Steatohepatitis

Last updated
Steatohepatitis
Steatohepatitis high mag.jpg
Micrograph of steatohepatitis. Liver biopsy. Trichrome stain
Specialty Gastroenterology   Blue pencil.svg

Steatohepatitis is a type of fatty liver disease, characterized by inflammation of the liver with concurrent fat accumulation in liver. Mere deposition of fat in the liver is termed steatosis, and together these constitute fatty liver changes. [1]

Fatty liver disease lipid storage disease characterized by the accumulation of large vacuoles of triglyceride fat in liver cells via the process of steatosis

Fatty liver disease (FLD), also known as hepatic steatosis, is a condition where excess fat builds up in the liver.

Inflammation signs of activation of the immune system

Inflammation is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molecular mediators. The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, and initiate tissue repair.

Liver vital organ in vertebrates and some other animals

The liver, an organ only found in vertebrates, detoxifies various metabolites, synthesizes proteins, and produces biochemicals necessary for digestion. In humans, it is located in the right upper quadrant of the abdomen, below the diaphragm. Its other roles in metabolism include the regulation of glycogen storage, decomposition of red blood cells and the production of hormones.

Contents

There are two main types of fatty liver disease: alcohol-related fatty liver disease and non-alcoholic fatty liver disease (NAFLD). [2] Risk factors for NAFLD include diabetes, obesity and metabolic syndrome. When inflammation is present it is referred to as alcoholic steatohepatitis and nonalcoholic steatohepatitis (NASH). [3] Steatohepatitis of either cause may progress to cirrhosis, and NASH is now believed to be a frequent cause of unexplained cirrhosis (at least in Western societies). NASH is also associated with lysosomal acid lipase deficiency.[ medical citation needed ]

Non-alcoholic fatty liver disease fatty liver disease characterized by the storing of excess fat in liver cells which is is not caused by heavy alcohol use

Non-alcoholic fatty liver disease (NAFLD) is when excess fat builds up in the liver due to causes other than alcohol use. There are two types: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). Non-alcoholic fatty liver usually does not progress to liver damage or NASH. NASH includes both a fatty liver and liver inflammation. It may lead to complications such as cirrhosis, liver cancer, liver failure, or cardiovascular disease.

Obesity medical condition in which excess body fat harms health

Obesity is a medical condition in which excess body fat has accumulated to an extent that it may have a negative effect on health. People are generally considered obese when their body mass index (BMI), a measurement obtained by dividing a person's weight by the square of the person's height, is over 30 kg/m2; the range 25–30 kg/m2 is defined as overweight. Some East Asian countries use lower values. Obesity increases the likelihood of various diseases and conditions, particularly cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, certain types of cancer, osteoarthritis, and depression.

Metabolic syndrome clustering of medical conditions (giving a total of 16 possible combinations giving the syndrome)

Metabolic syndrome, sometimes known by other names, is a clustering of at least three of the five following medical conditions: central obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL).

The word is from steato-, meaning "fat" and hepatitis , meaning "inflammation of the liver".

Hepatitis inflammation of the liver tissue

Hepatitis is inflammation of the liver tissue. Some people have no symptoms whereas others develop yellow discoloration of the skin and whites of the eyes, poor appetite, vomiting, tiredness, abdominal pain, or diarrhea. Hepatitis may be temporary (acute) or long term (chronic) depending on whether it lasts for less than or more than six months. Acute hepatitis can sometimes resolve on its own, progress to chronic hepatitis, or rarely result in acute liver failure. Over time the chronic form may progress to scarring of the liver, liver failure, or liver cancer.

Alcoholic steatohepatitis

Chronic alcohol intake commonly causes steatohepatitis. [4]

Non-alcoholic steatohepatitis (NASH)

Non-alcoholic steatohepatitis is fatty liver disease due to causes other than alcohol. No pharmacological treatment has received approval as of 2015 for NASH. [5] Some studies suggest diet, exercise, and antiglycemic drugs may alter the course of the disease. General recommendations include improving metabolic risk factors and reducing alcohol intake. [6] [7] NASH was first described in 1980 in a series of patients of the Mayo Clinic. [8] Its relevance and high prevalence were recognized mainly in the 1990s. Some think NASH is a diagnosis of exclusion, and many cases may in fact be due to other causes. [9]

Diet (nutrition) the sum of food consumed by an organism

In nutrition, diet is the sum of food consumed by a person or other organism. The word diet often implies the use of specific intake of nutrition for health or weight-management reasons. Although humans are omnivores, each culture and each person holds some food preferences or some food taboos. This may be due to personal tastes or ethical reasons. Individual dietary choices may be more or less healthy.

