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Fatty Liver
 What Is Fatty Liver? How Does Fat Get Into The Liver? Who gets it? What other factors can affect Fatty Liver disease? What drugs should I avoid? What are the symptoms? How is Fatty Liver diagnosed? What do my Liver function tests reveal? Is a Liver biopsy needed? What is the treatment? What are the long-term risks? What is NASH? Where can I get more information?What Is Fatty Liver?
Fatty liver is the accumulation of fat in liver cells. One of the important functions of the liver is to change substances in the foods you eat into proteins, fats, and carbohydrates. One form of fat the liver produces is triglycerides, which are important for new cell production and to make hormones. With fatty liver, the liver cells accumulate large droplets of fat that consist of mostly triglycerides.
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It is not certain how fatty liver occurs. A patient has fatty liver when the fat increases the weight of the liver by 5 percent. Possible explanations for fatty liver include the transfer of fat from other parts of the body, or an increase in the extraction of fat presented to the liver from the intestine. Other explanations are that the liver reduces the rate it breaks down and removes fat. Eating fatty food by itself does not produce a fatty liver.
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People who abuse alcohol often develop fatty liver. It is also seen in people who are obese, have diabetes mellitus or hyperlipidaemia, and in children with Reye’s syndrome. Very rarely pregnant women can develop this condition acutely during their pregnancy. There are several drugs, which may induce fatty infiltration in the liver.
What other factors can affect Fatty Liver disease?
These factors include total parenteral nutrition (TPN), rapid weight loss, intravenous glucose therapy and surgical removal of large portions of the small intestine or stomach to treat severe obesity.
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Several drugs used to treat medical conditions have been linked to Fatty liver, including Statins, Amiodorone, Tamoxifen, Ca++ channel blockers, Tetracyclines, Perhexilene maleate, steroids, Sodium Valproate and Chloroquine.
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Fatty liver usually produces no symptoms. In rare cases, it causes jaundice, right upper quadrant discomfort/pain, abdominal swelling, and malaise. Women with pregnancy-related fatty liver may experience nausea, vomiting, anorexia, and abdominal pain.
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Fatty liver is most often discovered during routine laboratory testing. Additional tests help confirm the presence of fatty liver and rule out other types of liver disease. An ultrasound or CT scan is also a common method of detection. However, these scans often fail to detect accumulation of fibrous tissue or inflammation and cannot differentiate fatty liver from other causes of liver disease that can have a similar appearance.
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Liver function tests determine blood levels of substances produced or metabolized by the liver. They can be helpful for diagnosing fatty liver and for differentiating from hepatitis. Levels of two liver enzymes SGOT [AST] and SGPT [ALT]) are elevated in about 90% of people with fatty liver; AST/ALT ratio is >1 is suggestive of alcoholic etiology. GGT (Gamma Glutamyl Transferase) can elevated in fatty liver and also in alcohol abuse.
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Although other tests may suggest that a person has fatty liver, a liver biopsy is the only test that can definitely confirm or rule out the presence of fatty liver. During a liver biopsy, small samples of liver tissue are collected and sent to the laboratory for microscopic examination and biochemical testing. A liver biopsy is also helpful for determining the severity of fatty liver, and in some cases, it may also provide clues about the etiology of fatty liver. Fat laden hepatocytes with vacuolated appearance. Click image to enlarge.
What is the treatment?The treatment of fatty liver is related to the cause. It is important to remember that simple fatty liver does not require treatment, since it does not result in damage to liver cells or clinical disease. Obese patients with fatty liver will have reduction or loss of excess fat in liver cells, as well as in other cells in the body, if substantial weight loss (at least 10%) can be achieved. Patients who drink alcohol to excess will also have a loss of fat in the liver when alcohol is discontinued. Good glycaemic control in patients with diabetes mellitus also decreases the fat content in the liver.
In fact, fatty liver is usually reversible. In some cases, fatty liver is reversible if caught early in its development. Pregnancy-related fatty liver is treated by delivering the baby, if viable. In cases of malnutrition, the goal is to develop a healthy diet, sometimes with the aid of vitamins and mineral supplements. Severe liver damage (cirrhosis/Acute liver failure) can occur if fatty liver is left untreated. In these cases, the patient may eventually require a liver transplant.
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Very few factors have been useful in predicting the course of this condition, although specific features in the liver biopsy can be helpful. The good news is that in most people, fatty liver appears to be a stable medical condition. The results of one study showed that people with fatty Liver live just as long as people without this condition. Furthermore, the results of liver function tests remain the same over time in most people with fatty liver. However NASH can progress in some people due to progressive fibrosis and eventual cirrhosis. This is seen in about 20% of people after15-20 years especially in obese diabetic women
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Nonalcoholic steatohepatitis (NASH) is a condition characterized by inflammation and the accumulation of fat and fibrous tissue in the liver. Although similar findings can be seen in patients who abuse alcohol, NASH occurs in people who do not drink (<20 gms/week). The exact cause of NASH is unknown. However, it is seen commonly in people with certain medical conditions such as diabetes and obesity. It is diagnosed in about 10% of people who have a liver biopsy.
Most affected people are between the ages of 40 and 60 years, although the condition can also occur in children over the age of 10 years. NASH is seen more often in women than men. Fatty liver is typically a benign condition. On the other hand, NASH can lead to progressive scarring and cirrhosis. Cirrhosis is the term used to describe a diseased liver that has been severely scarred (irreversible stage).
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Email at drliver@emirates.net.ae
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