Non-alcoholic Steatohepatitis (NASH)

00:02 Non-alcoholic fatty liver disease is the most common liver disease in the western world.

00:06 With worldwide prevalence between 6 and 35%.

00:10 Risk factors include obesity, type 2 diabetes, dyslipidemia and metabloic syndrome.

00:15 Non-alcoholic fatty liver diseases further subdivided into non-alcoholic fatty liver and NASH.

00:22 Most patients with non-alcoholic fatty liver disease fall into this category.

00:26 NAFL is generally benign in most patients who totally asymptomatic.

00:30 Obesity is considered to be the primary cause and treatment is based largely around lifestyle changes and metabolic correction of hyperlipidemia and blood sugar.

00:39 Some of these patients do experience disease progression and go on to develop a disorder called NASH.

00:45 I want you to focus upon the dreaded NASH or Non-Alcoholic Steatotic Hepatitis (NASH).

00:55 To briefly summarize all the different classes of liver disease, from this point onwards, whenever you're dealing with liver issues in medicine, have a huge list of differentials.

01:09 Including auto-immune causes such as Auto-immune hepatitis.

01:14 Other auto-immune diseases that may cause liver disease including Primary Biliary Cirrhosis, Primary Cirrhosis Cholangitis.

01:21 Then go into viral hepatitis.

01:23 Think about alcoholic hepatitis and then here the most common cause of abnormal liver function test in general population is this; Once again the patient, not necessarily an alcoholic or even causing or the alcohol causing liver damage.

01:40 In United States, obesity is an issue.

01:45 When obesity is kicking in, then you know that you have a patient that insulin resistant and so therefore, is suffering from Hyperglycemia.

01:53 Hypertension is an issue.

01:55 And in addition to that, with all of that Hypertriglyceride or hyperlipidemia, which may then accummulate in the liver, we call this Non-Alcoholic Steato. What's Steato mean? Fat.

02:07 Where are you? In the liver.

02:10 So therefore, you call this Non-Alcoholic Steato Hepatitis.

02:15 Histologically similar to very much, now which component of alcoholic liver disease? The fatty change.

02:22 Alright, Steatotic Hepatitis.

02:24 However here, the damage to liver is not being caused by alcohol.

02:29 I wish to emphasize that over and over again and the umbrella or the canvas of diagnosis is Non-Alcoholic Fatty Liver disease.

02:40 Under that, I'm having you focus on Non-Alcoholic Steatotic Hepatitis because this is the one that is going to give you clinical presentation.

02:49 Thus, this is the one that you will be asked about in number of ways, on the wards or on the boards.

02:59 As I've mentioned, the association here is absolutely Obesity.

03:03 As soon as Obesity kicks in, morbid Obesity, doesn't have to be but let's say that you weigh more than you should, then you're thinking about insulin resistance, Thus, your patient, along with liver disease, is also suffering from Hyperglycemia.

03:19 And this Hyperlipidemia, accummulation of triglycerides in liver, as I said, looks like, would you have found perhaps, alcohol fatty change.

03:29 Drugs and prolonged Total Parenteral Nutrition (TPN), could be risk factors as well for Non-Alcoholic Steatotic Hepatitis.

03:38 Let's take a look at management of NASH and based on the associations we've talked about.

03:45 If you know you're patient's obese, your recommendation is to obviously lose weight.

03:49 Exercise, diet.

03:50 Next, if you know your patient is diabetic, watch as to how much you eat.

03:55 So you will be quite agressive in terms of how you manage your patient with NASH.

04:00 Association Obesity.

04:02 Once that has come under control, then, you are decreasing the amount of damage that has taken place to the liver.

04:13 Unfortunately, the risk factor for severe liver disease, under Non-Alcholic Fatty Liver Disease and NASH, is so bad that often times liver transplantation for end stage liver disease may have to be necessary.

04:29 So as benign as it may seem, just because you hear the word "non-alcoholic", doesn't mean that the disease is any less dangerous.

04:35 Is that clear? And this is a huge problem in the US.