Metabolic dysfunction-associated steatohepatitis (MASH)

Background

  • Formerly known as non-alcoholic steatohepatitis
Stages of non-alcoholic fatty liver disease, progressing from healthy, to steatosis (fat accumulation), inflammation, fibrosis and cirrhosis.
Inferior view of the liver with surface showing lobes and impressions.
Liver vascular anatomy.
Bile duct and pancreas anatomy. 1. Bile ducts: 2. Intrahepatic bile ducts; 3. Left and right hepatic ducts; 4. Common hepatic duct; 5. Cystic duct; 6. Common bile duct; 7. Sphincter of Oddi; 8. Major duodenal papilla; 9. Gallbladder; 10-11. Right and left lobes of liver; 12. Spleen; 13. Esophagus; 14. Stomach; 15. Pancreas: 16. Accessory pancreatic duct; 17. Pancreatic duct; 18. Small intestine; 19. Duodenum; 20. Jejunum; 21-22: Right and left kidneys.
  • Fatty liver disease due to causes other than excessive alcohol
  • Associated with insulin resistance and metabolic syndrome


Clinical Features

  • Often asymptomatic or with mild RUQ discomfort
  • Signs of portal hypertension (e.g. ascites) if advanced fibrosis
  • Hepatomegaly


Differential Diagnosis

Hepatic Dysfunction

Infectious

Neoplastic

Metabolic

Biliary

  • Biliary cirrhosis

Drugs

Miscellaneous


Evaluation

  • LFTs, CBC
  • RUQ US
  • Outpatient elastography/Fibroscan


Management

  • Treat complications of portal hypertension, if present
  • Counsel on weight loss, increased coffee consumption
  • Vitamin E if known F2 fibrosis


Disposition

  • Discharge unless complications


See Also

  • Hepatomegaly


External Links

References

  1. ↑ Tintanelli's
This page is issued from WikEM. The text is available under an unknown license unless otherwise noted. Additional terms may apply for the media files.