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Steatohepatitis, Nonalcoholic (NASH)

Amal Shine, MD and Hugh R. Peterson, MD, FACP Reviewed 06/2019
 


BASICS

DESCRIPTION

  • A chronic liver disease causing hepatocellular injury and inflammation due to accumulation of fat

  • Nonalcoholic steatohepatitis (NASH) is part of the spectrum of nonalcoholic fatty liv...

DIAGNOSIS

HISTORY

  • Most patients with NAFLD are asymptomatic.

  • In symptomatic patients, malaise, fatigue, nausea, and right upper quadrant discomfort are most common.

  • Review history for comorbid conditions...

TREATMENT

Maximize control of comorbidities, and avoid factors that promote progression of liver disease. 

GENERAL MEASURES

  • Weight loss of at least 3–5% of body weight improves steatosis. Greater weight...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • All patients should be tested for hepatitis A and B and vaccinated, if not immune.

  • Consider screening patients with NASH cirrhosis for hepatocellular carcinoma acc...

REFERENCES

1
Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases...

ADDITIONAL READING

  • Chavez-Tapia NC, Tellez-Avila FI, Barrientos-Gutierrez T, et al. Bariatric surgery for non-alcoholic steatohepatitis in obese patients. Cochrane Database Syst Rev.  2010;(1):CD...

CODES

ICD10

  • K75.81 Nonalcoholic steatohepatitis (NASH)

  • K76.0 Fatty (change of) liver, not elsewhere classified

ICD9

571.8 Other chronic nonalcoholic liver disease 

SNOMED

  • 442685003 nonalcoholic steatohepati...

CLINICAL PEARLS

  • The prevalence of NAFLD and NASH is higher in patients with metabolic syndrome or any one of its components (diabetes, obesity, hypertriglyceridemia).

  • Liver biopsy is the gold standard ...

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