An Introduction to Fatty Liver Disease (Part 1)

As the largest organ in the body, the liver primarily aids in digestion, energy storage, and poisonous substance removal; so, it is natural for some fat to exist within its cells. However, when this fat storage exceeds 5% of the total liver mass, it is now considered ‘fatty’. Fatty liver disease is a gradually growing global health concern that is mainly due to sedentary lifestyles and trans-fat rich diets. Let’s discuss the stages and symptoms of fatty liver disease.

The Stages:

Fatty liver disease, if left unchecked, progresses from the initial harmless and easily reversible stage to complete liver damage and failure:

1- Simple Fatty Liver:

The earliest version of fatty liver disease is fat accumulation in the liver cells without causing any inflammation or liver cell damage. While difficult to detect, most individuals diagnosed with the condition can arrest further progression and reverse it completely.

2a- Non-Alcoholic Fatty Liver Disease (NAFLD):

Also known as hepatic steatosis, it is characterised by liver inflammation that mimics the effects of liver damage caused by excess alcohol consumption. With a high risk of progressing into irreversible liver damage, 20% of NAFLD patients will further experience liver scarring.

2b- Alcoholic Fatty Liver Disease (AFLD):

AFLD, is liver damage and fat accumulation due to extreme alcohol consumption. As alcohol cleared from the body on a regular basis by the liver, it generates harmful substances that damage liver cells, causes inflammation and reduces overall immunity. If left untreated, AFLD can rapidly progress into alcoholic hepatitis.

When over 5% fat accumulation is accompanied by severe inflammation and liver cell damage, then FLD is known as either alcoholic or non-alcoholic steatohepatitis (NASH) depending on the cause. The risk of liver scarring, damage and even liver cancer is magnified once FLD progresses into steatohepatitis.

3- Fibrosis:

During this brief phase, the liver is able to function normally. However, continued fat accumulation and increasingly severe and persistent inflammation causes scar tissue to form around the liver and near blood vessels.

4- Cirrhosis:

Years of persistent inflammation and fibrosis cause the liver to shrink, scar, and become ‘lumpy’, before eventually succumbing to complete functional failure and liver cancer, in some cases. Cirrhosis is commonly observed in patients over 50.

Acute Fatty Liver of Pregnancy:

Although rare, some pregnant women may face this potentially life-threatening complication during the third trimester, with common symptoms being persistent nausea, vomiting, headaches, fatigue, upper-right abdominal pain, jaundice, reduced appetite, and general discomfort. Women with this condition must undergo prompt delivery, and usually fully recover after childbirth.

Symptoms:

Although fatty liver disease does not present any definitive symptoms, certain common factors may serve as a forewarning to the condition:

1- Simple Fatty Liver:

• Fatigue
• Enlarged liver
• Upper-right abdominal pain

2- Inflammation (Steatohepatitis):

• Fatigue
• Confusion
• Weight loss
• Abdominal pain
• Reduced appetite
• Physical weakness

3- Cirrhosis:

• Jaundice
• Confusion
• Red palms
• Enlarged spleen
• Abnormal bleeding
• Enlarged breasts (in men)
• Ascites (abdominal swelling)
• Enlarged blood vessels beneath the skin’s surface

Causes:

While the actual cause is unknown, researchers speculate that certain factors, like illness or age, may reduce the liver’s ability to change fat into its decomposable form. Obesity along with hyperglycemia (high blood sugar), insulin resistance, and/or high triglyceride levels are thought to be common causative factors, as the excess fat buildup acts as a toxin and causes liver inflammation and fibrosis. Other common causes include a genetic history, type II diabetes, rapid weight loss, and certain medications like Tamoxifen, Methotrexate, Valproic acid etc.

Risk Factors

A risk factor makes a person more likely to have a condition or disease. There are many risk factors for non-alcoholic fatty liver disease, including:

• Being obese or overweight
• Having type 2 diabetes or insulin resistance
• Having metabolic syndrome (excess body weight, insulin resistance, high blood pressure and high triglyceride levels)

Some genetic metabolic conditions or prescription medications, including amiodarone (Cordarone), diltiazem (Cardizem), steroids, and tamoxifen (Nolvadex) also may increase the risk of non-alcoholic fatty liver disease. If you are taking one of these medications and are diagnosed with fatty liver, your doctor might substitute another drug.

Diagnosis

If your doctor thinks you may have fatty liver disease, he or she may order the following tests:

• Blood tests to check for higher levels of certain liver enzymes.
• An ultrasound or computed tomography (CT) scan of the liver to check for abnormalities and confirm the diagnosis of fatty liver disease.
• A liver biopsy (tissue sample) if your doctor suspects that you have severe liver disease.

Elastography is a newer technique that uses waves transmitted by ultrasound, magnetic resonance imaging (MRI) or vibration (Fibroscan) to estimate the amount of steatosis (fat) and fibrosis (stiffness) of the liver without taking a biopsy.

Fatty liver disease should be diagnosed and treated immediately in order to avoid its progression into permanent liver damage. If you observe any of the above symptoms consult your practitioner. You can also book an appointment with a top gastroenterologists in Lahore, Karachi and Rawalpindi through oladoc.com. or call our helpline at 042-3890-0939 for assistance to find the RIGHT doctor for your health concerns.