Non-Alcoholic Steatohepatitis

Question 1

Definition

Answer 1

A term used to describe a range of conditions caused by the build-up of fat in the liver due to causes other than excessive alcohol use.

Question 2

Aetiology

Answer 2

• A liver may initially become fatty due to alcohol abuse, however, these fatty deposits
tend to resolve over a matter of days

• If the fat persists, it can cause inflammation and fibrosis (steatohepatitis)

• NASH also increases the risk of:
o Diabetes mellitus
o MI
o Stroke

Question 3

Risk factors

Answer 3

o Obesity
o Type 2 diabetes mellitus
o Hypertension
o Hypercholesterolaemia
o Age > 50 yrs
o Smoking

Question 4

Epidemiology

Answer 4

• MOST COMMON liver disorder in developed countries

* 1/3 people in the UK have the early stages of NASH

Question 5

Presenting symptoms

Answer 5

• Usually NO SYMPTOMS in the early stages
• Usually found as an incidental finding

• Occasional symptoms include:
o Dull or aching RUQ pain
o Fatigue
o Unexplained weight loss
o Weakness

• Symptoms of cirrhosis will be experienced in the most advanced stages of NASH

Question 6

Signs on physical examination

Answer 6

• RUQ pain/tenderness

* Signs of cirrhosis (e.g. jaundice, ascites, pruritus - in advanced stages of NASH)

Question 7

Investigations

Answer 7

• LFTs - showing elevated AST and ALT
• Liver Ultrasound - may show steatosis
• Liver Biopsy

Question 8

Management plan

Answer 8

• Conservative - controlling risk factors:

o Blood pressure
o Diabetes
o Cholesterol
o Lose weight
o Stop smoking
o Exercise regularly
o Reduce alcohol consumption (although it is NOT caused by excessive alcohol,
drinking can make it worse)

Question 9

Possible complications

Answer 9

• CIRRHOSIS

o Ascites
o Oesophageal varices
o Hepatic encephalopathy
o Hepatocellular carcinoma
o End-stage liver failure

Question 10

Prognosis

Answer 10

• 20% with NASH will develop cirrhosis