NASH

I was resently diagnosed with NASH.  I am 63, very seldom drink alcohol & within normal weight limits.  My liver biopsy came back stating:  Grade of Portal Inflammatory activity 2 out of 4; Grade of Lobular Inflammatory activity 2 out of 4; Stage of Fibrosis 3 out of 4 & 5% macrovesticular steatosis.  Can you explain the "Grades" for me.  My doctor seems rather concerned.  I feel fine except I have gradually become more exhausted & my platelet count has dropped to 104,000 which is causing a lot of bruising.  

Do you have any suggestions?  What is the usual outcome?

[Isobella]

I have been looking into this lately because my sister was also recently diagnosed with NASH-she doesn't drink alcolhol, but is overweight. I haven;t found much information here on MedHelp, but google "fatty liver" and you will get some good information.  From what I have read, diet and excercise are probably the first things to address.  

It is a good idea to see a hepatologist-or at least a GI doctor.  The science of liver disease is constantly changing as new treatments become available and primary care/internal medicine physicians are not always up on the newest protocols.

Below is a copy of an explanation of grades and stages I found in the archives.  Altho grades are listed as letters, not numbers--this will give you a general idea.  Hope it helps :-)
  

Stage 1 Hepatitis -- Inflammation only (hepatitis only)
Stage 2 Hepatitis -- Some scarring (fibrosis)
Stage 3 Hepatitis -- More scarring (more fibrosis)
Stage 4 Hepatitis -- LOTS of fibrosis (cirrhosis)

Once a person gets to Stage 4/Cirrhosis, there are three grades:

Grade A -- Compensated (the liver is doing all it should despite the damage; no apparent symptoms)
Grade B -- DecompensatING (the liver is beginning to not be able to do all its functions; starting to have symptoms)
Grade C -- DecompensatED (liver failure -- the liver cannot perform its own functions; lots of symptoms)

Boils down to:
1. Stage 1 = very little fibrosis
2. Stage 2 = a little more fibrosis
3. Stage 3 = bridging fibrosis
4. Stage 4 = cirrhosis  (Grade A cirrhosis)
5. Grade B cirrhosis
6. Grade C cirrhosis (ESLD)
(Complications like Ascites appear in Grade B cirrhosis).