Steatohepatitis

A steatohepatitis ( colloquially fatty liver hepatitis ) is a disease where the inflammatory changes in a fatty liver ( steatosis lat ), where there is no infectious cause such as viruses.

  • 5.1 cause
  • 5.2 therapy
  • 6.1 causes
  • 6.2 Treatment of NASH

Clinic

In a pure fatty liver symptoms are absent. In a steatohepatitis occurs in about half of cases to non-specific symptoms such as sensitivity to pressure of the enlarged liver, loss of appetite, nausea, bloating, weight loss. In severe cases, jaundice ( " jaundice " ), fever and deterioration of the general condition occur.

Diagnostics

Laboratory tests are increased in the liver in steatohepatitis in contrast to pure fatty liver both cholestasis parameters (especially gamma - GT), and the transaminases as a sign of inflammation. Often also shows a slight increase of the white blood cell count ( leukocytosis), as well as possibly a small increase of C-reactive protein. On diagnostic imaging, ultrasonography is used in routine diagnostics. The phone may also further investigations are necessary, such as endoscopic ultrasonography, MRI scans or ERCP examination to complete the diagnosis and to exclude other diseases of the liver. The diagnosis is confirmed histologically by biopsy collection as part of a liver biopsy. Histologically, however, can not distinguish between an alcohol -induced steatohepatitis ( ASH) or non- alcoholic steatohepatitis ( NASH ).

Pathogenesis

The steatohepatitis is an inflammatory reaction due to factors in an immunulogischer preexisting fatty liver ( hepatic steatosis ), which is characterized by increased fat accumulation in the liver cells (hepatocytes ). Disturbances of cell metabolism occurs Zellballonierungen and cell loss. In a steatohepatitis in addition the image of liver inflammation (hepatitis) occurs for fatty liver.

Classification

Classification by cause

Two forms are distinguished due to the etiology:

  • Alcoholic steatohepatitis (including alcoholic hepatitis, alcohol- induced fatty liver hepatitis, called abbreviated ASH): Excessive consumption of alcohol can cause fatty liver and hepatitis.
  • Non-alcoholic Steatohepatitis ( or non-alcoholic steatohepatitis, NASH abbreviated ): all forms of fatty liver hepatitis, which have not been triggered by alcohol

Classification according to severity

One can distinguish two forms in relation to the severity of the disease:

  • The chronic persistent hepatitis
  • The chronic active (formerly chronic aggressive ) hepatitis.

Chronic persistent hepatitis is a lighter form of steatohepatitis. It causes no symptoms in most cases. In some cases, however, occur uncharacteristic symptoms such as general upper abdominal discomfort, indigestion, pressure and / or bloating.

The chronic active hepatitis occurs in about 15-20 % on all cases of fatty liver hepatitis. It is the more severe form of the disease and causes more pronounced symptoms (for example, loss of appetite, nausea, weight loss, jaundice and fever). The risk of progression to cirrhosis of the liver is markedly increased in patients with chronic active hepatitis.

Alcoholic steatohepatitis ( ASH)

Cause

The alcohol-induced steatohepatitis ( ASH) or German alcoholic fatty liver inflammation or steatohepatitis occurs at regular, excessive alcohol consumption. The distinction arises from the daily alcohol consumption. The tolerance of alcohol is very different from person to person and depends inter alia on possible pre-existing conditions, as well as of gender. The harmful limit is on average about 40 g ethanol for men and 20 g in women.

Therapy

Even in a state of acute alcohol-induced steatohepatitis (ASH, alcoholic hepatitis ) helps the abstinence from alcohol, that is, the strict waiver of any form of alcohol. As long as the liver cells have not yet been converted into cicatricial tissue, the body can regain its ability to function. While the prognosis of the chronic persistent form is quite good, it will appear at the chronically active depending on the stage of the disease: Can be achieved in part a complete regression of symptoms in strict abstinence, a transition into hepatic coma or in the cirrhosis on the other hand possible with increasing jaundice.

Non-alcoholic steatohepatitis ( NASH )

A non- alcoholic steatohepatitis ( NASH ) or nonalcoholic fatty liver inflammation or non-alcoholic steatohepatitis is present if indeed there is a steatohepatitis, the daily consumption of alcohol but less than 40 g in men or less than 20 g in women and liver function tests (transaminases ), even after a remain elevated three-month absolute alcohol abstinence. The NASH, although much less frequently than the ASH, but is nevertheless still at about one percent of the general population. In contrast to the ASH no jaundice occurs.

Causes

To a NASH occurs most often caused by metabolic disorders, but there are other, different causes.

The most common causes are:

  • Obesity
  • ( poorly controlled ) diabetes mellitus
  • Hyperlipoproteinemia

Less common causes include:

  • Copper storage disease Wilson's disease
  • State after intestinal surgery, in particular small-bowel resections
  • Blind loop syndrome
  • Parenteral nutrition
  • Inflammatory bowel Erkrankungenen
  • As a medication side effect ( prolonged treatment with corticosteroids, amiodarone, tamoxifen or other drugs )

Occasionally, the cause remains unclear or there are several possible causes together.

Treatment of NASH

The therapy consists of treatment of the underlying disease (eg: better setting of diabetes mellitus, weight loss, change of medication ). If an advanced liver cirrhosis has already occurred, there is a therapeutic option in liver transplantation ( LTx ).

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