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Non-Alcoholic Steatohepatitis: Causes, Symptoms, Diagnosis

Updated: Mar 10


Non-Alcoholic Steatohepatitis
Copyright: CDC on Unsplash I License: CC0 Public Domain

The liver is a football-sized organ sitting under the right part of the abdomen. It participates in the detoxification, digestion, and transportation of enzymes and hormones.


Common liver diseases include hepatitis, fibrosis, cirrhosis, and cancer. Liver problems can be caused by multiple factors, such as alcohol abuse, viruses, or other medical conditions like obesity. Some liver diseases can be inherited/genetic and can lead to further disease progression if not treated.


NASH, or Non-Alcoholic Steatohepatitis, is a liver disease that attacks the liver cells and causes a build-up of fats. Over time, NASH can lead to cirrhosis and potentially liver failure, which is considered a life-threatening condition.


In this brief guide, we’ll talk about the causes, symptoms, and diagnosis of NASH and whether people can prevent it from progressing. Read on to learn more about it.


What Are the Causes?

According to experts, the known causes of NASH are still under research. However, there’s limited understanding that NAFLD and NASH develop under certain circumstances and are linked to type 2 diabetes, obesity, hyperglycemia, and high levels of fats.


All of these medical conditions combined can lead to the development of Non-Alcoholic Steatohepatitis, which causes a build-up of fats in the liver cells. For some people, the fat build-up in the liver can cause liver inflammation and act as a toxin to the liver cells, leading to scarring and fibrosis over time.


The risk of NASH is increased when the patient suffers from the following:

  • High cholesterol

  • PCOS - Polycystic Ovary Syndrome

  • Sleep apnea

  • Hypothyroidism - underactive thyroid

  • Hypopituitarism - underactive pituitary gland

  • Obesity

  • Metabolic syndrome

  • Oxidative stress - an imbalance between the antioxidants and the free radicals in the body

  • Intestinal bacteria - causing liver inflammation

  • Genetic diseases

  • Apoptosis - programmed cell death

  • Overproduction of cytokines

Based on some statistics, NASH is more likely to develop in people with diabetes, older people, and those with most of their fat concentrated around the belly area and the abdomen. Also at increased risk are Hispanic or Asian people, women in the postmenopausal period, or people suffering from high blood pressure.


Many tests are performed to diagnose NASH, including a NASH blood test, biopsies, and imaging methods. We’ll discuss the diagnostic methods later in this article.


Symptoms of NASH

The early stages of NASH usually display no symptoms at all since it’s a silent disease. Over time, the disease will progress, and the person might show symptoms of fatigue and pain or discomfort in the right part of the abdomen.


As the disease advances to its later stages, symptoms like abdominal swelling or ascites, enlarged spleen, red palms, enlarged blood vessels, and jaundice appear. Additional symptoms like behavioral changes, including confusion or slurred speech, intense itchiness, and easy bruising, can also be indicators of NASH.


Non-alcoholic steatohepatitis makes it difficult for the liver to function, which leads to liver damage and swelling that can be serious or even life-threatening.


Make an appointment with your doctor immediately if you have any of these symptoms persistently.


Liver treatment
Copyright: Julien Tromeur on Unsplash I License: CC0 Public Domain

Diagnosis of NASH

Since people with NASH don’t usually experience any symptoms, it can be difficult to diagnose the disease in its early stages. Doctors usually recognize liver problems from other regular screenings or routine blood tests.


High levels of certain enzymes in the blood show liver disease, damage, inflammation, or injury.


Liver Function Tests

Some common liver function tests are ALT (alanine aminotransferase) and AST (aspartate aminotransferase). These show liver inflammation and rule out other diseases.


Other common tests are:

  • Alkaline phosphatase - ALP

  • Albumin and total protein tests

  • Bilirubin test

  • Gamma-glutamyltransferase test - GGT

  • Prothrombin time

Imaging Tests

Imaging tests like MRI, ultrasound, and CT are used to get imaging of the internal organs, tissues, and structures and diagnose scarring, fibrosis, or tumors.


Liver Biopsy

This is a minimally-invasive procedure that involves taking a small liver sample through a thin needle. The most common type of liver biopsy is percutaneous liver biopsy, where the liver tissue is taken through the belly.


A liver biopsy is used when the healthcare provider needs to diagnose a liver problem, obtain a sample tissue from the liver and send it for a lab examination to rule out liver cancer, determine the stages of the disease and develop a treatment plan based on the liver’s condition.


The healthcare provider might order a biopsy if there are irregular liver tests that can’t be explained or other irregularities or tumors are seen on the imaging tests. A liver biopsy is commonly performed to diagnose:


● Chronic hepatitis B

● Chronic hepatitis C

● Primary biliary cholangitis

● Hemochromatosis

● Autoimmune hepatitis

● NAFLD and NASH

● Liver cirrhosis

● Wilson’s disease


Take Care of Your Health

It’s important to take care of your health and go for regular check-ups. Your healthcare provider will inform you of the further steps if liver disease is diagnosed, so make sure you stay healthy and listen to your doctor’s advice.

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