Nonalcoholic Steatohepatitis NASH Causes, Symptoms & Treatment

Diagnosis of nonalcoholic steatohepatitis

Lab tests

Your doctor will examine you thoroughly for signs of liver dysfunction after listening to your complaint. Afterwards, they will ask for some tests and imaging studies. Lab tests commonly ordered for liver disease include:

• Liver function tests: Liver function tests include liver enzymes which are elevated in cases of hepatitis, prothrombin time which tests the ability of the liver to produce coagulation factors and bilirubin levels which are especially useful in cases with jaundice.
• Albumin level: Albumin level is essential in patients who have abdominal and leg swelling.
• Viral markers: All cases of hepatitis are tested for the possibility of having hepatitis markers including hepatitis B and C.
• Lipid profile: Lipid profile tests the percentage of fats in your blood. The main lipid is cholesterol, and different types of cholesterol are normally tested. The “good” cholesterol is HDL-C and the “bad” ones are LDL-C and VLDL-C.
• Blood sugar: Although blood sugar is not directly linked to hepatitis, cases of nonalcoholic fatty liver disease are more likely to have diabetes as well. In fact, this can be the first presentation of type II diabetes in some cases.

Imaging studies

Beside lab tests, imaging studies are also of use in cases of liver disease and they include:

• Ultrasonography: Ultrasonography is usually the first imaging study ordered in any abdominal condition. It is fast, safe and always available. In cases of liver disease, it helps outline the general condition of the liver and the presence of cirrhosis or problems in the liver’s circulation. A special type of ultrasonography was developed to help detect fatty liver disease called fibro scan. Despite all these benefits, there are some conditions that ultrasound can’t accurately diagnose.
• MRI: Magnetic resonance imaging is rarely used in fatty liver disease. It remains one of the most accurate imaging techniques, but it is costly and not available for all patients especially those with metal parts in their bodies such as in case of previous orthopedic operations. It can show fatty liver disease clearly and helps when the diagnosis is uncertain.
• CT scanning: It is highly unlikely that your doctor would request a CT scan for fatty liver disease. However, in a few cases, the diagnosis can be so uncertain that a liver tumor is a possibility particularly when the liver deteriorates quickly. A CT scan in these cases becomes a must.

Liver biopsy

All imaging studies mentioned before are helpful, but neither imaging nor lab tests are conclusive in diagnosing fatty liver disease nor steatohepatitis. Some signs seen in them can be highly suggestive, but for a certain diagnosis to be reached, a liver biopsy must be done. Liver biopsy means that a small part of your liver is sampled using a special needle after injecting a local anesthetic. Afterwards, this sample is examined under the microscope and fatty liver disease appearance on the cellular level.

Liver biopsy is very safe and there is no need to worry if your doctor requires it. A professional does it and the risk of complications like bleeding is rare. Also, your doctor will do it using ultrasound imaging to make sure they don’t injure any structure while performing the procedure. Ideally, a liver biopsy should be done for all patients to confirm the condition, but that is not always the case, and in patients whose diagnosis is clear, many doctors don’t need a biopsy.