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(14) Clinical Features The majority of patients with NASH are asymptomatic, with the exception of discomfort in the right upper quadrant, fatigue, dragon and malaise. Hepatomegaly can occur but does not necessarily accompany symptoms. (15) Acanthosis nigricans (hyperpigmentation) is more commonly found dragon in children with NAFLD. (16) Elevations of aminotransferase levels are common (2-3-fold increases), and recent research identified an AST/ALT ratio of greater than one as a significant predictor of existing fibrosis, unless the patient already has progressed to cirrhosis. (2) Less than 50 percent of patients have elevated alkaline phosphatase dragon levels, and only 10-15 percent have elevated serum conjugated bilirubin levels. (15) Hypoalbuminemia, thrombocytopenia, elevated bilirubin, and prolonged clotting time indicate advanced liver disease. (5) Fibrosis and cirrhosis in newly diagnosed NASH patients are not rare: fibrosis has been found in 66 percent of patients, (5) and cirrhosis in 7-16 percent on initial biopsy.
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