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Steatohepatitis J028

Document
Last amended 
16 May 2019
Current RMA Instruments

Reasonable Hypothesis SOP

79 of 2013

Balance of Probabilities SOP

80 of 2013

Changes from previous Instruments

SOP Bulletin 169

ICD Coding
  • ICD-9-CM Codes: 571.01, 571.81
  • ICD-10-AM Codes: K70.0, K70.6
Brief description

Steatohepatitis means fatty liver with inflammation.   This is often alcohol-related and is part of the spectrum of liver disease between mild reversible change (fatty liver without inflammation) and severe disease (cirrhosis).

Confirming the diagnosis

Diagnosis is normally based on a specialist opinion.  Steatohepatitis is definitively diagnosed on liver biopsy, but can also be diagnosed based on imaging changes plus evidence of liver cell destruction with a significant elevated blood level of liver pattern enzymes (AST, ALT, LDH, GGT) in the absence of other causes of liver disease.

The appropriate medical specialist is a gastroenterologist.

Additional diagnoses covered by SOP
  • Alcoholic steatohepatitis
  • Non-alcoholic steatohepatitis
Conditions excluded from SOP
  • Biliary obstruction#
  • Cirrhosis of the liver*
  • Drug-inducted hepatitis#
  • Haemochromatosis*
  • Hepatic steatosis (fatty liver without inflammation) #
  • Viral hepatitis* - SOPs for Hepatitis A though E
  • Wilson’s disease*

* another SOP applies

# non-SOP condition

Clinical onset

The condition is often asymptomatic.  Vague symptoms such as fatigue, malaise, and right upper abdominal discomfort may be present.  The condition most often comes to attention when abnormalities are detected on liver function (blood) tests or abdominal imaging.

Clinical worsening

The course of the condition is variable. Management of relevant risk factors influences the outcome (e.g. abstinence from alcohol, weight loss, control of diabetes).  Progression to fibrosis/development of cirrhosis is an onset of cirrhosis, rather than a worsening of steatohepatitis.