Exercise bodily activity that enhances or maintains physical fitness and overall health and wellness

Exercise is any bodily activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons, including increasing growth and development, preventing aging, strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance, improving health and also for enjoyment. Many individuals choose to exercise outdoors where they can congregate in groups, socialize, and enhance well-being.

Mayo Clinic medical practice and medical research group based in Rochester, Minnesota, United States

The Mayo Clinic is a nonprofit academic medical center based in Rochester, Minnesota, focused on integrated clinical practice, education, and research. It employs more than 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff. The practice specializes in treating difficult cases through tertiary care and destination medicine. It is home to the highly ranked Mayo Clinic Alix School of Medicine in addition to many of the largest, best regarded residency education programs in the United States. It spends over $660 million a year on research and has more than 3,000 full-time research personnel.

See also

Chronic liver disease in the clinical context is a disease process of the liver that involves a process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis. "Chronic liver disease" refers to disease of the liver which lasts over a period of six months. It consists of a wide range of liver pathologies which include inflammation, liver cirrhosis, and hepatocellular carcinoma. The entire spectrum need not be experienced.

Steatosis

Steatosis, also called fatty change, is the process describing the abnormal retention of lipids within a cell or organ. When not further specified, it is defined as affecting the liver. It reflects an impairment of the normal processes of synthesis and elimination of triglyceride fat. Excess lipid accumulates in vesicles that displace the cytoplasm. When the vesicles are large enough to distort the nucleus, the condition is known as macrovesicular steatosis; otherwise, the condition is known as microvesicular steatosis. While not particularly detrimental to the cell in mild cases, large accumulations can disrupt cell constituents, and in severe cases the cell may even burst.

Aramchol is an investigational drug being developed by Galmed Pharmaceuticals as a first-in-class, potentially disease modifying treatment for nonalcoholic steatohepatitis, or NASH, a more advanced condition of non-alcoholic fatty liver disease.

Related Research Articles

Hepatocellular carcinoma liver carcinoma that has material basis in undifferentiated hepatocytes

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer in adults, and is the most common cause of death in people with cirrhosis.

Alcoholic liver disease

Alcoholic liver disease is a term that encompasses the liver manifestations of alcohol overconsumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with liver fibrosis or cirrhosis.

Alcoholic hepatitis hepatitis (inflammation of the liver) due to excessive intake of alcohol

Alcoholic hepatitis is hepatitis due to excessive intake of alcohol. It is usually found in association with fatty liver, an early stage of alcoholic liver disease, and may contribute to the progression of fibrosis, leading to cirrhosis. Signs and symptoms of alcoholic hepatitis include jaundice, ascites, fatigue and hepatic encephalopathy. Mild cases are self-limiting, but severe cases have a high risk of death. Severe cases may be treated with glucocorticoids.

Liver disease Human disease

Liver disease is a type of damage to or disease of the liver.

Zieve's syndrome is an acute metabolic condition that can occur during withdrawal from prolonged alcohol abuse. It is defined by hemolytic anemia, hyperlipoproteinaemia, jaundice, and abdominal pain. The underlying cause is liver delipidization. This is distinct from alcoholic hepatitis which, however, may present simultaneously or develop later.

Liver biopsy

Liver biopsy is the biopsy from the liver. It is a medical test that is done to aid diagnosis of liver disease, to assess the severity of known liver disease, and to monitor the progress of treatment.

Acute fatty liver of pregnancy is a rare life-threatening complication of pregnancy that occurs in the third trimester or the immediate period after delivery. It is thought to be caused by a disordered metabolism of fatty acids by mitochondria in the mother, caused by long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency. The condition was previously thought to be universally fatal, but aggressive treatment by stabilizing the mother with intravenous fluids and blood products in anticipation of early delivery has improved prognosis.

