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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The May 2013 update sees updates to chapters focusing on Respiratory Medicine and Haematology.

Respiratory Medicine updates include substantial updates to key chapters and new material on a wide range of topics including: new bronchoscopic techniques for early detection of lung cancer, specific causes of effusion and pleural disease, and chronic obstructive pulmonary disease.

Haematology updates include extensive revisions of key chapters on chronic myeloid leukaemia, aplastic anaemia and bone marrow failure disorders, and blood transfusion, with new information on a wide range of matters.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2010
DOI:
10.1093/med/9780199204854.001.1

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Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Nonalcoholic steatohepatitis

Chapter:
Nonalcoholic steatohepatitis
Author(s):

Stephen F. Stewart,

Chris P. Day

DOI:
10.1093/med/9780199204854.003.152202_update_001

Update:

Increased use of noninvasive staging tools in clinical practice PIVENS trial supporting vitamin E.

Updated on 28 November 2012. The previous version of this content can be found here.

Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorder in the developed world, affecting 20 to 30% of Western adults. Nonalcoholic liver disease occurs with a range of severity from simple steatosis through nonalcoholic steatohepatitis (NASH) to fatty fibrosis—and, ultimately, cirrhosis. The condition is a manifestation of the metabolic syndrome, strongly associated with obesity, insulin resistance, and dyslipidaemia; dietary and genetic factors appear to determine susceptibility to the disease and its progression.

In most patients the condition is discovered incidentally when abnormal values of serum liver-related liver tests are reported.. The diagnosis is usually one of exclusion: liver biopsy is not usually required , but is needed disease staging in some individuals. Treatment is directed at components of the metabolic syndrome: diet and exercise have been shown to reduce steatosis; metformin and pioglitazone can have beneficial effects on steatosis, inflammation and fibrosis in patients with type 2 diabetes; pharmacological antiobesity agents and other treatments are under evaluation.

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