Alcoholic And Non Alcoholic Steatohepatitis Fatty Liver Diseases

Question 1

Note

Answer 1

Both alcoholic steatohepatitis (ASH) and non-alcoholic steatohepatitis (NASH) are conditions characterized by fatty liver disease, meaning there’s an abnormal buildup of fat in the liver. However, they differ in their causes and risk factors.

Question 2

Definition of ASH

Answer 2

Alcoholic Steatohepatitis (ASH): This is a type of liver disease caused by excessive alcohol consumption. It’s a more severe form of alcoholic fatty liver disease (AFLD) and can lead to cirrhosis, liver failure, and liver cancer.

alcoholic disease should not be considered
limited to the liver but as a true systemic disease
including damage to the
• digestive tract,
• the central and peripheral nervous systems,
• the heart and vascular system,
• the bone and skeletal muscle,
• the endocrine and immune systems,
• disruption of nutritional status,
and finally cancer.

Question 3

Causes of ASH

Answer 3

Excessive alcohol consumption

Question 4

Risk Factors of ASH or ALD

Answer 4

Risk Factors | Heavy alcohol use, female sex, obesity, genetic predisposition
Divert viral
Iron

Question 5

Mechanism of Action

Answer 5

Alcohol damages liver cells, leading to inflammation and fat buildup

Question 6

Clinical symptoms of ALD

Answer 6

Abdominal pain and swelling nausea, vomiting, fatigue, jaundice, fever, confusion loss of appetite
Nausea vomitting dry mouth itching fainting jaundice mood disorder numbness in limbs red spider like veins on skin

Question 7

Diagnosis of ALD

Answer 7

Medical history, physical exam, blood tests, liver biopsy ASH: Diagnosis involves:
* Medical history (including alcohol consumption)
* Physical exam
* Blood tests (liver function tests)
* Liver biopsy (to confirm the diagnosis and assess the severity of liver damage) Liver enzymes
Hepatic function panel (with severe
disease)
AST > ALT; AST usually > 2 × ALT, both values usually < 300
IU/dL Albumin decreased
GGT increased Bilirubin usually increased
Alkaline phosphatase increased Prothrombin time usually prolonged
Complete blood count Metabolic panel
Leukocytosis Hypertriglyceridemia
Mild anemia, raised MCV Hyperuricemia
Thrombocytopenia Hyperglycemia
Hypokalemia
Hypomagnesemia
Hypophosphatemia
MRI ct scan fibroscan

Question 8

Treatment of ALD

Answer 8

ASH: The most important treatment is to stop drinking alcohol completely. Other treatments may include:
* Healthy diet
* Weight loss (if overweight or obese)
* Medication (in some cases)
* Liver transplant (in severe cases) Pentoxiphyllin
 Hepatoprotectors(?) (heptral, essentiale, essliver
forte)
 Propylthiouracil (?)
 In severe cases (acute conditions) – parenteral use
of prednosolone, methylprednisolone (?)
 Stem cell therapy
 Transplantation Therapeutic Agents for Long-term Alcoholic Liver Disease
Evidence supporting use
Abstinence
Nutrition
Propylthiouracil
Transplantation
Insufficient evidence
Colchicine
Anabolic steroids
SAM
Antioxidants
Antibiotics
Calcium channel blockers
Bile acids
Phosphatidyl-choline
Saturated fatty acids
Cytokine inhibitors
CYP2E1 inhibitors
Steam cell
Evidence not supporting use
Corticosteroids
•Polyphen

Question 9

Definition of NASH

Answer 9

NASH): This is a type of liver disease that occurs in people who drink little to no alcohol. It’s a more severe form of non-alcoholic fatty liver disease (NAFLD) and can also lead to cirrhosis, liver failure, and liver cancer. Non-alcoholic fatty liver disease (NAFLD)
represents a spectrum of liver disease with key
stages consisting of hepatic steatosis (NAFL),
steatohepatitis (NASH), fibrosis, and eventual
cirrhosis

Question 10

Risk factors of Nash

Answer 10

Obesity, type 2 diabetes, low high DLcholesterol, high blood pressure, metabolic syndrome, older age, and Hispanic ethnicity are the main risk factors. Insulin resistance

Question 11

Mechanism of action of NaSh

Answer 11

The exact mechanisms are complex and not fully understood, but they involve:
* Insulin resistance
* Oxidative stress
* Inflammation
* Gut microbiome dysbiosis  ectopic adipose tissue distribution,
 dyslipidemia,
 endothelial dysfunction,
 Adiponectin

Question 12

Clinical symptoms of NASH

Answer 12

Many people with NASH have no symptoms, especially in the early stages. When symptoms do occur, they may include:
* Fatigue
* Abdominal discomfort
* Enlarged liver
* Weight loss or gain

Question 13

Diagnosis of NASH

Answer 13

Medical history
* Physical exam
* Blood tests (liver function tests)
* Imaging tests (ultrasound, CT scan, MRI)
* Liver biopsy (to confirm the diagnosis and assess the severity of liver damag

Question 14

Treatment of Nash

Answer 14

• Healthy diet
  
  • Weight loss
  • Exercise
  • Medication (in some cases)
  • Liver transplant (in severe cases Мanagement of the features of metabolic syndrome are
    vital for all patients with NAFLD.
    •Lifestyle modification (aimed at weight loss and
    increasing physical activity)
    •Metformin is the first-line therapy for diabetic patients
    •Statin for the management of dyslipidaemia
    •Antihypertensive agents that target the RAS for the
    management of hypertension.
    •For patients with progressive disease, liver-directed
    pharmacotherapy (?) with vitamin E should be
    considered
    Daily consumption of cereal, vegetables, bread, pasta, fruit,
    olive oil and dairy products. Eggs, sweets, fish, poultry,
    potatoes, pulses and nuts are recommended weekly. Red
    meat a few times per month and in a very small amount.
    Traditional

Question 15

Classification of both NASH and ASH

Answer 15

Both ASH and NASH can be classified into different stages based on the severity of liver damage:
* Steatosis: Fatty liver without inflammation
* Steatohepatitis: Fatty liver with inflammation
* Fibrosis: Scarring of the liver
* Cirrhosis: Severe scarring of the liver, leading to liver failure

Question 17

Fatty liver disease definition

Answer 17

chronic disease of the liver with increased
deposition of the fat in the liver
parenchima
 Alcoholic (ALD)
 Nonalcoholic (NAFLD