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Fatty deposits throughout the LIVER, also called fatty liver, that create irritation and INFLAMMATION. Doctors believe steatohepatitis represents a malfunction of the body’s lipid processing and transfer mechanisms, many of which take place in the liver. Steatohepatitis is common with long-term ALCOHOL use and ALCOHOLISM (alcoholic steatohepatitis). It also occurs without alcohol involvement (nonalcoholic steatohepatitis), notably with DIABETES (which alters lipid METABOLISM) and OBESITY.
The most common form of steatohepatitis, called macrovesicular because the fatty deposits are large, may not show symptoms. Rather, the doctor may detect it during physical examination as HEPATOMEGALY (enlarged LIVER). When symptoms are present they reflect noninfectious HEPATITIS: JAUNDICE (yellow discoloration of the SKIN), tenderness or PAIN in the upper right abdomen, fatigue, NAUSEA, and loss of APPETITE. LIVER FUNCTION TESTS may be inconclusive; ULTRASOUND or COMPUTED TOMOGRAPHY (CT) SCAN often reveals the fatty accumulations. PERCUTANEOUS LIVER BIOPSYconfirms the diagnosis. The form of steatohepatitis associated with alcoholism, obesity, and diabetes is macrovesicular.
Symptoms of Steatohepatitis
Steatohepatitis occasionally manifests as an acute illness with significant symptoms and rapid progression to clotting dysfunction (coagulopathy) and neurologic involvement (hepatic NEUROPATHY). This form of steatohepatitis, called microvesicular because the fatty deposits are small, can be fatal without appropriate supportive treatment until the liver recovers.
Macrovesicular steatohepatitis generally does not require treatment though treating any underlying condition helps restore normal lipid metabolism with the result that fatty acids move out of the liver. When alcohol consumption is a factor, steatohepatitis nearly always goes away with abstinence from alcohol though any CIRRHOSIS (replacement of liver tissue with SCAR tissue) that has already developed is permanent.
Nonalcoholic steatohepatitis associated with diabetes generally improves with tighter management of the diabetes, and with obesity when weight loss occurs. Microvesicular steatohepatitis may require extensive support, including intravenous fluids and nutrients, during its acute phase. For many people recovery is complete and without residual damage to the liver.