Page Jeni
University of Texas Southwestern, Dallas, Texas, USA.
J Am Acad Nurse Pract. 2012 Jun;24(6):345-51. doi: 10.1111/j.1745-7599.2012.00716.x. Epub 2012 Apr 20.
To examine a case of nonalcoholic fatty liver disease (NAFLD) and review the incidence, pathophysiology, appropriate diagnostic procedures and imaging, clinical considerations, and treatment options.
Findings from the history, physical examination, and diagnostic testing of a 39-year-old man with elevated liver enzymes presenting to the hepatology clinic; a search of evidence-based literature in the PubMed and CINAHL database with the terms "fatty liver,""nonalcoholic fatty liver disease," and "nonalcoholic steatohepatitis."
NAFLD is the deposition of fat in the liver that can progress to nonalcoholic steatohepatitis, resulting in fibrosis and cirrhosis. The exact pathophysiology is unknown, but risk factors can include those criteria associated with metabolic syndrome. NAFLD is a diagnosis of exclusion and can lead to serious health consequences if it is not identified and interventions are not implemented promptly. Treatment options remain limited but currently focus on weight loss, exercise, and diet.
The clinician must include the spectrum of NAFLD in the differential diagnosis for any patient with elevated liver enzymes. The key actions for diagnosing NAFLD are identifying risk factors and ordering appropriate testing for confirmation. These considerations will lead to early diagnosis and implementation of treatment interventions.
研究一例非酒精性脂肪性肝病（NAFLD）病例，并综述其发病率、病理生理学、合适的诊断程序与影像学检查、临床注意事项及治疗选择。
对一名前往肝病门诊就诊、肝酶升高的39岁男性患者的病史、体格检查及诊断性检查结果；在PubMed和CINAHL数据库中以“脂肪肝”“非酒精性脂肪性肝病”及“非酒精性脂肪性肝炎”为关键词检索循证文献。
NAFLD是肝脏脂肪沉积，可进展为非酒精性脂肪性肝炎，进而导致肝纤维化和肝硬化。确切的病理生理学尚不清楚，但危险因素可能包括与代谢综合征相关的那些标准。NAFLD是一种排除性诊断，如果未被识别且未及时实施干预，可导致严重的健康后果。治疗选择仍然有限，但目前主要集中在体重减轻、运动和饮食方面。
临床医生必须将NAFLD纳入任何肝酶升高患者的鉴别诊断范围。诊断NAFLD的关键措施是识别危险因素并安排适当的检查以进行确诊。这些考虑因素将有助于早期诊断并实施治疗干预措施。
