All you need to know- non alcoholic steatohepatitis (NASH)

What is NASH? Non-alcoholic steatohepatitis (NASH) is an advanced form of non-alcoholic fatty liver disease (NAFLD). 
NAFLD is caused by build-up of fat in the liver. 
When this build-up causes inflammation and damage, it is known as NASH, which can lead to scarring of the liver. 
Scarring of the liver is a potentially life-threatening condition called cirrhosis. 

Symptoms of NASH
There are often no outward signs or symptoms associated with NASH. The most common symptoms are fatigue and mild pain in the upper right abdomen.
NASH may lead to cirrhosis of the liver, causing one or more of the following symptoms as the condition progresses.
*Easy bruising and bleeding
*Itchy skin
*Yellow discoloration in the skin and eyes (jaundice)
*Fluid accumulation in your abdomen
*Nausea and loss of appetite
*Swelling in your legs
*Confusion & slurred speech
*Drowsiness
*Spider-like blood vessels on your skin

Diagnosis of NASH
One of the challenges with NASH is that most people who have it feel fine and may not know that they have a liver problem until the disease is well advanced. This can be dangerous because NASH can lead to serious liver damage.
*As part of the medical history, your doctor will ask:​
What medicines you take to determine whether a medicine might be causing your fatty liver.
*About your alcohol use, to determine whether the fat in your liver is a sign of alcoholic fatty liver disease or non-alcoholic fatty liver disease. 
*What your diet is like, your level of physical activity, and other lifestyle factors that can contribute to the likelihood of developing NAFLD
*If you have a history of other health conditions that make you more likely to develop NAFLD, such as type 2 diabetes, obesity, high blood pressure and high levels of fats such as triglycerides or abnormal cholesterol levels.

Diagnosis of NASH
Tests done to pinpoint the diagnosis and determine disease severity include:
*Complete blood count
*Liver function tests
*Tests for chronic viral hepatitis (hepatitis A, hepatitis C and others)
*Fasting blood sugar
*Haemoglobin A1C, which shows how stable your blood sugar is
*Lipid profile, which measures blood fats, such as cholesterol and triglycerides
*Other tests
Your doctor may order tests that take images, or pictures, of your liver to help make the diagnosis of fatty liver disease. Different types of images can be obtained by using various types of equipment, including ultrasound, CT scan, MRI etc.

Treatment of NASH
If you have NASH, it’s important to control any conditions that may contribute to fatty liver disease. Treatments and lifestyle changes may include:
*Losing weight
*Medication to reduce cholesterol or triglycerides
*Medication to reduce blood pressure
*Medication to control diabetes
*Limiting over the counter drugs
*Avoiding alcohol

Risk factors to NASH
The exact cause of fatty liver disease is difficult to ascertain. But obesity is one of the most common cause. Doctors are seeing a steady rise in fatty liver disease. Although children and young adults can get fatty liver disease, it is most common in middle age. 
Risk factors include:
*Being overweight
*Having high blood fat levels, either triglycerides or LDL (“bad”) cholesterol
*Having diabetes or prediabetes
*Having high blood pressure

Complications of NASH
The main complication of NASH is cirrhosis, which is late-stage scarring in the liver. Cirrhosis occurs in response to liver injury, such as the inflammation in NASH. As the liver tries to halt inflammation, it produces areas of scarring (fibrosis). With continued inflammation, fibrosis spreads to take up more and more liver tissue.
If the process isn't interrupted, cirrhosis can lead to:
*Fluid build-up in the abdomen (ascites)
*Swelling of veins in your oesophagus (oesophageal varices), which can rupture and bleed
*Confusion, drowsiness and slurred speech (hepatic encephalopathy)
*Liver cancer
*End-stage liver failure, which means the liver has stopped functioning

Prevention of NASH
To prevent NASH, one must;
Choose a healthy diet- Choose a healthy plant-based diet that's rich in fruits, vegetables, whole grains and healthy fats.
Maintain a healthy weight- f you are overweight or obese, reduce the number of calories you eat each day and get more exercise. If you have a healthy weight, work to maintain it by choosing a healthy diet and exercising.
Exercise- Exercise most days of the week. Get an OK from your doctor first if you haven't been exercising regularly.

Management of NASH
*If you have NASH (Non-alcoholic steatohepatitis), your doctor may recommend gradually losing weight if you are overweight or obese. 
*Your doctor may suggest limiting your intake of fats to help prevent or treat NASH. Fats are high in calories and increase your chance of becoming obese.
*Weight loss and exercise are among the most promising of treatments for non-alcoholic fatty liver disease.
*Vigorous exercise results in a reduction of liver fat and may reduce the inflammation of NASH. 

Disclaimer: The advice provided is intended for informational purpose only and does not substitute for professional medical advice.  Consult with your doctor if you’re seeking medical advice, diagnoses, or treatment.​