Fatty Liver Disease

Introduction

Fatty liver disease occurs due to excessive buildup of fat in your liver. A small amount of fat is normal, but extra fat stored in your liver tissues can impair its function. The medical term for this condition is known as hepatic steatosis. This disease progresses in stages, and if it persists for too long, it can lead to cirrhosis of the liver. Fortunately, fatty liver disease can be managed and reversed to a certain extent with treatment measures and lifestyle modifications. Lack of treatment can lead to serious complications.

 

Causes

Fatty liver disease can occur due to a variety of different factors. One of those factors is excessive alcohol consumption. A normal amount of alcohol can get metabolized by your liver, but excessive alcohol can produce byproducts that combine with fatty acids and accumulate in liver tissues. People who do not drink alcohol can also get fatty liver disease, but the exact cause is unclear. It is theorized that it can occur due to multiple factors, including obesity, diabetes, high triglycerides in the blood, or metabolic syndrome. In such cases, either too much fat is consumed or not enough fat is metabolized, which results in a buildup of fat tissues in the liver. Certain medications may also contribute to fatty liver disease, including amiodarone, tamoxifen, diltiazem, etc. In rare cases, pregnancy or some genetic disorders can also lead to this condition.

 

Types

Fatty liver disease is divided into alcoholic and non-alcoholic fatty liver disease.

Alcoholic fatty liver disease (AFLD) is caused due to high intake of alcohol for a long time. The disease may not present with any symptoms in the early stages, but later, it can cause liver inflammation (alcoholic steatohepatitis). If left untreated, this condition can lead to cirrhosis or liver failure.

Non-alcoholic fatty liver disease (NAFLD) is when excessive fats accumulate in people who do not drink alcohol. Like AFLD, it may be asymptomatic in the early stages. If it gets accompanied by inflammation, the condition is called non-alcoholic steatohepatitis. This can also progress to severe liver-related complications if left untreated.

 

Risk Factors and Epidemiology

The risk of ALFD is higher in those who are chronic alcoholics. NAFLD can develop in people who have a high body mass index (around 25-30) and excessive belly fat. A positive family history of fatty liver disease can increase the risk in the presence of other contributing factors. People with diabetes, insulin resistance, high blood pressure, high triglycerides, obstructive sleep apnea, and PCOS are also at risk. In some cases, malnutrition or rapid weight loss may also contribute to this condition. Those with a history of a chronic liver infection such as hepatitis C are also prone to develop fatty liver disease.

 

Signs and Symptoms

Fatty liver disease can progress in certain stages that vary in severity. In its early stage, there is simple fat accumulation in the liver without any other problem. You may not experience any symptoms during this stage. As it progress, inflammation of the liver occurs, which may be characterized by pain or discomfort in the upper left quadrant of your abdomen. Soon your liver begins to form scar tissues, and if the condition continues to persist, it may progress to cirrhosis which is an irreversible stage. During these severe stages, you may experience multiple symptoms, which include pain, jaundice, persistent itching, light-colored stools, dark urine, fluid buildup in your feet and around the abdomen, spider-like vessels on your skin, redness in palms, confusion, memory loss or difficulty in performing cognitive tasks.

 

Diagnosis

The diagnosis procedure of fatty liver disease begins with taking a detailed medical history. Your history can point toward the possible cause of liver damage. A thorough physical examination follows this to check if any physical signs such as jaundice, tenderness in the upper right quadrant, enlarged or rough texture of liver, spider angiomas, redness in palms, etc., are present.

The conformational diagnosis of fatty liver disease is made on the basis of multiple tests. These can include complete blood count (CBC), liver function tests (LFTs), INR, hepatitis tests, renal function tests (RFTs), and other suitable tests according to the suspected cause. Imaging tests are also done to visualize the extent of this disease. These can include CT scans, abdominal ultrasounds, and MRI. Transient elastography can be done to measure the stiffness of the liver. A liver biopsy can be done if there is a risk of liver cancer.

 

Differential Diagnosis

Fatty liver disease can occur due to many different underlying causes, making it difficult to differentiate the original cause. ALFD and NALFD can both present with similar symptoms. Differentiation between these two types should be made on the basis of history, physical examination, and diagnostic tests.

 

Treatment

At present, there is no cure for fatty liver disease through medications, but the disease can be reversed if it gets diagnosed early. This can be achieved by adopting some lifestyle modifications. If you have ALFD, your doctor will ask you to abstain from alcohol. Detoxification and counseling sessions are recommended for people with alcohol addiction or alcohol use disorder. People with NAFLD are advised to maintain a healthy diet, perform exercise regularly and take active measures to lose weight. Diet should include products containing less saturated fat and trans fat. If you have a pre-existing condition such as diabetes or hypertension, medications are given to maintain them.

 

Prognosis

The prognosis of fatty liver disease is good if diagnosed at an earlier stage. Lifestyle changes can help in reversing the accumulation of fat. However, untreated fatty liver disease can progress to cirrhosis, liver failure, or liver cancer at very late stages.

 

Prevention

Fatty liver disease can be prevented by preventing its common causes. Reduce alcohol consumption and do not intake alcohol if you have at high risk of liver disease. Eat a balanced diet, exercise regularly, and maintain a healthy weight to reduce the stress on your liver. Take special precautions if you have a positive family history, obesity, or diabetes.