GASTROENTEROLOGY ARTICLE OF THE WEEK
November 1, 2001
Reid AE. Nonalcoholic steatohepatitis. Gastroenterology 2001;121:710-723.
1. Metabolic features of NASH include
a. a shift to lipogenesis in favor of lipolisis leading to fat accumulation
b. hyperinsulinemia probably plays a role
c. increased fatty acid oxidation within the liver
d. endotoxemia from bacterial overgrowth predisposes to fatty liver
e. lipid peroxidation appears to be the “2nd hit” that initiates steatohepatitis from
fatty liver
2, Typical features of the patient with NASH include
a. female sex
b. age <20
c. alcohol use
d. type I diabetes
e. obesity
f. type II diabetes
3. Other conditions that have been associated with NASH include
a. hepatitis C
b. jejunoileal bypass
c. small intestinal diverticulosis with bacterial overgrowth
d. bilioenteric bypass
e. primary biliary cirrhosis
f. amiodarone
g. tamoxifen
True or False
4. Hepatomegaly is rarely associated with NASH and when present suggests another disease process.
5. The presence of Mallory bodies suggests alcoholic hepatitis instead of NASH
6. Many cases of cirrhosis due to NASH do not have histologic features of NASH once cirrhosis develops.
7. Liver transplantation for NASH end stage liver disease cures the condition, recurrence after transplant is extremely rare.
8. Rapid weight loss is one of the most effective interventions in the treatment of NASH
9. Degree of liver enzyme elevation in NASH does not correlate with histologic severity
10. Serum ferritin is often increased in NASH, most patients are homozygous for the hemochromatosis mutation
11. Lobular inflammation is present in the majority of cases of NASH
12. Medications that may be of help in treating NASH include
a. ursodeoxycholic acid
b. colfibrate
c. gemfibrozil
d. methotrexate
e. betaine
f. vitamin E
h. vitamin B6