Liver failure

Liver failure or hepatic insufficiency is the inability of the liver to perform its normal synthetic and metabolic function as part of normal physiology. Two forms are recognised, acute and chronic. Recently a third form of liver failure known as acute-on-chronic liver failure (ACLF) is increasingly being recognized.

Cirrhosis long-term disease of the liver

Cirrhosis is a condition in which the liver does not function properly due to long-term damage. This damage is characterized by the replacement of normal liver tissue by scar tissue. Typically, the disease develops slowly over months or years. Early on, there are often no symptoms. As the disease worsens, a person may become tired, weak, itchy, have swelling in the lower legs, develop yellow skin, bruise easily, have fluid build up in the abdomen, or develop spider-like blood vessels on the skin. The fluid build-up in the abdomen may become spontaneously infected. Other complications include hepatic encephalopathy, bleeding from dilated veins in the esophagus or dilated stomach veins, and liver cancer. Hepatic encephalopathy results in confusion and may lead to unconsciousness.

The AST/ALT ratio is the ratio between the concentrations of the enzymes aspartate transaminase (AST) and alanine transaminase, aka alanine aminotransferase (ALT) in the blood of a human or animal. It is measured with a blood test and is sometimes useful in medical diagnosis to differentiate between causes of liver damage, or hepatotoxicity.

Ballooning degeneration form of liver parenchymal cell (i.e. hepatocyte) death

In histopathology, ballooning degeneration, formally ballooning degeneration of hepatocytes, is a form of liver parenchymal cell death.

Obeticholic acid chemical compound

Obeticholic acid, is a semi-synthetic bile acid analogue which has the chemical structure 6α-ethyl-chenodeoxycholic acid. It is used as a drug to treat primary biliary cholangitis, and is undergoing development for several other liver diseases and related disorders. Intercept Pharmaceuticals Inc. hold the worldwide rights to develop OCA outside Japan and China, where it is licensed to Dainippon Sumitomo Pharma.

Detlef Schuppan is a German biochemist and physician. He focuses on the diagnosis and treatment of coeliac disease and wheat sensitivity, fibrotic liver diseases and the immunology of chronic diseases and cancer. He is the director of the Institute of Translational Immunology and a professor of internal medicine, gastroenterology, and hepatology at the Medical Center of the Johannes Gutenberg University of Mainz in Germany. He directs the outpatient clinic for coeliac disease and small intestinal diseases. He is also a professor of medicine and senior visiting scientist at Harvard Medical School.

References

  1. "Alcoholic Steatohepatitis – Causes, Symptoms And Treatment" . Retrieved 21 Dec 2016.
  2. "Steatohepatitis and Steatosis (Fatty Liver)" . Retrieved 17 May 2016.
  3. Vuppalanchi R, Chalasani N (January 2009). "Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management". Hepatology. 49 (1): 306–17. doi:10.1002/hep.22603. PMC   2766096 . PMID   19065650.
  4. "Alcoholic Steatohepatitis – Causes, Symptoms And Treatment" . Retrieved 21 Dec 2016.
  5. Ratziu, V; Goodman, Z; Sanyal, A (April 2015). "Current efforts and trends in the treatment of NASH". Journal of Hepatology. 62 (1 Suppl): S65–75. doi:10.1016/j.jhep.2015.02.041. PMID   25920092.
  6. Adams LA, Angulo P (2006). "Treatment of non-alcoholic fatty liver disease". Postgrad Med J. 82 (967): 315–22. doi:10.1136/pgmj.2005.042200. PMC   2563793 . PMID   16679470.
  7. Veena J, Muragundla A, Sidgiddi S, Subramaniam S (2014). "Non-alcoholic fatty liver disease: need for a balanced nutritional source". Br. J. Nutr. 112 (11): 1858–72. doi:10.1017/S0007114514002591. PMID   25274101.
  8. Ludwig J, Viggiano TR, McGill DB, Oh BJ (1980). "Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease". Mayo Clin Proc. 55 (7): 434–438. PMID   7382552.
  9. Cassiman D, Jaeken J (2008). "NASH may be trash". Gut. 57 (2): 141–4. doi:10.1136/gut.2007.123240. PMID   18192446.
Classification
D
External resources