Non-alcoholic Steatohepatitis Flashcards
Define Non-Alcoholic Steatohepatits (NASH)?
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
What is the aetiology of NASH?
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)
What can NASH increase the risk of?
DM
MI
Stroke
What are the risk factors for NASH?
Obesity T2DM Hypertension Hypercholesterolaemia Age > 50 yrs Smoking
What is the epidemiology of NASH?
Most common liver disorder in developed countries
1/3 people in the UK have the early stages of NASH
What are the presenting symptoms of NASH?
Usually NO symptoms in the early stages Usually found as an incidental finding Occasional symptoms include: - Dull or aching RUQ pain - Fatigue - Unexplained weight loss - Weakness
What symptoms will you see in the most advanced stages of NASH?
Symptoms of Cirrhosis
What are the signs of NASH on physical examination?
RUQ pain/tenderness
Signs of cirrhosis (e.g. jaundice, ascites, pruritus)
What investigations do you do for NASH?
LFTs - showing elevated AST and ALT
Liver US - may show steatosis
Liver Biopsy
What is the general plan of the management of NASH?
Conservative - controlling risk factors)
What is the Conservative management plan for NASH?
Control:
- BP
- Diabetes
- Cholesterol
- Lose weight
- Stop smoking
- Exercise regularly
- Reduce alcohol consumption
Why do we reduce alcohol consumption for NASH?
Although it is not caused by excessive alcohol, drinking can make it worse
What are the possible complications of NASH?
Cirrhosis:
- Ascites
- Oesophageal varices
- Hepatic encephalopathy
- Hepatocellular carcinoma
- End-stage liver failure
What is the prognosis for patients with NASH?
20% with NASH will develop cirrhosis
