Non-alcoholic steatohepatitis

Background

Stages of non-alcoholic fatty liver disease, progressing from healthy, to steatosis (fat accumulation), inflammation, fibrosis and cirrhosis.

• 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

Hepatic Dysfunction

Infectious

• Hepatitis
  • Viral hepatitis
• Malaria
• HIV (present in 50% of AIDS patients)
• EBV
• Babesiosis, leptospirosis
• Typhoid
• Hepatic abscess, amebiasis

Neoplastic

• Metastases
• Hepatocellular carcinoma
• Multiple myeloma
• Leukemia
• Lymphoma
• Myeloproliferative disorders

Metabolic

• Hemochromatosis
• Wilson's disease
• Non-alcoholic steatohepatitis
• Inborn errors of metabolism

Biliary

• Biliary cirrhosis

Drugs

• Alcoholic cirrhosis
• Alcoholic hepatitis
• Hepatotoxic drugs

Miscellaneous

• Other causes of cirrhosis
• Autoimmune hepatitis
• Veno-occlusive disease
• 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