Hepatic steatosis with cardiometabolic risk factors and no other cause; may progress through steatohepatitis to cirrhosis.
Investigations
- • Ultrasound steatosis, LFTs (ALT often only mildly raised)
- • FIB-4 then transient elastography for fibrosis staging
- • Exclude viral, autoimmune, Wilson's, haemochromatosis, alcohol
Management
- • 10% weight loss reverses steatohepatitis; 7% improves inflammation
- • Treat diabetes, hypertension and dyslipidaemia aggressively — statins are safe
- • Pioglitazone or GLP-1 RA in diabetic MASH
- • HCC surveillance if cirrhotic
Clinical pearls
- • Cardiovascular disease, not liver failure, is the leading cause of death
- • FIB-4 <1.3 essentially excludes advanced fibrosis in primary care
Related in WardRound
Educational — verify locally.
