Difference between revisions of "Steatohepatitis"
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'''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.<ref>MG. 22 September 2009.</ref> | |||
Etiology: | |||
#Alcohol = alcoholic steatohepatitis (ASH). | |||
#Not alcohol = non-alcoholic steatohepatitis (NASH). | |||
#Drug/toxin.<ref name=pmid12016549>{{Cite journal | last1 = Farrell | first1 = GC. | title = Drugs and steatohepatitis. | journal = Semin Liver Dis | volume = 22 | issue = 2 | pages = 185-94 | month = | year = 2002 | doi = 10.1055/s-2002-30106 | PMID = 12016549 }}</ref> | |||
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 [[liver|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.<ref name=pmid14991537>{{Cite journal | last1 = Gramlich | first1 = T. | last2 = Kleiner | first2 = DE. | last3 = McCullough | first3 = AJ. | last4 = Matteoni | first4 = CA. | last5 = Boparai | first5 = N. | last6 = Younossi | first6 = ZM. | title = Pathologic features associated with fibrosis in nonalcoholic fatty liver disease. | journal = Hum Pathol | volume = 35 | issue = 2 | pages = 196-9 | month = Feb | year = 2004 | doi = | PMID = 14991537 }}</ref> | |||
DDx: | |||
*[[Wilson disease]]. | |||
*[[Hepatitis C]]. | |||
*[[Drug-induced liver disease]]. | |||
===Grading steatohepatitis=== | |||
Grading inflammation:<ref name=pmid10484010>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.</ref> | |||
*Grade 1 - steatosis, occasional ballooning degeneration, PMNs. | |||
*Grade 2 - obvious ballooning, obvious PMNs, chronic inflammation. | |||
*Grade 3 - panacinar steatosis. | |||
===Image=== | |||
<gallery> | |||
Image:Steatohepatitis_high_mag.jpg | Steatohepatitis. (WC) | |||
</gallery> | |||
==See also== | |||
*[[Medical liver disease]]. | |||
*[[Alcohol abuse]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Medical liver disease]] | |||
Revision as of 04:59, 17 September 2014
| Steatohepatitis | |
|---|---|
| Diagnosis in short | |
| 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:
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.