NASH
Matthew M. Yeh, MD, PhD
Key Facts
Etiology/Pathogenesis
-
Associated conditions
-
Diabetes
-
Obesity
-
Hyperlipidemia
-
Dyslipidemia
-
Drugs
-
Malabsorption, malnutrition
-
Clinical Issues
-
Patients often have metabolic syndrome
-
Transaminases usually elevated
Microscopic Pathology
-
NASH in pediatric population has different injury pattern
-
Inflammation, fibrosis accentuated in portal region
-
Ballooning degeneration and perisinusoidal fibrosis not obvious
-
-
Steatosis (predominantly macrovesicular)
-
Ballooned hepatocytes
-
Mallory-Denk bodies
-
Megamitochondria
-
Glycogenated nuclei
Top Differential Diagnoses
-
Steatosis without specific liver injury
-
Chronic hepatitis B
-
Chronic hepatitis C
-
Autoimmune hepatitis
-
Glycogenic hepatopathy
-
Microvesicular steatosis
-
Wilson disease
-
Alcoholic hepatitis
TERMINOLOGY
Abbreviations
-
Nonalcoholic steatohepatitis (NASH)
Definitions
-
Steatosis, inflammation, and liver cell injury in absence of excessive alcohol use history
ETIOLOGY/PATHOGENESIS
Mechanism
-
Abnormal accumulation of lipids in hepatocytes provides source of oxidative stress
-
Leads to injury/inflammation
-
Subsequent activation of TGF-β and hepatic stellate cells results in liver fibrosis
Associated Conditions
-
Diabetes, obesity, hyperlipidemia, dyslipidemia, drugs, malabsorption, malnutrition
CLINICAL ISSUES
Presentation
-
Hepatomegaly
-
Metabolic syndrome
-
Central (visceral) obesity
-
Type 2 diabetes
-
Dyslipidemia (hypertriglyceridemia and low HDL)
-
Systemic hypertension
-
Laboratory Tests
-
Elevated transaminases
Treatment
-
Management of associated metabolic conditions (diabetes, hyperlipidemia, and dyslipidemia)
-
Exercise
-
Dietary control and weight reduction
Prognosis
-
May lead to liver fibrosis, cirrhosis, and hepatocellular carcinoma
MICROSCOPIC PATHOLOGY
Histologic Features
-
Steatosis (predominantly macrovesicular)
-
Portal inflammatory infiltrate
-
Lymphocytes, pigmented macrophages, Kupffer cells
-
Inflammation typically accentuated in portal region, unlike typical zone 3 injury pattern seen in adult nonalcoholic fatty liver disease (NAFLD)/NASH
Stay updated, free articles. Join our Telegram channel
-

Full access? Get Clinical Tree

