Difference between revisions of "Steatohepatitis"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = | | Image = Steatohepatitis_high_mag.jpg | ||
| Width = | | Width = | ||
| Caption = | | Caption = Steatohepatitis. Trichrome stain. | ||
| Synonyms = | | Synonyms = | ||
| Micro = | | Micro = [[liver steatosis|steatosis]] (usually macrovesicular); hepatocyte injury -- [[ballooning degeneration]] (key feature), [[Mallory bodies]]; portal bridging (late stage) | ||
| Subtypes = | | Subtypes = by etiology: [[ASH]], [[NASH]], drugs; histologically identical | ||
| LMDDx = | | LMDDx = [[liver steatosis|steatosis]], [[Wilson disease]], [[hepatitis C]], [[drug-induced liver disease]] | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = | ||
| Line 13: | Line 13: | ||
| Molecular = | | Molecular = | ||
| IF = | | IF = | ||
| Gross = | | Gross = pale/yellowish, often enlarged | ||
| Grossing = | | Grossing = | ||
| Site = | | Site = [[iver]] - see ''[[medical liver disease]]'' | ||
| Assdx = | | Assdx = [[obesity]], [[alcohol abuse]] | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = | ||
| Prevalence = | | Prevalence = common | ||
| Bloodwork = | | Bloodwork = | ||
| Rads = | | Rads = | ||
| Endoscopy = | | Endoscopy = | ||
| Prognosis = | | Prognosis = dependent on underlying cause | ||
| Other = | | Other = | ||
| ClinDDx = | | ClinDDx = | ||
| Line 58: | Line 58: | ||
DDx: | DDx: | ||
*[[Steatosis]] - lacks ballooning degeneration. | |||
*[[Wilson disease]]. | *[[Wilson disease]]. | ||
*[[Hepatitis C]]. | *[[Hepatitis C]]. | ||
Revision as of 05:07, 17 September 2014
| Steatohepatitis | |
|---|---|
| Diagnosis in short | |
 Steatohepatitis. Trichrome stain. | |
|
| |
| LM | steatosis (usually macrovesicular); hepatocyte injury -- ballooning degeneration (key feature), Mallory bodies; portal bridging (late stage) |
| Subtypes | by etiology: ASH, NASH, drugs; histologically identical |
| LM DDx | steatosis, Wilson disease, hepatitis C, drug-induced liver disease |
| Gross | pale/yellowish, often enlarged |
| Site | iver - see medical liver disease |
|
| |
| Associated Dx | obesity, alcohol abuse |
| Prevalence | common |
| Prognosis | dependent on underlying cause |
| Treatment | dependent on underlying cause |
Steatohepatitis is a fatty change of the liver and is due to a number of different causes.
General
- Steatohepatitis is a label for a set of histopathologic findings.
- Fat accumulation in hepatocytes.
- It may be a pattern seen in drug toxicity, e.g. methotrexate toxicity.[1]
Etiology:
- Alcohol = alcoholic steatohepatitis (ASH).
- Not alcohol = non-alcoholic steatohepatitis (NASH).
- Drug/toxin.[2]
Notes:
- Pathologists can comment on the etiology; however, the histomorphology is not distinctive. In other words, ASH and NASH are clinical diagnoses.
- Steatohepatitis is a misnomer. It is not an -itis; inflammation is not the (predominant) pathologic process.
Microscopic
Features:
- Steatosis (usually macrovesicular) - key feature.
- If less than 10% ... consider alt. diagnosis/disease process.
- Hepatocyte injury:
- Ballooning degeneration - key feature (see introduction to liver).
- Mallory bodies.
- Mallory body wannabes: "occasional cytoplasmic clumping".
- +/-Chicken-wire perisinusoidal fibrosis +/- zone III (centrilobular) fibrosis (early).
- Late-stage disease - portal bridging.[3]
DDx:
- Steatosis - lacks ballooning degeneration.
- Wilson disease.
- Hepatitis C.
- Drug-induced liver disease.
Grading steatohepatitis
Grading inflammation:[4]
- Grade 1 - steatosis, occasional ballooning degeneration, PMNs.
- Grade 2 - obvious ballooning, obvious PMNs, chronic inflammation.
- Grade 3 - panacinar steatosis.
Image
Steatohepatitis. (WC)
See also
References
- ↑ MG. 22 September 2009.
- ↑ Farrell, GC. (2002). "Drugs and steatohepatitis.". Semin Liver Dis 22 (2): 185-94. doi:10.1055/s-2002-30106. PMID 12016549.
- ↑ Gramlich, T.; Kleiner, DE.; McCullough, AJ.; Matteoni, CA.; Boparai, N.; Younossi, ZM. (Feb 2004). "Pathologic features associated with fibrosis in nonalcoholic fatty liver disease.". Hum Pathol 35 (2): 196-9. PMID 14991537.
- ↑ Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander-Tetri BA, Bacon BR. Am J Gastroenterol. 1999 Sep;94(9):2467-74. PMID 10484010.