You are caring for Mrs. Bailey, a 56 year-old female, who was admitted two days ago due to vomiting blood which was diagnosed as bleeding esophageal varices. Her medical history reveals she was diagnosed with metabolic syndrome four years ago which progressed to Type 2 diabetes three years ago. Mrs. Bailey had previously been obese with a BMI of 30. However, over the last year she has lost 36 pounds without dieting. She explains she is not hungry because she feels full all the time, so she does not eat. She tells you she is also very tired all the time and she is often too tired to cook and eat. Mrs. Bailey’s physician informed her this morning she has cirrhosis of the liver. Mrs. Bailey is upset and asks you how she can have cirrhosis of the liver when she has never been “a drinker” and does not drink alcohol now. You determine from her medical history and previous lab test results she had nonalcoholic fatty liver disease (NAFLD) that progressed to cirrhosis. Discuss the etiology, pathogenesis, and clinical manifestations of nonalcoholic fatty liver disease (NAFLD). Compare and contrast the etiology and pathogenesis of NAFLD to alcohol-induced liver disease. Discuss the clinical manifestations of cirrhosis of the liver. Explain why patients with cirrhosis of the liver develop esophageal varices from portal hypertension and why the varices bleed in liver disease. Include the etiology and pathogenesis.
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