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In contrast to ALD, HBV, and HCV, symptoms of severe, acute (rapid onset) liver failure (due conference to intense hepatitis) are not observed in NAFLD or NASH. The symptoms conference and signs of liver failure include yellowing of the skin (jaundice), intense fatigue, loss of appetite, nausea, vomiting, conference and confusion. The classic signs of insulin resistance dominate the physical exam in NAFLD and NASH. As mentioned above, obesity (especially abdominal obesity) is the most frequent finding. In addition, patients with long-standing DM2 may have complications from the diabetes, such as retinopathy (abnormal blood vessels in the eye), kidney (renal) failure, and coronary artery heart disease. Elevated blood pressure (hypertension) is frequent. Acanthosis nigricans, a dark pigmentation of the skin of the armpits and neck, can be a sign of insulin resistance and is frequently seen in children with NASH. When the liver is palpated (felt by the doctor), it usually feels normal. However, when very large amounts of fat accumulate in the liver, it can be become quite large with a soft, rounded edge that can be easily felt by the doctor.
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