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Steatohepatitises: etiological variants, principles of diagnosis and management

https://doi.org/10.21518/2079-701X-2022-16-6-74-82

Abstract

Steatohepatitises is an etiologically heterogeneous group of pathological changes in the liver, which are characterized by the inflammatory infiltration of the hepatic parenchyma with underlying fatty degeneration of hepatocytes. Whatever is the etiological cause, the clinical significance of steatohepatitis involves the formation of liver fibrosis and, as a result, an increased risk of developing liver cirrhosis and hepatocellular carcinoma, which are life-threatening conditions. It is common practice to identify the following etiological variants of steatohepatitis: metabolic (55–65% of cases), alcoholic (45–55% of cases) and drug-induced (approximately 5% of cases). The pathogenetic basis of metabolic steatohepatitis lies in the mechanisms of increased lipolysis, excess free fatty acid pool and reduced β-oxidation stemming from obesity and insulin resistance. Pathogenetic factors mediating the development of alcoholic steatohepatitis are the toxic activity of acetaldehyde and increased CYP2E1 activity. Intake of some hepatotoxic drugs increases lipogenesis in  hepatocytes and disrupts the electron transport chain, which leads to the formation of liver steatosis followed by transformation into steatohepatitis. Whatever is the etiological varient, steatohepatitis is asymptomatic in the prevailing majority of cases. However, some patients may present complaints of weakness, discomfort, or indolent pain in the right hypochondrium. A detailed history taking is essential for the establishment of the etiological cause of liver damage. Laboratory tests allow to diagnose steatohepatitis in increased levels of hepatic transaminases, usually not exceeding 2–3 times the normal values. In addition to liver enzymes, increased levels of alkaline phosphatase and GGTP can also be observed in steatohepatitis. Ultrasound imaging is the most accessible instrumental tool in clinical practice to establish the primary diagnosis of hepatic steatosis. Indirect elastometry is an equally informative non-invasive method for diagnosing steatohepatitis, which allows to measure both the degree of steatosis (the function of determining the ultrasonic controlled attenuation parameter (CAP) and liver fibrosis. 

About the Authors

D. T. Dicheva
Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation

Cand. Sci. (Med.), Associate Professor, Associate Professor of Department of Propaedeutics of Internal Diseases and  Gastroenterology, 

20, Bldg. 1, Delegatskaya St., Moscow, 127473



D. N. Andreev
Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation

Cand. Sci. (Med.), Associate Professor, Associate Professor of Department of Propaedeutics of Internal Diseases and Gastroenterology,

20, Bldg. 1, Delegatskaya St., Moscow, 127473



E. V. Partsvania-Vinogradova
Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation

Cand. Sci. (Med.), Assistant of Department of Propaedeutics of Internal Diseases and Gastroenterology, 

20, Bldg. 1, Delegatskaya St., Moscow, 127473



R. M. Umyarova
Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation

Postgraduate Student of Department of Propaedeutics of Internal Diseases and Gastroenterology, 

20, Bldg. 1, Delegatskaya St., Moscow, 127473



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Dicheva DT, Andreev DN, Partsvania-Vinogradova EV, Umyarova RM. Steatohepatitises: etiological variants, principles of diagnosis and management. Meditsinskiy sovet = Medical Council. 2022;(6):74-82. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-6-74-82

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