Metabolic dysfunction-associated steatohepatitis (MASH)

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Background

Formerly known as non-alcoholic steatohepatitis

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

Inferior view of the liver with surface showing lobes and impressions.

Liver vascular anatomy.

Bile duct and pancreas anatomy. 1. Bile ducts: 2. Intrahepatic bile ducts; 3. Left and right hepatic ducts; 4. Common hepatic duct; 5. Cystic duct; 6. Common bile duct; 7. Sphincter of Oddi; 8. Major duodenal papilla; 9. Gallbladder; 10-11. Right and left lobes of liver; 12. Spleen; 13. Esophagus; 14. Stomach; 15. Pancreas: 16. Accessory pancreatic duct; 17. Pancreatic duct; 18. Small intestine; 19. Duodenum; 20. Jejunum; 21-22: Right and left kidneys.

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

Hepatic Dysfunction

Infectious

Hepatitis
- Viral hepatitis
Malaria
HIV (present in 50% of AIDS patients)^[1]
EBV
Babesiosis, leptospirosis
Typhoid
Hepatic abscess, amebiasis

Neoplastic

Metabolic

Biliary

Biliary cirrhosis

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

External Links

References

↑ Tintanelli's

Authors:

[1] Tintanelli's

[1]