Non alcoholic steatohepatitis

Question 1

What is NASH (or NAFLD)?

Answer 1

Non-alcoholic fatty liver disease (NAFLD) is a clinico-histopathological entity that includes a spectrum of conditions characterised histologically by macrovesicular hepatic steatosis in those who do not consume alcohol in amounts generally considered harmful to the liver.

Question 2

What is the epidemiology of NASH?

Answer 2

It is estimated that NAFLD affects 20% to 40% of the Western world.

Question 3

What are the risk factors of NASH?

Answer 3

> Obesity
> Insulin resistance
> Dyslipidaemia
> Hypertension
> Metabolic syndrome
> Rapid weight loss
> Hepatotoxic medications
> Total parenteral Nutrition

Question 4

What are the signs and symptoms of NASH?

Answer 4

> No alcohol
> Fatigue/ Malaise
> Hepatosplenomegaly
> Truncal obesity
> RUQ discomfort
> Peripheral stigmata of liver disease

Question 5

What are the appropriate investigations of NASH?

Answer 5

> AST and ALT (elevated)
> BR (raised)
> Alk Phos (raised)
> GGT (raised)
> FBC (anaemia/ thrombocytopenia)
> Abnormal metabolic panel
> Lipid panel (raised)
> INR/ PT
> Serum albumin
> ANA
> Iron studies

Question 6

What is the managment of NASH?

Answer 6

> Diet/ exercise
> Vitamin E
> Weight loss
> Roux-en- Y gastric bypass
> Lipid lowering agents

Question 7

What are the complications of NASH?

Answer 7

Ascites
Variceal haemorrhage
Portosystemic encephalopathy
Hepatocellular carcinoma
Hepatorenal syndrome
Hepatopulmonary syndrome
Death

Question 8

What is the prognosis of NASH?

Answer 8

The natural history seems to be dependent on the histological subtype of NAFLD at the time of diagnosis. The overall prognosis in patients with bland steatosis (fatty liver without evidence of active inflammation) is considered to be good and a majority of patients will remain stable throughout their lifetime.