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Clinical Manifestations of Liver Disease in Diabetes Mellitus

  • Lucija Virović-Jukić
  • Jelena Forgač
  • Doris Ogresta
  • Tajana Filipec-Kanižaj
  • Anna Mrzljak
Chapter
Part of the Clinical Gastroenterology book series (CG)

Abstract

Non-alcoholic fatty liver disease (NAFLD) is becoming one of the most common causes of chronic liver disease worldwide and a major cause of liver-related morbidity and mortality.

NAFLD includes simple hepatic steatosis and non-alcoholic steatohepatitis (NASH), a condition where steatosis is associated with hepatic inflammation with or without fibrosis. Pathogenesis of these conditions is complex, but insulin resistance and obesity play a major role, together with emerging evidence for adipose tissue dysfunction, adipokines, and gut microbiota as important contributors. Non-alcoholic fatty liver disease and type 2 diabetes are common conditions that regularly co-exist and can act synergistically to drive adverse outcomes. It’s hard to predict the disease course in an individual. Most of the patients will have stable liver function and will not develop serious complications. But in some patients NASH may cause severe fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Subjects with compensated NAFLD-related cirrhosis have an annual overall mortality risk of 3.5–4%. All patients with decompensated liver cirrhosis should be evaluated for liver transplantation (LT). In Western countries, NASH is predicted to become the most frequent indication for LT in the next 20 years. NAFLD is becoming the major cause of HCC, with a steadily rising trend. Although HCC predominantly occurs in the setting of cirrhosis, the chance of HCC occurrence in non-cirrhotic liver is a worrisome aspect of NAFLD. Current knowledge of the pathways in hepatocarcinogenesis is still limited, so present interventions should be directed to prevention of metabolic syndrome and NAFLD, reducing the risk of HCC through lifestyle changes such as exercise and dietary modification.

Keywords

Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Liver cirrhosis Hepatocellular carcinoma Insulin resistance Adipokines Gut microbiota Liver transplantation 

Abbreviations

ALP

Alkaline phosphatase

ALT

Alanin aminotransferase

AST

Aspartate aminotransferase

AUROC

Area under receiver operating characteristic

BMI

Body mass index

C0

Through level

Ca

Calcium

CKD

Chronic kidney disease

CMV

Cytomegalo-virus

CNI

Calcineurin inhibitors

CRP

C reactive protein

CsA

Cyclosporine

CTP score

Child–Pugh–Turcotte score

CVD

Cardiovascular disease

dL

Decilitre

EB

Oesophageal variceal bleeding

EBL

Endoscopic band ligation

EBV

Epstein–Barr virus

EEG

Electroencephalography

eGFR

Estimated glomerular filtration rate

F

Fibrosis stage

GGT

Gamma-glutamil transferase

GOV1

Gastroesophageal varices type 1

GOV2

Gastroesophageal varices type 2

HAV

Hepatitis A virus

HBV

Hepatitis B virus

HCC

Hepatocellular carcinoma

HCV

Hepatitis C virus

HE

Hepatic encephalopathy

HbA1c

Hemoglobin A1c

HHV-8

Human herpes virus 8

HIV

Human immunodeficiency virus

HPS

Hepatopulmonary syndrome

HRS

Hepatorenal syndrome

HSV

Herpes simplex virus

IFN

Interferon

Ig

Immunoglobuline

IGV

Isolated gastric varices

IS

Immunosuppressive

K

Potassium

LDH

Lactate dehydrogenase

LT

Liver transplantation

MDRD

Modification of diet in renal disease formula

MELD

Model of end-stage liver disease

MeS

Metabolic syndrome

Mg

Magnesium

mg

Milligram

MMF

Mycophenolate mofetil

MR

Magnetic resonance

MRCP

Magnetic resonance cholangio-pancreatograph

MRE

Magnetic resonance elastography

MSCT

Multi-slice computed tomography

mTOR

Mammalian target of rapamycin

Na

Sodium

NAFLD

Non-alcoholic fatty liver disease

NASH

Non-alcoholic steatohepatitis

NSBB

Non-selective beta blockers

OR

Odds ratio

PCR

Polymerase chain reaction

PET

Positron emission tomography

PNPLA3

Patatin-like phospholipase domain-containing 3

PPD

Purified protein derivative

PPHTN

Portopulmonary hypertension

PSC

Primary sclerosing cholangitis

SBP

Spontaneous bacterial peritonitis

T2DM

Type 2 diabetes mellitus

Tac

Tacrolimus

TE

Transient elastography

TIPS

Transhepatic portosystemic shunt

US

United States

VDRL

Venereal disease research laboratory

VZV

Varicella zoster virus

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Lucija Virović-Jukić
    • 1
  • Jelena Forgač
    • 2
  • Doris Ogresta
    • 2
  • Tajana Filipec-Kanižaj
    • 3
  • Anna Mrzljak
    • 3
  1. 1.Department of Gastroenterology and HepatologyUniversity of Zagreb School of Medicine, Sestre Milosrdnice University Hospital CenterZagrebCroatia
  2. 2.Department of Gastroenterology and HepatologySestre Milosrdnice University Hospital CenterZagrebCroatia
  3. 3.Department of GastroenterologyUniversity of Zagreb School of Medicine, University Hospital MerkurZagrebCroatia

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