1. Fatty Liver Disease Non-Alcoholic
Dr. Peter MacKercher, II, MD
No conflicts of interest

2. Objectives Risk Factors Symptoms Proper Treatment
NASH: by 2020 will surpass Hepatitis C for reason for liver transplant

3. Dr. Peter MacKercher II, MD
Undergraduate Education
Westminster College, Fulton, MO BA 168
Medical Education
Medical School
University of Missouri-Columbia
MD 1972
Internship
Straight Medicine
Residency
Internal Medicine
Fellowship
Gastroenterology
Military Service
Great Lakes Naval Hospital
Lt. Commander
Employment
Mountain Home, AR
1979-Present
Board Certifications
National Board of Examiners 1973
American Board of Internal Medicine 1977
Advanced Achievement in Internal Medicine 1987
State Licensure
Arkansas
Missouri
Current Hospital Affiliation
Baxter Regional Medical Center
Mountain Home, AR 72653

4. Peter MacKercher II, MD
Positions Held:
Acting Assistant Chief of Medicine
Great Lakes Naval Hospital
Chief of Medicine
Baxter County Regional Hospital
Baxter County Regional Hospital
Chief of Staff
Baxter County Regional Hospital
January 1988 to January 1990
Director, Alcoholism Treatment Unit
Baxter County Regional Hospital
Society Memberships:
American Society of Gastrointestinal Endoscopy
Arkansas-Oklahoma Endoscopy Society
American Society of Internal Medicine
Arkansas Medical Society
Baxter County Medical Society
American Association for the Advancement of Science

5. Peter MacKercher II, MD
Papers Published:
1. Krause, W. J., Ivey, J. K., Baskin, W. N., and MacKercher, P. A.
Ultrastructure of the Human Pyloric Glands with Emphasis on the Mucus Cell Component Part I Acta Anat 99:1-10 (1977)
2. MacKercher, P. A., Ivey, K. J., Baskin, W. N., and Krause, W. J.
Protective Effect of Cimetidine on Aspirin-Induced Gastric Mucosal Damage Ann Int Med 87: (1977)
3. MacKercher, P. A., Ivey, J. H., Baskin, W.N., and Krause, W. J.
A Scanning Electron Microscopic Study of Normal Human Oxyntic Mucosa Using Blunt Dissection and Freeze Fracture Am
J Dig Discomfort 23: (1978)
4. Ivey, K. J., and MacKercher, P.A. Effect of Cimetidine on Ion Fluxes and Potential Difference Across the Human Stomach.
Gut 19: (1978)
5. Krause, W. J., Ivey, K. J., Baskin, W.N., and MacKercher, P.A.
Morphological Observations on the Normal Human Cardiac Glands Anat Rec 192:59-72 (n1978)
6. Silvoso, G. R., Ivey, K.J., Butt, J. H., Lockard, O. O., Hold, S. D.,
Sisk, C., Baskin, W. J., MacKercher, P.A., and Hewett, J.
Incidence of Gastric Lesions in Patients with Rheumatic Disease on Chronic Aspirin Therapy Ann Int Med 91: (1979)

6. NASH Rambler 1950 Nash Rambler

7. Liver Diseases
There are many different types of liver diseases and a few of them are:
Hepatitis A
Hepatitis B
Hepatitis C
Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH)
Cirrhosis
We will be discussing Nonalcoholic Fatty Liver Disease, Nonalcoholic Steatohepatitis, and Cirrhosis.

8. The most common form of liver disease in the United States is now infiltration fatty liver disease. The occurrence of nonalcoholic fatty liver disease is growing around the world but in the United States the occurrence is suggestive that this disease is affecting approximately 75 to 100 million people. While this disease can occur at any age, persons in their 40’s and 50’s who are obese and have type 2 diabetes are most at risk.

9. Definition
The liver normally has some fat but when 5%-10% of the liver’s weight is fat it is called fatty liver (steatosis).
Non-alcoholic fatty liver disease is due to an excess amount of fat in the liver cells that is not caused by alcohol and is associated with an inflammatory response.

10. Non-alcoholic Steatohepatitis NASH
This is very serious form fatty liver disease which is noted by liver inflammation. Liver scarring and permanent damage can result and advance to cirrhosis and liver failure.

11. Risk Factors For NALD and NASH
There are many diseases that can increase the chance of a person developing nonalcoholic fatty liver disease and among the more familiar of those are:
Obesity
Type 2 Diabetes
Hyperlipidemia
High Cholesterol
The risk of developing nonalcoholic steatohepatitis (NASH) is more frequent in individuals with:
Type 2 Diabetes
Obesity
Metabolic Syndrome
Middle aged and older
Increased fat around the abdomen

12. What causes some people to develop nonalcoholic fatty liver disease is not known. Research has shown that it is inclined to run in families as well as the other risk factors of being middle aged, being overweight or obese, having diabetes, and increased cholesterol levels. There are also other risk factors or causes of this disease that include:
Medications
Rapid weight loss
Malnutrition
Viral hepatitis
Autoimmune liver disease

13. Signs and Symptoms
The majority of people with NAFLD have no signs or otherwise very indistinct symptoms such as:
Fatigue
Pain in right upper quadrant
Weakness
Weight loss
The symptoms of NASH and Cirrhosis may include the following:
Red Palms
Gynecomastia
Splenomegaly
Ascites
Jaundice

14. Cirrhosis
Cirrhosis is the main complication of NAFLD and NASH. Cirrhosis is triggered in by injury to the liver. This can be from the inflammation in the live due to NASH. When the liver tries to stop the inflammation scarring occurs. This cycle can continue to take up more liver tissue.
Cirrhosis can progress to:
Ascites
Esophageal varices
Hepatic encephalopathy
Liver cancer
End stage liver failure

15. The progression of NAFLD
The complication of NAFLD is that it advances into NASH leading to Cirrhosis.

17. Diagnosis Physical exam Imaging Studies CBC Liver ultrasound
Hemoglobin A1C
Lipid profile
Tests for chronic viral hepatitis
Liver Biopsy
Imaging Studies
Liver ultrasound CT
MRI
Hepatic elastography
Fiber Scan

18. Treatment The leading treatment for NAFLD is weight loss.
A healthy diet and exercise program is ideal. A 10% weight loss is preferred but even a 3 to 5 percent loss of the starting weight can show an improvement in risk factors. For the severely obese, weight loss surgery is an option.
Avoiding alcohol
Vaccinations against hepatitis A and hepatitis B may be recommended as a safeguard against further liver damage.
Avoiding any unnecessary medications
Alternative medicine treatments have not shown any evidence to cure NAFLD. There are some studies by researchers of natural compounds that could be helpful but further research is needed.

19. Projection
As obesity rates among men, women, and children rise is this country, an unrelenting focus on a healthy lifestyle in this country and worldwide needs to be addressed due to the rise in NALFD diagnosis. Maintaining a healthy weight, eating a health diet, and exercising regularly are the best ways to prevent NAFLD. We as healthcare providers need to address this issue and provide education about this disease.

20. https://personalliberty.com/detoxifying-bodys-city-dump/

21. References http://www.liverfoundation.org/abouttheliver/info/nafld/
Rinella, M. E. (2015). Nonalcoholic fatty liver disease: a systematic review. JAMA: Journal Of The American Medical Association, 313(22), doi: /jama