One of my favourite disease abbreviations. That’s NASH, like the start of Nashville.
Non-Alcoholic Steatohepatitis (NASH)
Definition: an advanced form of non-alcoholic fatty liver disease (NAFLD). NASH is characterised by increased fat in hepatocytes (steatosis) + inflammation (steatohepatitis), associated with various degrees of hepatocellular injury, inflammation and fibrosis that can progress to cirrhosis and hepatocellular carcinoma. There is no background of significant alcohol intake.
NASH is a diagnosis of exclusion.
Risk factors: obesity, diabetes, hypertension, hyperlipidaemia, parenteral feeding, jejuno-ileal bypass (short bowel syndromes), Wilson’s disease, drugs (amiodarone, methotrexate, tetracycline, tamoxifen)
Typically occurs in middle-aged obese
Epidemiology: up to 30% of the population have some degree of non-alcoholic fatty liver disease
-Most patients with NAFLD are asymptomatic
-RUQ abdominal discomfort
-As liver disease progresses towards NASH and cirrhosis, signs and symptoms of chronic liver disease become apparent
-hepatosplenomegaly (liver size may decrease as cirrhosis develops)
-signs of chronic liver disease
LFTs- raised ALT and AST (AST:ALT <1/ >2 in alcoholic liver disease, ratio reverses as disease progresses towards cirrhosis)
Lipid panel- elevated total cholesterol, LDL, triglyceride, low HDL
Ultrasound/CT/MRI- fatty liver. U/S shows a bright liver because of diffuse fatty infiltration. CT and MRI can show fatty liver but the findings are non-specific.
Liver biopsy- Mallory bodies +/- neutrophil infiltrate (can be indistinguishable from alcoholic liver disease), cirrhosis (bridging fibrosis + regenerative nodules)
-control risk factors: diet and exercise, weight loss, treat diabetes
-bariatric surgery helps
-transplantation may be needed in end-stage disease
-Patients with NASH progress 9-20% of the time to cirrhosis, and up to 1/3 of these patients will die from complications of liver failure or require liver transplantation.