Nash

Nash or Nonalcoholic steatohepatitis is a type of fatty liver disease, which is characterized by inflammation of the liver with concurrent fat accumulation in liver. It is related to insulin resistance and the metabolic syndrome and may respond to treatments originally developed for other insulin-resistant states (e.g., diabetes mellitus type 2) such as weight loss, metformin, and thiazolidinediones.

Signs and Symptoms

The majority of people with Nash are asymptomatic and only discovered during incidental testing. Some people may experience fatigue, malaise, and dull right upper quadrant abdominal discomfort. Mild jaundice can rarely be noticed, although this is not typical of the disease.

Causes

Nash is believed to occur due to a combination of genetic and environmental factors. The exact reasons are still not fully understood, but it is known that insulin resistance plays a major role. Other factors such as oxidative stress, mitochondrial dysfunction, and fat accumulation in the liver also contribute to the development of Nash.

Diagnosis

The diagnosis of Nash is confirmed by a liver biopsy. The histological findings vary from simple steatosis to cirrhosis, but the hallmark is steatosis with inflammation and ballooning of hepatocytes, with or without fibrosis.

Treatment

The primary treatment for Nash is weight loss, which reduces liver fat, inflammation, and fibrosis. If weight loss is not sufficient, treatments used for type 2 diabetes such as metformin and thiazolidinediones can be used. In severe cases, liver transplantation may be necessary.

See Also

• Fatty liver
• Alcoholic liver disease
• Cirrhosis
• Hepatitis

References

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