Fatty Liver Disease

In the healthy state, it’s natural for the liver to store a small amount of fat in it. However, in some people, fat starts accumulating in the liver, creating an unhealthy condition called fatty liver disease (FLD) or hepatic steatosis. FLD is serious as it can lead to various complications including liver failure.

Types of Fatty Liver Disease

• Alcoholic FLD: Excessive alcohol consumption reduces the liver function progressively leading to accumulation of fat in the liver. Alcoholic Fatty Liver Disease are of 2 types:
  • Without symptoms: This condition is diagnosed only by investigations such as Ultrasonogram and Fibroscan. It’s called simple alcoholic FLD (AFLD).
  • With symptoms: If the damage to the liver is severe which is seen as inflammation or scarring, the condition is called alcoholic steatohepatitis (ASH).
• Non-alcoholic FLD: Though there is no alcohol consumption due to various risk factors, there is an accumulation of fat in the liver.
  • If the fat accumulation is mild to moderate, the condition is called a simple non-alcoholic fatty liver disease or NAFLD.
  • If the fat accumulation is severe, there can be inflammation and scarring of the liver and the condition is known as non-alcoholic steatohepatitis (NASH). If it has not been treated it can lead to liver cirrhosis and liver cancer
• Acute Fatty Liver of Pregnancy (AFLP): Some pregnant women develop this condition in their third trimester of pregnancy. This may require a premature delivery and a few weeks after giving birth, the liver returns to its normal, healthy state.

RISK FACTORS FOR NON-ALCOHOLIC FLD

There are several risk factors.

• Obesity or being overweight
• A high BMI (body mass index)
• High blood sugar (hyperglycaemia)
• Insulin resistance, pre-diabetes and type-2 diabetes
• High blood Cholesterol/Triglycerides.
• Hypothyroidism
• High blood pressure
• Sleep apnoea
• Polycystic ovary syndrome (PCOS) in women
• Rapid weight loss following obesity surgery
• Some infections such as hepatitis C
• Genetic Factors
• Some drugs such as Steroids.

Read Also: How can fatty liver progress to liver cancer

Symptoms

Most of the early stage of FLD patients will not have any symptoms.Depending on the type and stage of FLD, there can be one or more of these:

• Weakness and fatigue
• Jaundice with yellowing of skin and eyes
• Web-like clumps of blood vessels under the skin and red -coloured palms particularly in Alcoholic FLD.
• Pain or swelling in the abdomen
• Swelling in the legs
• Enlarged breasts in men
• Confusion, feeling disoriented and loss of memory
• Nausea and vomiting
• Bruising or bleeding in any part of the body
• Night time sleeplessness

Stages

• Simple Fatty Liver: There is more than normal fat build-up in the liver
• Steatohepatitis: Now there is inflammation in the liver
• Fibrosis: The inflammation has resulted in scarring in some parts of the liver
• Cirrhosis: The scarring is now widespread throughout the liver

Complications

• End-stage liver failure, wherein the liver stops functioning and medical therapy fails to act.
• Excessive fluid accumulation in the abdomen (Ascites)
• Excessive fluid accumulation within the lung (Hydrothorax)
• Dilatation of veins in the oesophagus (Oesophageal Varices) which can eventually cause blood vomiting or blood in the motion.
• Hepatic encephalopathy that is marked by confusion, sleeplessness, slurred speech, drowsiness and unconsciousness.
• Reduced urine output and worsening of kidney function (Hepato renal syndrome)
• Increased risk of infections such as cellulitis (leg infections), urinary tract infection, and respiratory infections due to low immunity.
• Significant weight loss ( sarcopenia)
• Liver cancer ( Hepatocellular carcinoma)

Read Also: Advantages of Interventional Radiology for Liver Cancer

Diagnosing Fatty Liver Disease

If you or any of your dear ones are showing any of the above symptoms, rush to a reputed hospital. The specialists there will undertake one or more of these:

• Medical History: The doctor will evaluate your medical history as well as your family’s medical history.
• Physical Exam: The doctor will gently press on your abdomen to assess pain or swelling.
• Blood Tests: FLD is one of the causes for inflammation of the liver and this is marked by a higher level of liver enzymes in the blood. Two blood tests – ALT and AST help detect the presence of elevated liver enzymes at the early stage of the FLD.
• Imaging Tests: The doctor may suggest Ultrasound, Fibroscan, CT and MRI scan to get a perfect picture of the liver.
• Liver Biopsy: A small sample of the liver tissue is extracted using a fine needle, under local anaesthesia and then examined under a microscope.

Treatment for Fatty Liver Disease

While some drugs and vitamin E supplements (in small doses) are given to treat non alcoholic FLD, the most effective treatment is a change in lifestyle. This includes:

• Alcohol: The person should completely abstain from alcohol. If this is becoming difficult, he/she should reach out to alcohol de-addiction agencies.
• Weight Reduction: Reducing weight gradually and maintaining a healthy weight is an absolute must. If this is difficult to achieve with diet and exercise, the person should even consider bariatric surgery.
• Exercise: Exercise is indispensable for both liver and cardiovascular health and must be undertaken for 30 minutes every day.
• Diet: The person should consume a diet rich in fresh fruits and vegetables, whole grains and healthy fats. He/she should abstain from refined food, processed snacks and transfats.

However, if the condition has reached an advanced stage and is rapidly progressing towards liver failure, a liver transplantation is the only option.

Conclusion

If you or any of your dear ones are diagnosed with fatty liver disease, do not panic. Medication, lifestyle changes and liver transplantation will help you overcome the condition. Reach out to a reputed hospital in Chennai. They will have specialists to diagnose your condition precisely and design a course of treatment for quick recovery and rehabilitation.

Dr Joy Varghese

Director - Department of Hepatology & Transplant Hepatology

Disclaimer:The views and opinions expressed in this article belong solely to the author. They do not reflect the opinions or views of the organization.