NASH / Liver Biopsy

[Kay1973]

I posted here earlier in the week that my husband has ALT 1598 AST 693 or so.  The doctor told us to schedule a liver biopsy so we have it scheduled for Tuesday.  I was doing some research and found a disease called NASH. Non- Alcoholic Steato-Hepatitis (sp?).  2-5% of Americans get it.  They said it is a 'silent' liver disease.  I want the biopsied tissue to be tested for Nash...is that possible? Are liver enzymes elevated to that point linked to NASH or are they still to high.  I could not find specific numbers related to NASH. We were told that NAFLD would not get his enzymes that high with out another factor like triglycerides or cholesterol or sugar out of whack.  

[MedHH]

The posters here are partially correct.  NASH definitely is a real condition.  It is one where the liver is depositing fat within itself (the steato/steatosis, or the "S" of NASH) and there is inflammation (the hepatitis, or the "H" of NASH), and fairly commonly scarring as well.  Liver biopsy has been considered the "gold standard" for confirming NASH (although imaging techniques are in the works).  But, labs (bloodwork), and history is also important.  NASH appears quite similarly to alcoholic liver disease (though there are some differences in the labs, etc.), and so it is important for the patient to be candid with the physician attempting to diagnose the condition about his/her history, including alcoholic use (the NA in NASH = non-alcoholic, meaning it occurs in the absence of significant alcohol use).  While NASH is commonly associated with metabolic syndrome (insulin resistance, elevated blood fats, etc.), that is not always the case.  Good luck to you and your husband.

[dgbeam]

Mike is correct NASH is a real disease and can be diagnosed with liver biopsy. during a biopsy they will do several test to determine the cause, Hepatitis , iron overload , copper deposits, Autoimmune changes in the liver etc...
Cirrhosis of unknown causes is usually referred to as cryptogenic cirrhosis or as Mile mentioned idiopathic
Gail

[mikesimon]

NASH is a real disease and it is diagnosable on biopsy. There are also bio-markers which can strongly suggest NASH and NAFLD.
I believe the term used when they aren't sure about the disease is "idiopathic liver disease".
Mike

[KjFlicka]

I *think* NASH is really a term they use when they don't know for sure the cause of the liver disease... like a big 'none of the above' box. I would be interested to know if they can tell the difference in biopsy. I know they thought mine was NASH for the first few weeks *after* the biopsy because they couldn't fathom me at age 34 already having alcoholic cirrhosis. That was all on them and their assumptions. These same doctors then made the next jump and assumed I could only be that horribly cirrhotic so young if I had liver cancer. It was just plain old alcoholic cirrhosis, no cancer. Needless to say, find yourself a good and reputable hepatologist if you haven't already. If it's NASH or not, they will have the latest and greatest tools. Take care!