Steatosis and Steatohepatitis
Patients with chronic, asymptomatic elevations in serum aminotransferase
levels are often found by liver biopsy to have steatosis (fatty liver) or steatohepatitis.
[99]
Hultcrantz and coworkers[100]
studied 149 asymptomatic patients with at least a 6-month history of elevated aminotransferase
levels found incidentally during routine laboratory screening.[100]
Liver biopsy confirmed the diagnosis of steatosis in 64% of these patients, most
of whom were obese or diabetic or had a history of excessive alcohol use. In a subsequent
study, Hay and colleagues[99]
demonstrated a 21%
incidence of steatohepatitis in a similar patient population. Both studies concluded
that chronic
hepatitis or cirrhosis cannot be differentiated from steatosis or steatohepatitis
based solely on clinical laboratory or noninvasive radiologic or ultrasonographic
criteria. In a retrospective analysis of 135 patients who underwent hepatic resection,
Behrns[101]
noted an increased incidence of postoperative
liver failure and mortality when the histopathology revealed hepatocytes with greater
than 30% fatty infiltration. Brolin and associates[102]
noted a 6% incidence of biopsy-proven nonalcoholic steatohepatitis and subclinical
cirrhosis in patients undergoing gastric bypass surgery; postoperative mortality
was higher in affected patients than those with normal hepatic histology. Despite
recommendations to the contrary,[103]
steatosis
and steatohepatitis should probably be considered significant risk factors for postoperative
complications, especially after abdominal procedures. For this reason, patients
with asymptomatic, chronic (> 6 months) elevations in hepatic enzyme levels should
be thoroughly evaluated before elective surgery.
