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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