We see a large amount of patients admitted to the ICU for end stage liver failure from alcoholism.  Occasionally we will see someone admitted with the same symptoms, but they do not have a history of alcoholism or hepatitis. How do they end up in such horrible liver failure? 

Nonalcoholic Steatohepatitis

Nonalcoholic Steatohepatitis (NASH) is a condition in which fatty deposits in the liver cause damage and inflammation to the liver.  

It is not uncommon for someone to be told they have a "fatty liver." Only when the fat causes inflammation and damage is it considered to be NASH.  If damage continues to occur, a patient's liver can become scarred causing cirrhosis. 

Causes

It is unsure what the exact cause of NASH is. There are some predisposing factors which put a person at risk for developing NASH: obesity, insulin resistance and type two diabetes, high cholesterol and high triglycerides, and metabolic syndrome. 

NASH...[is] becoming more common, possibly because of the greater number of Americans with obesity. In the past 10 years, the rate of obesity has doubled in adults and tripled in children.”
— The National Institute of Diabetes and Digestive and Kidney Diseases

Diagnosis

Stages of liver failure from The National Institute of Diabetes and Digestive and Kidney Diseases

Stages of liver failure from The National Institute of Diabetes and Digestive and Kidney Diseases

Patients with this diagnosis start with more subtle symptoms than we see in the ICU.  They will commonly have elevated liver enzymes (such as alanine aminotransferase (ALT) or aspartate aminotransferase (AST)) on routine blood panels.  It can take years or even decades for these symptoms to start appearing in some patients. Weakness or weight loss may start to present itself once the disease becomes more advanced.

After doctors have ruled out other more typical reasons for liver failure (hepatitis, excessive alcohol consumption, etc.), NASH is often suspected.  In order to confirm that a patient does not just have a fatty liver but indeed has NASH, a liver biopsy must be performed and looked at under a microscope. 

Treatment

The overall treatment plan is for patients to reduce their overall body weight, lower cholesterol and triglyceride levels, eat a more balanced diet, and begin to exercise.   In short, it is for the patients to change some of their daily habits and become healthier.  Patients should also try to avoid initiating any further damage to their liver (ingesting alcohol or unnecessary medications).

Using the above treatments can help patients to a certain extent.  Much of the reversibility of this disease depends on how far advanced it is.  For patients with very advanced cirrhosis, there may not be treatments available to reverse the permanent liver scarring. 

Other relevant articles include:

Source: http://www.niddk.nih.gov/health-informatio...

Posted
AuthorCourtney Tracy
CategoriesPhysiology