The Association betweenNon-alcoholic Fatty Liver Disease and Gall Bladder diseases

Abstract

Non alcoholic fatty liver disease describes a wide extent of liver conditions ranging from simple non alcoholic fatty liver (NAFL) to non alcoholic steatoheptitis (NASH). NAFL which is the accumulation of fat in the liver of people who drink no alcohol and NASH which is more accumulation of fat in the liver leading to inflammation of hepatocytes which end in liver cell failure and hepatocellular carcinoma (Vuppalanchi et al., 2013). NAFL is also frequently found in people with diabetes and obesity and is related to metabolic syndrome. Ultrasound (US) can identify it with reasonable Accuracy (Gholam et al., 2013). Gallstonesare hard particles that develop in the gall bladder, risk factorfordevelopinggallstones include: women in childbearing period, over 40 yrs, family history, obesity, rapid weight loss, diet (high calories and carbohydrates), certain intestinal diseases (such as crohn's disease), metabolic syndrome (George et al., 2014). Gallstones and non-alcoholic fattyliverdisease (NAFLD) share the same risk factors. Patients with metabolic risk factors and gallstones suffer significantly more often from NAFLD. Gallstones represent an independent risk factor of NAFLD in addition to metabolic risk factors and could be regarded as an additional risk factor of liver damage in patients with NAFLD. Furthermore, NAFLD is an independent risk factor and might represent a pathogenetic link between the metabolic syndrome and gallstones (Koller et al., 2013). It is possible that having had a cholecystectomy might increase the risk of NAFLD through the metabolic effects of the loss of gallbladder (Nervi et al., 2013). The aim of this study was to find the association between non-alcoholic fatty liver disease and patient with gall bladder stones. The study was conducted on50: Patients with GB (gall bladder) stones, 48 Patients with Non Alcoholic Fatty Liver Disease (NAFLD) and 20Patients with past history of cholecystectomy for GB stones. All patients were subjected to the following: -A written consent - Careful medical and family history taking. - General and abdominal examination. - Laboratory investigations including: • fasting blood glucose • Lipid profile (Cholesterol, TG, LDL, and HDL). • Liver biochemical profile (ALT, AST, T.BIL, D.BIL, albumin, alk. Phos. INR, GGT, T.protien). • Viral seromarkers including HCV antibody, HBV and HAV IgM viral markers (hepatitis B surface antigen; hepatitis B core Antibody) and HAV IgM. • ANA, AMA, ASMA. • Serum ceruloplasmine, serum copper test, urine copper test. • Serum iron, total iron binding capacity, serum ferritin. - Abdominal ultrasonography. We found that 64% of patients with NAFLD had GB stones and 75% of patients presented with GB stones had NAFLD. And 10% of patients underwent cholecystectomy have NAFLD. The present study showed that pure GB disease was predominant in females of older age group and all cases of pure NAFLD were men. While association between GB and NAFLD occurred mainly in females (62.9) % of and had the highest mean BMI. In the current study we found that higher total bilirubin level in patients of both GB stones and NAFLD than that of patients with GBstones only or NAFLD only, also higher T bilirubin level are associated with higher risk to develop NAFLD among GBS patients.