Fatty Liver

Fatty liver is also called fatty liver disease, which is too much of fat accumulated in the liver. Medical term for fat deposited in the liver alone is called steatosis, which is usually a benign condition. The problem is that steatosis can lead to inflammation of the liver, which is called steatohepatitis. Steatohepatitis like other forms of hepatitis can cause liver damage and scaring of the liver. Fatty liver disease is now the number 1 reason accounts for abnormal liver function tests in the United States. It affects about 30% of the population.

Types, causes, and risk factors of fatty liver

There are several types of fatty liver with a variety of causes and risk factors. The most common ones are:

Alcoholic liver disease. This problem is related to alcohol consumption. You do not need to be a heavy drinker to get fatty liver. It may happen with only drinking 10 oz of alcohol per week.

Nonalcoholic fatty liver disease (NAFLD). NAFLD is not related to drinking alcohol. In NAFLD, some patients may have only fat in their liver without inflammation or damage, the other patients develop inflammation and scar tissues in their liver, which is called nonalcoholic steatohepatisis (NASH). NASH can lead to liver cirrhosis and cirrhosis related complications and death. The common causes and risk factors of NAFLD include:

  • Diabetes
  • Hypertension
  • Obesity
  • High cholesterol
  • Autoimmune or inherited liver disease
  • Some medications
  • Viral hepatitis
  • Rapid weight loss
  • Malnutrition
  • Malabsorption

Acute Fatty Liver of Pregnancy. This is a serious condition during pregnancy, putting both mother and fetus at danger.

Symptoms and Signs

Most patients with fatty liver have no symptoms, especially in the beginning. The usual symptoms and signs of fatty liver are:

  • Fatigue
  • Weakness
  • Abdominal discomfort or pain
  • Jaundice
  • Nausea
  • Vomiting

Once cirrhosis happens, the patient has tendency to have bleeding, infection, fluid in the belly, swelling in the legs, yellow skin and eyes, confusion and coma, renal failure, difficulty breathing, cancer, etc. Patient with cirrhosis should be evaluated for liver transplant.

Diagnosis and Treatment

Diagnosis is based on history, physical examination, risk factors, rule out other causes, degree of liver damage and effects to other organs. This usually involves one or more of the following tests:

  • Blood works
  • Abdominal ultrasound with Doppler
  • CT scan
  • MRI/MRCP
  • Liver biopsy
  • Endoscopy
  • ERCP
  • EUS

Treatment is based on the cause. If fatty liver is due to alcohol consumption, stop drinking is a good approach to treat alcohol related fatty liver. Diet and exercise to lose weight are effective ways to treat NAFLD. The treatment will also be focused on reducing complications and properly managing complications if they happen, etc.

References:

  1. PubMed Health.
  2. Wikipedia.
  3. Mayo clinic online health information.
  4. Sleisenger and Fordtran's Gastrointestinal and Liver Disease- by Mark Feldman MD, et al.
  5. The Little Black Book of Gastroenterology-by David W. Hay.
  6. Principles of Clinical Gastroenterology by Tadataka Yamada, et al.


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