Metabolic Dysfunction-Associated Steatohepatitis (MASH) Symptoms

When it first develops, MASH often has no symptoms or may only cause general fatigue or discomfort in the abdomen. If the condition progresses, however, its symptoms — such as itching, swelling, excessive bruising, and muscle wasting — will accumulate and become more serious.

• Persistent fatigue, or feeling tired consistently
• Discomfort or pain in the upper right abdomen where your liver sits
• Unexplained weight loss
• Weakness or general malaise

• Pruritus, or intense itching
• Ascites, or swelling in the abdomen from fluid buildup
• Edema, a swelling in the legs
• Jaundice, a yellowing of the skin and eyes
• Bruising and bleeding easily
• Spider angiomas, or blood vessels just under the surface of your skin that look like a spiderweb
• Hepatic encephalopathy, or a buildup of blood toxins that can cause behavior changes, slurred speech, and confusion

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• Red palms

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• Shortness of breath
• Internal bleeding

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• Muscle wasting

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• Portal hypertension, or increased pressure in the portal vein that causes the liver and spleen to enlarge

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MASH doesn’t appear overnight. It evolves over time as part of MASLD, which is defined by a buildup of unhealthy fat within your liver. The stage of MASH you have depends on how much liver scarring, or fibrosis, you have.

The stages of MASH describe increasing levels of liver damage:

• Stage 1: MASH with mild fibrosis indicates an early level of liver scarring that can often be reversed with self-care.
• Stage 2: In MASH with moderate fibrosis, inflammation and cellular damage have caused some liver scarring that could be reversed. Your liver is still working well.
• Stage 3: MASH with advanced fibrosis includes extensive liver scarring. Some of this damage can be reversed. But at this stage, treatment from healthcare professionals is necessary to prevent further, permanent damage and maintain your liver function.
• Stage 4: When cirrhosis sets in at this stage, scarring is severe enough to change your liver’s shape. Some of the scarring is permanent, but some damage may still be reversible. Your liver may still function at a reduced capacity, but liver cancer and failure are serious risks.

• Coronary artery disease
• Atherosclerosis, a buildup of plaque in the arteries
• Changes in heart size and shape
• Heart failure
• Arrhythmia, or irregular heartbeat

• Muscular atrophy, in which your muscles progressively weaken and degenerate
• Sarcopenia, a loss of muscle mass and function
• Inflammatory myopathies, rare muscle disorders that include skeletal muscle inflammation

Because MASH symptoms can be vague or nonexistent in early stages, it can be difficult to know if you have MASH before it becomes a serious issue.

• Jaundice
• Easy bruising
• Dark urine
• Swelling in the abdomen or legs
• Vomiting blood
• Dark or black tarry feces
• Periods of confusion, mood changes, forgetfulness, or poor judgment
• Unexplained skin itching

• MASH is a progressive and potentially serious liver condition, but it may not present symptoms until damage is advanced.
• Early MASH may include fatigue, pain in the upper right abdomen, weakness, and unexplained weight loss.
• The earlier MASH is detected, the more likely you can halt or even reverse the damage to your liver.
• Left untreated, MASH can lead to serious complications such as liver failure and liver cancer, cardiovascular disease and other heart issues, and muscular issues.