Non alcoholic steatohepatitis (NASH)

- commonest cause of a persistently raised ALT in patient with no risk factors of chronic liver disease
- also raised AST and GGT
- most patients are asymptomatic
- commoner in patients with obesity, diabetes and hypercholesterolemia (metabolic syndrome)
- diagnosis is by liver biopsy which shows increased fat deposition and necro-inflammatory response to hepatocytes
- ultrasound: hyperechogenicity or 'bright liver'
- management: aggressive weight loss, strict control of hypertension, diabetes and hyperlipidemia