Digestive Diseases and Sciences

The spectrum of nonalcoholic fatty liver disease (NAFLD) ranges from asymptomatic steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. Hepatic steatosis occurs when free fatty acids, released in the setting of insulin resistance and the metabolic syndrome, are taken up by the liver. Additional biochemical insults, including oxidative stress, upregulation of inflammatory mediators, and dysregulated apoptosis, can result in inflammation (producing NASH) and fibrosis. Noninvasive methods (e.g., abdominal ultrasonography) are safe ways to support a diagnosis of hepatic steatosis, but advanced liver histopathologic findings including NASH and fibrosis cannot be identified without pursuing liver biopsy. Recent advances in serologic and imaging methods aim to determine severity of inflammation and fibrosis noninvasively. Currently, therapeutic options for NAFLD are limited to medications that reduce risk factors, but the future holds promise for therapies that might slow the progression of this increasingly prevalent disorder.

A case of primary systemic amyloidosis in which the diagnosis was made antemortem is presented. Unusual gastroenterologic features included epigastric pain as the presenting complaint, proved gastric and duodenal ulceration, an episode of acute pancreatitis, and terminal jaundice. The usual gastrointestinal features included diffuse gastrointestinal tract involvement, hepatomegaly, changes in serum protein, and essentially normal liver-function tests.