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09 Gastroenterology

Nonalcoholic SteatoHepatitis (NASH)                                                                                                       

Most NASH pts are obese, middle-aged women with asymptomatic hepatomegaly, diabetes, or hyperlipidmia who do not abuse alcohol.  Lab findings typically show that the ALT level is equal to or > the AST level  (the reverse in alcoholic hepatitis).

Although some pts develop cirrhosis, portal hypertension, & liver failure, most pts have a good prognosis..  In some cases, the disease can be reversed with weight reduction.

Age:  usually between 41-60 years.  Predominantly female.

Commonly associated conditions:  Obesity, diabetes, hyperlipidemia.

Symptoms: none in 48-100%; vague abdominal discomfort, RUQ abd. pain, fatigue or malaise.

Signs: hepatomegaly, rarely, stigmata of chronic liver disease or portal hypertension.

Lab. features:
2-3x increase in ALT & AST; normal or midly elevated alkaline phosphatase levels; normal serum albumin, prothrombin time, & bilirubin levels; possible elevation of serum ferritin levels.

Ann Intern Med 1997;126:137 - Sheth SG, Gordon FD, Chopra S