Non-Alcoholic Steatohepatitis (NASH)

Question 1

def of non-alcoholic fatty liver disease

Answer 1

most common cause of liver disease in developed worlds
spectrum of disease
1 steatosis - fat in liver
2 steatohepatitis - fat with inflammation
3 progressive disease may cause fibrosis and liver cirrhosis

Question 2

def of NASH

Answer 2

fat in the liver causing inflammation

Question 3

NASH vs alcoholic hepatitis

Answer 3

NASH has similar changes to those seen in alcoholic hepatitis in the absence of alcohol abuse

Question 4

associated factors

Answer 4

1 obesity
2 hyperlipidaemia
3 T2DM (insulin resistance)

Question 5

aetiology

Answer 5

build up of fat in liver
leads to inflammation
can cause cirrhosis

Question 6

epi

Answer 6

most common cause of liver disease in developed world

Question 7

history and examination

Answer 7

1 usually asymptomatic
-possibly dull RUQ discomfort
2 hepatomegaly
3 splenomegaly

Question 8

investigations

Answer 8

1 bloods
-ALT>AST
-50% can have normal LFTs
2 USS
-increased echogenicity
3 CT/MRI
-monitoring disease
4 liver biopsy
-definitive test

Question 9

management

Answer 9

1 weight loss
2 reduce cholesterol
3 control diabetes
4 regular exercise

Question 10

complications

Answer 10

cirrhosis + liver failure

Question 11

prognosis

Answer 11

dependent on stage of disease

NASH: 10% of patients progress to cirrhosis in 8yrs