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bILIary SySTeM Liver Right Hepatic Duct Cystic Duct Gallbladder Common Bile Duct Duodenum NASH. Experts suggest that NASH affects up to 3 percent of the adult population. The main difference between NAFLD and NASH is the presence of inflammation. Chronic low-grade inflammation in the liver can lead to the accumulation of scar tissue that essentially scrambles the delicate and highly organized hepatocytes. The reasons some people progress from NAFLD to NASH while others do not are not clearly understood. • The end-stage of NASH is cirrhosis— the condition of having masses of scar tissue in the liver that disrupts so much hepatocyte function that serious symptoms and complications develop. Nonalcoholic fatty liver disease has only been studied as a condition separate from other liver diseases since 1980, and we know that it is very slowly progressive, so the actual percentage of people diagnosed with NAFLD who progress all the way to NASH and then cirrhosis is not yet known. Some studies suggest that the progression rate from NASH to cirrhosis may be about the same as seen with hepatitis C. This would indicate that diagnosis rates for nonalcoholic cirrhosis will rise significantly within the next 10–20 years. Left Hepatic Duct Common Hepatic Duct Stomach Pancreas Pancreatic Duct (taken to reduce the risk of breast cancer recurrence), methotrexate (a type of chemotherapy), and NSAIDs (nonsteroidal anti- inflammatory drugs). SECONDARY LIVER DISEASE NAFLD and NASH are discussed currently as primary liver diseases; that is, they occur without a specific underlying infection or toxic exposure. This distinguishes them from secondary liver disease—conditions that develop as complications of an underlying disorder. Some of these include: • Alcoholic liver disease. This is associated with excessive alcohol consumption (typically more than four 10-gram units each day). It is usually seen in younger patients than with NASH, and the onset of symptoms is usually severe and acute. • Hepatitis B, C. These viral infections are associated with a relatively high risk of long-term liver damage, cirrhosis, liver failure, and liver cancer. They are directly tied to chronic inflammation and scar tissue that develops in response to a pathogenic invasion. • Wilson's disease. This genetic disorder involves the accumulation of copper in the liver and other tissues. This interferes with liver function and can lead to cirrhosis. • Drug-induced liver disease. Several prescription and nonprescription drugs can contribute to liver degeneration. Some of the most common ones include prednisone (a steroidal anti-inflammatory), tamoxifen SYMPTOMS OF LIVER DISEASE Early symptoms of NAFLD (where there are any) include fatigue, unintended weight loss, and vague pain in the upper right quadrant of the abdomen. Elevated levels of transaminases may alert doctors to liver stress. More identifiable markers are signs that indicate insulin resistance, including abdominal obesity, hypertension, elevated blood glucose, and elevated cholesterols. Some people develop patches of darkened skin at the axilla or neck. This is called acanthosis nigricans, and it is an indicator of blood glucose dysregulation. Ultimately, the diagnostic criteria for NAFLD include the signs of insulin resistance along with long-term elevated liver enzymes, an ultrasound that shows a fatty liver, and the exclusion of other possible causes. If NAFLD progresses to NASH, inflammatory chemicals may damage hepatocytes and scar tissue may begin to invest healthy liver tissue. However, the liver is remarkably good at compensatory function, so these dangerous steps may not be associated with specific symptoms. If NASH finally complicates to cirrhosis, this tends to look different from the cirrhosis seen with secondary liver disease as discussed earlier. Cirrhosis related to NAFLD and NASH tends to have a very slow onset that occurs late in life; it is rarely seen in people under 60 years old, and it is usually seen along with type 2 diabetes. The liver damage seen with this type of cirrhosis tends to lead to the appearance of spider veins in the skin, blotchy red patches on the palms, a loss of body hair, and feminizing characteristics for men and masculinizing characteristics for women. Very late-stage cirrhosis connect with your colleagues on massageprofessionals.com 99