Non-alcoholic steatohepatitis (NASH)

Question 1

Define non-alcoholic steatohepatitis

Answer 1

Describes 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 of NASH

2 + increases the risk of 3

Answer 2

Liver may initially become fatty due to alcohol abuse but these fatty deposits resolve in days
If fat persist it can cause inflammation & fibrosis (steatohepatitis)
NASH increased the risk of:
diabetes mellitus
MI
stroke

Question 3

Risk factors for NASH

6

Answer 3

Obesity 
T2DM
Hypertension 
Hypercholesterolaemia 
Age >50yrs
Smoking

Question 4

Epidemiology of NASH

2

Answer 4

MOST COMMON liver disorder in developed countries

1/3 in UK have early stages of NASH

Question 5

Presenting symptoms of NASH

2 general + 4 + 1

Answer 5

Usually ASYMPTOMATIC in early stages
Usually found as incidental finding

Occasional symtoms:
Dull/aching RUG pain 
Fatigue
Unexplained weight loss
Weakness

Symptoms of cirrhosis in most advanced stages of NASH

Question 6

Signs of NASH on physical examination

2

Answer 6

RUQ pain/tenderness

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

Question 7

Investigations for NASH

3

Answer 7

LFTs - raised AST & ALT
Liver US - may show steatosis
Liver biopsy

Question 8

Management of NASH

7

Answer 8

Conservative - controlling risk factors 
BP
Diabetes
Cholesterol
Lose weight
Stop smoking 
Exercise regularly
Reduce alcohol consumption

Question 9

Complications of NASH

5 all associated w/1

Answer 9

CIRRHOSIS
Ascites
Oesophageal varices
Hepatic encephalopathy
Hepatocellular carcinoma 
End stage liver failure

Question 10

Prognosis of NASH

Answer 10

20% w/ NASH will develop cirrhosis