Metabolic dysfunction-associated steatohepatitis (MASH)

Background

• Fatty liver disease due to causes other than excessive alcohol
• Associated with insulin resistance and metabolic syndrome

Clinical Features

• Often asymptomatic or with mild RUQ discomfort
• Signs of portal hypertension (e.g. ascites) if advanced fibrosis
• Hepatomegaly

Differential Diagnosis

• Cirrhosis
• Hepatitis
• Viral hepatitis
• Autoimmune hepatitis
• Wilson's disease
• Hemochromatosis
• Hepatocellular carcinoma
• CHF (right heart failure]]

Evaluation

• LFTs, CBC
• RUQ US
• Outpatient elastography/Fibroscan

Management

• Treat complications of portal hypertension, if present
• Counsel on weight loss, increased coffee consumption
• Vitamin E if known F2 fibrosis

Disposition

• Discharge unless complications

See Also

• Hepatomegaly