What is Steatohepatitis
This is a disease of the liver that is characterized by inflammation as a result of fat deposits. Generally steatohepatitis is divided into two groups: those patients who suffer from nonalcoholic steatohepatitis and those that suffer from alcoholic steatohepatitis. While the symptoms may not be present for many years, if the disease is left untreated, it’s possible that it will progress to cirrhosis, or scarring of the liver. When steatohepatitis symptoms become apparent, they include fatigue, unexplained weight loss, a general sense of weakness, and a specific pain in the upper right abdomen.
Who Can Get Steatohepatitis
When it comes to alcoholic stetohepatitis, the culprit is clear: excessive alcoholic intake has caused the liver to malfunction, specifically in the metabolic breakdown of alcohol. This metabolic failure leads to fatty deposits that form fibrosis (scar tissue), which are the cause of steatohepatitis. In non-alcoholic steatohepatitis, patients tend to be females who have had issues with obesity or Type 2 diabetes, though Type 1 diabetics are likely to develop complications of the liver as well if they do not control their diabetes and glycolic metabolism becomes an issue. Most patients are between the ages of 40-50 and also share a medical history of high cholesterol and fatty triglycerides.
There are several scans that can be done to the body after symptoms of liver disease have been identified. These body scans include abdominal ultrasounds, CT scans, and MRIs. The definitive test for steatohepatitis, which will be performed after the initial body scans suggest further testing is necessary, is the performance of a live biopsy on the liver. This living tissue sample will provide the best evidence of what is going on in a patient’s body.
Grading and Staging Steatohepatitis
After a positive diagnosis for steatohepatitis, doctors will then ascertain the grade and stage of the disease based on duration of symptoms and degree of damage done to the liver by surrounding fibrosis (thickening or scarred tissues.) This steatohepatitis grading is useful in determining the likelihood of it progressing to cirrhosis. There are three proposed grades of non-alcoholic steatohepatitis and four proposed stages, which are based off of the grading and staging of chronic viral hepatitis that are currently globally accepted. The grades of non-alcoholic steatohepatitis (NASH) are mild, moderate, and severe with mild measuring less than 33% of zone 3 lubules (cluster of cells), moderate affecting 33-66% and severe affecting more than 66%of the lobules in zone 3. For clarification, zone three cells are a division of cells in the liver that deal specifically with the glycolysis, lipgenesis, and the cytochrome drug detoxification process, as opposed to other purposes for cells in the liver. Steatohepatitis staging is divided into zone 3 mild fibrosis, zone three focused fibrosis, bridging fibrosis (the scarring tissue begins to connect together), and finally cirrhosis (end stage liver disease.)
Treatment for Steatohepatitis
There is no steatohepatitis treatment in the early stages. Patients are encouraged to limit activities and habits that are interfering with metabolic processes. Some lifestyle changes can improve the chances of a patient halting damage already done to the liver, but once done, the damage cannot be reversed. Patients are also advised to improve diet and increase exercise levels to reduce cholesterol, keep diabetes under control, maintain a healthy weight and if necessary lose weight at a healthy pace, no more than 1-2 pounds per week. Those patients who have been diagnosed with alcoholic steatohepatitis are instructed to stop alcoholic intake altogether, or if this is impossible, to wean off of alcohol to halt the progress of steatohepatitis.
If steatohepatitis has progressed to the final stages, then liver failure is imminent, though timing and experimental medication play a factor as to how long this will be. Experimental medications include pioglitazone or metformin, which are insulin sensitizers usually prescribed to diabetics that work to decrease the body’s resistance to insulin produced by the pancreas. Another experimental treatment is Vitamin E therapy.
Prognosis for Patients with Steatohepatitis
Liver failure is the leading cause of death for those suffering with steatohepatitis, particularly in its final stages. Those who make drastic changed to increase their metabolism in the early stages of diagnosis stand a better chance at prolonging the disease, though the damage already done is irreversible. If the stages are reported at three or four, then scarring has become moderate to severe, and cirrhosis has already begun, thus liver failure is impending, and a pathology timeline will be determined by medicinal practices.
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