Editing Hepatitis (section)

=== Alcoholic versus non-alcoholic ===
The most apparent distinguishing factor between [[Alcoholic hepatitis|alcoholic steatohepatitis]] (ASH) and [[Nonalcoholic Steatohepatitis|nonalcoholic steatohepatitis]] (NASH) is a history of excessive alcohol use.<ref name="Neuman, French, et al">{{Cite journal|last1=Neuman|first1=Manuela G.|last2=French|first2=Samuel W.|last3=French|first3=Barbara A.|last4=Seitz|first4=Helmut K.|last5=Cohen|first5=Lawrence B.|last6=Mueller|first6=Sebastian|last7=Osna|first7=Natalia A.|last8=Kharbanda|first8=Kusum K.|last9=Seth|first9=Devanshi|date=2014-12-01|title=Alcoholic and non-alcoholic steatohepatitis|journal=Experimental and Molecular Pathology|volume=97|issue=3|pages=492–510|doi=10.1016/j.yexmp.2014.09.005|pmc=4696068|pmid=25217800}}</ref> Thus, in patients who have no or negligible alcohol use, the diagnosis is unlikely to be alcoholic hepatitis. In those who drink alcohol, the diagnosis may just as likely be alcoholic or nonalcoholic hepatitis especially if there is concurrent obesity, diabetes, and metabolic syndrome. In this case, alcoholic and nonalcoholic hepatitis can be distinguished by the pattern of liver enzyme abnormalities; specifically, in alcoholic steatohepatitis AST>ALT with ratio of AST:ALT>2:1 while in nonalcoholic steatohepatitis ALT>AST with ratio of ALT:AST>1.5:1.<ref name="Neuman, French, et al" />

Liver biopsies show identical findings in patients with ASH and NASH, specifically, the presence of [[Granulocyte|polymorphonuclear]] infiltration, hepatocyte [[necrosis]] and [[apoptosis]] in the form of [[ballooning degeneration]], [[Mallory body|Mallory bodies]], and fibrosis around veins and sinuses.<ref name="Friedman 55e" />