NASH

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
Low-power view of a liver biopsy in a child with steatohepatitis reveals chronic portal inflammation image. Macrosteatosis is noted within the hepatic lobules image, and bridging fibrosis is evident.
A chronic portal inflammation image with expansion into zone 1 image is illustrated here. The lobular inflammatory cells are situated among steatotic hepatocytes.
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
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Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on NASH

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