Non-alcoholic steatohepatitis Flashcards
Define Non-alcoholic steatohepatitis
Most common cause of Liver cirrhosis is west -define by steatic changes in the liver in those that don’t consume that much alcohol
Early version, before fibrosis-non alcoholic fatty liver disease
After fibrosis-NASH
Aetiology and risk factors of Non-alcoholic steatohepatitis
Not fully understood but maybe insulin resistance leads to accumulation of TAG in liver (NAFLD), leading to oxidative damage, scarring and fibrotic changes (NASH) (ballooning degeneration)-> last stage is cirrhosis (cirrhosis) (change is architecture, mallory bodies)-> can develop to failure
Primary-Pt that have insulin resistance
Risk factors Obesity Insulin resistance Age 40-60 Hispanic HTN Dyslipedemia
Epidiemology of Non-alcoholic steatohepatitis
MOST common cause of Chronic liver disease in west
maybe affects 20-40% in early stages
40-60 years old, but increasing in paeds population
NASH has been increasing
Signs and Sx of Non-alcoholic steatohepatitis
Patients with NAFLD will not have Sx, or vague (malaise/fatigue) and hepatomegaly
(or even NASH)
The most important one-Not excessive alcohol use
Fatigue, malaise, truncal obesity, hepatomegaly
then signs of Chronic liver disease/Cirrhosis (stage after NASH): (end stage) RUQ discomfort Variceal bleeds Hepatomegaly, Splenomegaly Jaundice, pruritus, excoriation Spider naevi, spider angiomata, caput medusa Duypurtrens, palmar erythema Gynacomastia, testicular small Ascites asterisks
Investigations of Non-alcoholic steatohepatitis
Early stage-LFT raised but mild
Bilirubin fine
GGT fine
Lipids not fine, Hba1c can be high
end stage-liver days LFT-raised Billirubin raised af ALP raised (not as much as AST/ALT) GGT raised FBC-aneamia/thrombocytopenia Albumin low antinuclear AB, anti smooth muscle-absent
Liver biopsy is useful, but CANNOT tell you if its alcohol or non alcohol related-thats from Hx alone
Management of Non-alcoholic steatohepatitis
Mainly has to be dietary and behavioural-no cure drug
Weight loss through lifestyle
HTN loss through lifestyle
drugs for weight loss/HTN (bariatric surgery, classic drugs)
Fibrins for hyperlipidemia
Treat insulin resistance/diabetes-metoformin does NOT help
When end stage liver failure-its shunts to reduce portal HTN
and liver replacement in time
Complications of Non-alcoholic steatohepatitis
Generally CVD and clotting risk factor
NASH progresses to cirrhosis about 20% of time
When cirrhosis is there-unable to reverse
Cirroshis-Ascites,
Cirroshis-Portosystemic Cirroshis-hypertension
Cirroshis-Liver cancer
Cirroshis-Encelopathy
death
Prognosis of Non-alcoholic steatohepatitis
NAFLD-its good, and patients should remain stable with simple modifications (or even nada)
Progressive form of NAFLD-NASH-Bad
1/3 progress, 1/3 stay 1/3 regress
NASH -> cirrhosis about 20% of time-1/3 die soon after
