Non Alcofolic Fatty Liver Disease (NAFLD) – Non Alcoholic Steatohepatitis (NASH)

Causes

Fatty liver is excessive accumulation of lipid in hepatocytes. Nonalcoholic fatty liver disease (NAFLD) includes simple fatty infiltration (a benign condition called fatty liver), whereas nonalcoholic steatohepatitis (NASH) is defined as the presence of fat leading to lipotoxicity and inflammatory damage to hepatocytes.
Histologically, NASH is indistinguishable from alcoholic hepatitis. Thus to diagnosis NASH, underlying alcohol use must be ruled out.
Differentiating simple steatosis from NASH can be difficult, and elevated liver enzymes are not a sensitive predictor for identifying NASH.

Symptoms and Signs

Most patients are asymptomatic. However, some have fatigue, malaise, or right upper quadrant abdominal discomfort.
Hepatomegaly develops in about 75% of patients.
Splenomegaly may develop if advanced hepatic fibrosis is present and is usually the first indication that portal hypertension has developed.
Patients with cirrhosis due to NASH can be asymptomatic and may lack the usual signs of chronic liver disease.

Diagnosis

• History (presence of risk factors, absence of excessive alcohol intake)
• Serologic tests that rule out hepatitis B and C
• Ultrasound evidence of steatosis or MR elastography with fat fraction
• Liver biopsy

Treatment

• Lifestyle changes
• Elimination of causes and control of risk factors