1. BY: Asmaa Alastal. wafaa hanouna. Salma abu taha. .Sara shaban
Non-Alcoholic Steato-Hepatitis
BY: Asmaa Alastal.
wafaa hanouna.
Salma abu taha.
.Sara shaban

2. :Case Details
A 62-year-old woman with no history of alcohol intake, she had a history of hypertension and diabetes.
she was having :
Fatigue.
Malaise.
Vague right-upper-quadrant abdominal pain.
Hepatomegaly.
Acanthosis nigricans, (brown, velvety, hyperkeratotic plaques) is found on the back of the neck.

3. Laboratory Findings
AST=68 AIT=120 FBS=121 T.G=486 HDL=41 LDL=144 Albumin=4 Total bilirobin=.9 WBC=6100/μl plt =19.0×104/μl. HB=12.8 g/dl Hyaluronic acid=19 ng/ml.

4. Continue… CT revealed severe fatty liver with an L/S ratio of 0.70.
US-guided biopsy revealed NASH characterized by predominantly macrovesicular fatty change
(80%) with occasional ballooning, slight fibrosis.
intraacinar inflammation
with neutrophil infiltration, and mild portal chronic
.inflammation with piecemeal necrosis

5. Case Discussion…
The most likely diagnosis is: Non-Alcoholic Steato-Hepatitis.
Nonalcoholic steatohepatitis (NASH) is liver inflammation and damage caused by a buildup of fat in the liver. It is part of a group of conditions called nonalcoholic fatty liver disease. You may be told you have a "fatty liver." Many people have a buildup of fat in the liver, and for most people it causes no symptoms and no problems. But in some people, the fat causes inflammation and damages cells in the liver. Because of the damage, the liver doesn't work as well as it should.

6. NASH can get worse and cause scarring of the liver, which leads to cirrhosis. But the disease doesn't always get worse.
NASH is similar to the kind of liver disease that is caused by long-term, heavy drinking. But NASH occurs in people who don't abuse alcohol.

7. class 1 constitutes simple steatosis
NASH classification system has also been proposed that correlates certain histologic features with long-term prognosis (these groups are identified variably by class or type).
class 1 constitutes simple steatosis
class 2 is steatosis with lobular inflammation
class 3 requires the additional presence of ballooned hepatocytes
class 4 requires the presence of either Mallory’s hyaline or fibrosis.

8. What causes NASH?
Experts don't know why some people with a buildup of fat in the liver get NASH and some don't. It could be that something in the environment triggers the inflammation in those people. Or maybe it runs in their families
Things that put people at risk for NASH and for liver damage include
Obesity.
Insulin resistance and type 2 diabetes.
High cholesterol and high triglycerides.
Metabolic syndrome
Most people who have NASH are 40 to 50 years old and have one or more of the problems listed above. But NASH can happen in people who have none of these risk factors

9. Why some patients with NAFLD progress to fibrosis and cirrhosis and others generally have a benign course without progressive clinical or histological sequelae is unclear?
One concept for the initiation of necroinflammation suggests a two-hit process: accumulation of excessive fat and development of oxidative stress. Both steps result in the
production of lipid peroxidation products (malondialdehyde
and 4-hydroxynonenal) that are probably involved in the
.stimulation of collagen production, fibrosis, and cirrhosis
Liver biopsy is the only means of assessing the presence
and extent of specific necroinflammatory changes and
fibrosis. Firm recommendations of when to conduct a liver
biopsy in the routine clinical setting have not yet been
developed, however, and care will continue to require
individualization.

10. How is it treated?
Treatment for NASH includes managing conditions that increase your risk for NASH or make it worse.
Reduce your total cholesterol level.
Reach a healthy weight. Losing 3% to 10% of your total body weight can make a difference.
Control diabetes.
Stop or cut back on drinking alcohol.
Exercise regularly.
Also, ask your doctor or pharmacist about all the medicines you are taking. Some may harm your liver.
In some cases, your doctor may suggest medicine to control or reverse liver damage caused by NASH