Updated: 10/9/2019

Nonalcoholic Steatohepatitis (NASH)

Review Topic
  • A 40-year-old obese woman with a history of diabetes presents to her primary care physician for a routine visit. She denies having any complaints. On physical exam, her physician notices mild hepatomegaly without tenderness to palpation. To address this, a liver enzyme panel is sent and reveals elevated transaminases. She is sent for a hepatic ultrasound to evaluate for nonalcoholic fatty liver disease or steatohepatitis.
  • Overview
    • nonalcoholic fatty liver disease (NAFLD) is characterized by fatty changes in the liver in patients without a history of alcoholism
      • this may lead to inflammation and lobular hepatitis or nonalcoholic steatohepatitis (NASH)
      • causes chronic hepatitis
  • Epidemiology
    • incidence
      • common
    • demographics
      • can affect adults and adolescents
    • risk factors
      • obesity
      • hyperlipidemia
      • hypertriglyceridemia
      • diabetes or insulin resistance
  • Pathogenesis
    • mechanism
      • high levels of lipids or triglycerides, insulin resistance, and increased body weight cause fat to accumulate within the hepatic cells, resulting in decreased rate of metabolizing and excreting fat
      • this results in inflammation and eventually fibrosis of the liver
  • Symptoms
    • often asymptomatic
    • common symptoms
      • vague abdominal discomfort
  • Physical exam
    • inspection
      • hepatomegaly
  • Ultrasound of the liver
    • indications
      • all patients
    • findings
      • steatohepatitis
        • increased echogenicity
        • coarsened echotexture of the liver
      • cirrhosis
        • nodular surface
  • Serum labs
    • liver function panel
      • elevated AST and ALT
      • elevated alkaline phosphatase
    • viral hepatitis panel
      • to exclude viral cause of chronic hepatitis
  • Invasive studies
    • liver biopsy
      • findings
        • macrovesicular steatosis
        • lobular inflammation with lymphocytes and Kupffer cells
        • ballooned hepatocytes (liver damage)
        • pericellular/perivenular or “chicken wire” fibrosis
  • Autoimmune hepatitis
    • key distinguishing factors
      • autoimmune hepatitis presents with flares of jaundice, abdominal pain, pruritus, and may progress to encephalopathy
      • positive anti-smooth muscle antibodies
  • Lifestyle
    • weight loss
    • alcohol cessation
    • good control of diabetes
    • low-fat diet and good control of dyslipidemia
  • NASH-associated cirrhosis
  • Hepatocellular carcinoma

Please rate topic.

Average 5.0 of 1 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (0)
Private Note