NASH



NASH


Matthew M. Yeh, MD, PhD









The typical features of NASH include steatosis, lobular inflammation, and ballooned hepatocytes.






Macrovesicular steatosis is commonly seen in NASH.


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 provide 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)


  • Lobular inflammatory infiltrate



    • Lymphocytes, pigmented macrophages, Kupffer cells


    • Typically more severe than portal inflammation


  • Liver cell injury



    • Ballooned hepatocytes


    • Apoptotic bodies


    • Hepatocyte injury predominantly zone 3


  • Hepatocytes may contain Mallory-Denk bodies, megamitochondria, glycogenated nuclei


  • Zone 3 perivenular/pericellular (“chicken wire”) fibrosis


Variants

Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on NASH
Premium Wordpress Themes by UFO Themes
%d bloggers like this: