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RESUMOO presente artigo apresenta uma revisão narrativa sobre epidemiologia, fisiopatologia, diagnóstico e tratamento da esteato-hepatite não alcóolica (EHNA). Nas últimas décadas, houve um crescimento na incidência mundial de obesidade e de doenças associadas. Dentre elas, destaca-se a EHNA, uma desordem metabólica com ampla variedade de apresentação, parte do espectro da doença hepática gordurosa não-alcóolica (DHGNA). A prevalência da DHGNA pode acometer até 25% da população em alguns estudos, sendo homens e hispânicos os grupos mais acometidos. A fisiopatologia da doença é complexa e multifatorial, com bases na obesidade, na resistência à insulina e na herança genética. Após diagnóstico, o manejo da EHNA consiste principalmente em mudanças de estilo de vida, tratamento da síndrome metabólica, farmacoterapia e manejo das complicações da cirrose hepática. Diante do aumento Brazilian Journal of health ReviewBraz. 1078 na prevalência de EHNA, é de grande interesse para a medicina a busca por melhores formas de obter sua detecção precoce, tratamento e controle de complicações. Essas questões são complexas e exigem uma abordagem multidisciplinar.Palavras-chave: Doença hepática gordurosa não alcoólica; esteato-hepatite não alcóolica; obesidade; hepatologia; medicina interna; fígado gorduroso. ABSTRACTThis article presents a narrative review covering epidemiology, physiopathology, diagnosis and treatment of non-alcoholic steatohepatitis (NASH). During the last decades, there has been a growth on the global incidence of obesity and related diseases. Among them, NASH is highlighted as a metabolic disease with varied clinical presentation, part of the spectrum of the non-alcoholic fatty liver disease (NAFLD). In some studies, NAFLD has almost 25% prevalence on select populations, being more prevalent on male and hispanic subjects. The pathogenesis of the disease is highly complex and multifactorial, mostly based on obesity, insulin resistance and genetic heritage. After diagnosis, management mostly consists of lifestyle changes, treating metabolic syndrome, use of drugs, and treatment for hepatic cirrhosis. In face of the growing of its prevalence, it is of great medical interest to seek better early detection, treatment and complication control for this disease. These complex topics demand a multidisciplinary approach.

Study objectives  To evaluate blood supply in the anal canal, rectal wall and mesorectal fat of men and women, using color Doppler endorectal sonography to establish normal ranges for vascular parameters. Methods  A prospective cross-sectional study conducted at a tertiary-care hospital recruited asymptomatic volunteers (≤50 years). Vascularity percentage and index were calculated for defined regions. Results  Vascularity percentage and index were significantly higher in the puborectalis, mid-level external and upper internal anal sphincter compared to the low anal canal; these parameters were higher in men than in women at upper and middle levels of the inner anal canal structures. At mid-level, vascularity was greater in the external compared to the internal anal sphincter in both sexes; however, at the upper level it was greater in the puborectalis compared to the internal anal sphincter in women. Vascularity was greater in the rectal wall compared to the mesorectal fat, with no difference between middle and lower levels. Conclusions  Blood supply is highest at upper levels of the anal canal; however, inner structures are better irrigated in men. Moreover, the rectal wall is better irrigated than the mesorectal fat. Establishing normal ranges may permit future comparisons of the studied structures in disease states as well as the hormonal and age related changes.

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