steatohepatitis (fatty liver)

introduction

steatohepatitis is a progression of fatty liver disease and may progress on to cirrhosis and hepatocellular carcinoma
initially it is asymptomatic and may only be discovered as a result of:
- raised liver function tests (LFTs)
- hepatomegaly
- diagnosis on USS or CT abdo
it is classified into:
- alcoholic steatohepatitis
- non-alcoholic steatoheptatitis (NASH)

currently affects 3.5-5% of adults in Western cultures and > 75% of those with morbid obesity
risk factors:
- high fructose diet
  - excessive fructose metabolism in intestinal cells reduces production of proteins that maintain the gut barrier and can cause a chronic endotoxaemia which in the liver is thought to provoke increased production of inflammatory cytokines and stimulate the conversion of fructose and glucose into fatty acid deposits¹⁾
- metabolic syndrome
- central obesity
- hyperglycemia
- type 2 diabetes
- arterial hypertension
- hypertriglyceridemia
it is a progression from nonalcoholic fatty liver disease (NAFLD) which affects ~20% of the population in Western cultures and is rising rapidly due to obesity
- 90% of obese patients have NAFLD, while up to 70% of type 2 diabetics have NAFLD
histologically, it is characterised by unique zone 3 “chicken wire” fibrosis
accounts for 13% of all cases of hepatocellular carcinoma
in the Pioglitazone versus Vitamin E versus Placebo for the Treatment of Nondiabetic Patients with Nonalcoholic Steatohepatitis (PIVENS) trial, for patients with NASH but without diabetes mellitus, the use of very high dosages of vitamin E (800 IU/day) for four years was associated with a significantly higher rate of improvement than placebo (43% vs. 19%) in the primary outcome

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