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Non-Alcoholic Steatohepatitis (NASH)


Diagnosis


In most cases, fatty liver disease, regardless of the cause, produces no overt symptoms. When the disease has progressed to causing liver inflammation, that may not be the case. Hepatitis can cause pain in the upper abdomen, near the location of the liver, and also visible swelling of the region. When a patient presents with these symptoms, diagnostic tests to seek liver disease are commonly prescribed.

NASH can cause impairment of liver function, although usually not to the degree that other overt symptoms such as jaundice or loss of appetite are experienced. This impairment can be detected through blood tests for elevated liver enzymes in the blood. Fatty liver disease and inflammation of the liver can also be detected through use of medical imaging techniques such as an ultrasound or CT scan. The presence of fatty liver deposits and liver inflammation (hepatitis) are together sufficient to diagnose steatohepatitis, and a blood test for AST elevation compared to ALT elevation can indicate whether or not the cause is alcohol abuse. In addition, a simple survey of the patient's lifestyle can determine whether excessive alcohol consumption is happening. If it isn't, then alcohol abuse can be ruled out as a cause, resulting in a diagnosis of NASH.

Causes


The diagnosis of NASH is only partial, since it indicates what the cause is not, but not what it is. Non-alcoholic causes of steatohepatitis include obesity and diabetes, as well as hereditary predispositions. Sometimes the cause cannot be clearly identified.

Prognosis


The problem with fatty liver disease is that it can progress to something more serious. Fatty liver is a recognized precursor to cirrhosis of the liver, a progressive liver disease resulting in increasing liver failure, fatal in the final stages. Steatohepatitis is a more serious progression of the relatively harmless fatty liver disease in that it is causing liver inflammation and impairment of hepatic function. A more aggressive treatment approach is called for in order to prevent progression of the disease to the even more serious cirrhosis.

Treatment


Treatment of NASH involves addressing the causes of the disease for the most part, which means in most cases controlled and gradual weight loss for obese patients and/or treatment of diabetes through lifestyle changes and a high-fiber, low-fat, low-sugar diet together with regular aerobic exercise.

In addition, medications used to treat Type 2 diabetes may be recommended in cases where the disease has produced NASH as a complication. These drugs lower the body's glucose levels and are a more aggressive diabetes treatment than the more conservative approach through diet and exercise (which should always accompany any drug treatments).

NASH is unlikely to produce liver failure great enough to warrant a liver transplant, although it can progress to cirrhosis of the liver which may reach that point. The goal of treating NASH is to arrest its progression and ultimately reverse the accumulation of fatty deposits and liver inflammation. Unlike some other liver diseases, damage to the liver from NASH may be reversible if the condition is arrested and the causes are addressed.

Steatohepatitis is a form of fatty liver disease that has progressed to the point where the liver is inflamed ("hepatitis" being an inflammation of the liver). This should not be confused with viral hepatitis, which produces the same symptom but due to a viral infection. Fatty liver disease is often caused by alcohol abuse; this is the single largest cause of fatty liver disease as well as of some other liver disorders including cirrhosis of the liver, but the majority of cases of steatohepatitis are not alcoholic in origin. The designation "non-alcoholic steatohepatitis," or NASH, refers to steatohepatitis from some other cause and not from alcohol abuse.

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NASH Liver