸 B. Chronic NAFLD / NASH (Inflammation, Fibrosis, Liver
Dysfunction)
• Carduus Marianus – Hepatoprotective, enlarged liver, nausea, ascites
• Lycopodium Clavatum – Liver insufficiency with bloating, gas,
intolerance to onions
• Phosphorus – Fatty degeneration of the liver, burning pains, craving
for cold drinks
• Natrum Sulphuricum – Liver congestion, diabetes-related fatty
liver
• China Officinalis – Weakness due to liver dysfunction, ascites
