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Fettleversjukdom, icke-alkoholrelaterad (NAFLD)

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Definition:
Tillstånd med ökad fetthalt (steatos) i levern hos personer som inte dricker eller endast dricker måttliga mängder alkohol. Kan delas in i icke-alkoholrelaterad fettlever (non-alcoholic fatty liver, NAFL) och icke-alkoholrelaterad steatohepatit (non-alcoholic steatohepatitis, NASH).
Förekomst:
Den vanligaste leversjukdomen i västvärlden med en prevalens på 20–30 %.
Symtom:
De flesta med NAFLD är symtomfria. Vissa presenterar med trötthet och sällan rapporterar patienter smärta i höger övre del av buken.
Kliniska fynd:
Vanligtvis fetma. Eventuellt andra tecken på metabolt syndrom (hypertoni) samt manifest typ 2-diabetes.
Diagnostik:
I vanliga fall hittas NAFLD vid utredning av patologiska leverprover eller som bifynd. Ultraljud är en trygg och billig metod för diagnostik av NAFLD. Vid konstaterad NAFLD är det viktigt att bedöma kardiovaskulära riskfaktorer.
Behandling:
Behandling av det metabola syndromet, där viktminskning anses vara den viktigaste åtgärden. Hos patienter typ 2-diabetes kan läkemedelsbehandling med metformin och eventuellt pioglitazon vara aktuell.
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  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas
  • Hanns-Ulrich Marschall, professor och universitetssjukhusöverläkare, Medicinkliniken gastrosektionen, Sahlgrenska Universitetssjukhuset, Göteborg