Fatty Liver Disease

Symptoms: Fatigue, pain in the upper right abdomen, yellow skin, weight loss, loss of appetite, jaundice, swollen abdomen, oedema, weakness, liver damage, confusion
Causes: Metabolic syndromes like insulin resistance, high cholesterol, high blood pressure, high triglycerides, type2 diabetes, obesity, prescription drugs like amiodarone, tamoxifen, and diltiazem or steroids

Risk Factors: Obesity, type 2 diabetes, prediabetes, Hispanic and non-Hispanic ethnicity, high cholesterol and triglyceride level, high blood pressure, drugs like corticosteroids, cancer drugs, age, rapid weight loss, hepatitis C, insulin resistance
Severity: Mild to severe
Which doctor to consult: Hepatologist or Gastroenterologist

Overview:

Fatty liver disease is a relatively common condition that indicates fat accumulation in the liver. It is also called steatohepatitis and is caused primarily by excessive consumption of alcohol, occasionally resulting in liver damage. The liver is the body's most vital component for transferring nutrients and blood filtration. Other than that, it also helps prevent specific infections. So, any damage can sabotage the body's normal functioning, giving rise to numerous other symptoms. Maintaining a balance is essential since a small amount of fat is necessary for the proper functioning of a healthy liver. The problem arises when the fat increases by 5% to 10%.

 
Types of Fatty Liver Disease: 

Fatty liver disease is mainly of two types

1. Nonalcoholic fatty liver disease(NAFLD)

This type is very common, affecting one out of every three adults. Researchers aren't sure what causes it, but obesity and diabetes increase your chances of getting it. Unlike the other major types, you do not get it from drinking alcohol. NAFLD can take two forms:

a. Simple fatty liver: This means that you have fat in your liver but no inflammation or cell damage. It usually does not worsen or cause problems with your liver. The majority of people with NAFLD have simple fatty livers.

b. Nonalcoholic steatohepatitis (NASH): This is much more severe than simple fatty liver. NASH indicates that your liver is inflamed. NASH-related inflammation and liver cell damage can lead to serious complications such as fibrosis and cirrhosis, both types of liver scarring as well as liver cancer. These issues can result in liver failure, necessitating a liver transplant. About 20% of people with NAFLD have NASH.

2. Alcoholic fatty liver disease (ALD)

This type is less common and is caused by alcohol consumption. As a result, stopping drinking alcohol usually improves your situation. If you continue to drink, ALD can lead to serious complications. Some examples are:

Enlarged Liver: It does not always produce symptoms, but you may experience pain or discomfort on the upper right side of your abdomen.
Alcoholic hepatitis: This is liver swelling that can cause fever, nausea, vomiting, abdominal pain, and jaundice.
Alcoholic cirrhosis: This is the buildup of scar tissue in your liver. It can cause the same symptoms as alcoholic hepatitis, including:

Large amounts of fluid buildup in your stomach (the doctor will call it ascites).
High blood pressure in the liver
bleeding in your body.
Confusion and behaviour changes.
An enlarged spleen (a small organ inside your rib cage that is part of your immune system)
Liver failure can be fatal.

Alcohol-induced fatty liver disease usually comes first. It can worsen and become alcoholic hepatitis. Over time, it may progress to alcoholic cirrhosis. 
If you drink heavily, consult your doctor. It is confidential, and they can assist you in reducing your alcohol consumption in order to save your health.
 

Symptoms:

ALD and NAFLD typically have no symptoms. Some people may experience tiredness or pain in the upper right side of their abdomen, where their liver is located.

If you have NASH or develop cirrhosis, you may experience symptoms like:
Swollen stomach;
Symptoms may include enlarged blood vessels under the skin and larger-than-normal breast size in men;
Red palms;
Jaundice characterized by yellowish skin and eyes;
Nausea, weight loss, or appetite;
Fatigue or mental confusion

Causes of Fatty liver disease: 

Excess fat accumulates when the liver does not process and break down fats as it should. Obesity, diabetes, and high triglycerides are all risk factors for developing fatty liver. Alcohol abuse, rapid weight loss, and malnutrition may all contribute to fatty liver.

Risk Factors of Fatty Liver Disease:

The cause of nonalcoholic fatty liver disease (NAFLD) is unknown. Researchers do know that it is more common in people who:

Have type 2 diabetes and prediabetes
Have obesity
Are middle-aged or older (although children can also get it)
Have high levels of fats in the blood, such as cholesterol and triglycerides
Have high blood pressure
Take certain drugs, such as corticosteroids and some cancer drugs
Have certain metabolic disorders, including metabolic syndrome
Have rapid weight loss
Have certain infections, such as hepatitis C
Have been exposed to some toxins

Possible Complications:

Fibrosis: If left untreated, fatty liver disease can trigger inflammation of the liver cells, causing an excess of liver fat accumulation. This, in turn, can infiltrate the immune cells and increase the secretion of cytokines. This condition is usually observed in patients suffering from non-alcoholic steatohepatitis or NASH and can gradually cause liver fibrosis. Over time, fibrosis can reduce the blood throughout the organ, causing permanent scarring of the tissues. 
Untreated Cirrhosis: Patients with fatty liver disease are also susceptible to developing liver cirrhosis. The signs of the disease are similar to excessive alcohol use and are irreversible. Even if the symptoms are resolved, the damage to the liver is permanent. However, with proper treatment, it is possible to keep the symptoms under control. 
Liver Failure: The stages of advanced liver fibrosis and cirrhosis can eventually cause liver failure. The condition can aggravate other issues, such as diabetes, high blood pressure, and kidney disease. 
Liver Cancer: Both cirrhosis and steatohepatitis are risk factors for hepatocellular carcinoma or liver cancer. The chance of developing liver cancer increases if fatty liver syndrome occurs at a young age. However, the liver can recover from mild cases of fatty liver disease with proper lifestyle changes and medical supervision. 

Prevention:

To prevent ALD:

Drink in moderation: Men over 65 and women of all ages are allowed one drink per day, while men 65 and younger may have up to two drinks.
Protect yourself from hepatitis C: If you drink alcohol, this viral liver infection increases your chances of developing cirrhosis.

Check before mixing medications and alcohol: Ask your doctor if you can drink alcohol while taking prescription medications. Read the warning labels on over-the-counter medications. Avoid drinking while taking acetaminophen, which can harm your liver when combined with alcohol.

For NAFLD and NASH:

Consume healthy food: Choose a plant-based diet that includes plenty of fruits, vegetables, whole grains, and healthy fats.
Maintain a healthy weight: Lose weight if you have to. If you have a healthy weight, work to keep it that way by eating well and exercising regularly.Exercise: Get some exercise most days of the week. If you haven't been physically active in a while, consult your doctor first.
 

When to Consult a Doctor? 

It is highly recommended to seek medical assistance for any of the following situations:
On Symptoms: Fatty liver disease may not always be fatal, but it is better to consult a specialist. Sudden weight loss despite following a healthy diet and sufficient physical activity immediately indicates something wrong. Other symptoms to consider are a yellow tint on the skin and the whites of the eyes. Even individuals who do not consume alcohol can be diagnosed with fatty liver. Hence, a medical assessment by a professional is recommended. However, alcoholic fatty liver may go away on its own once the alcohol consumption is stopped.

 
During Pregnancy: Obstetric emergencies can become problematic for pregnant women as these can result in a dysfunctional liver and even death. So, supportive maternal care needs to be provided to the expecting mother. 

Diagnosis:

A hepatologist and gastroenterologist can diagnose and treat fatty liver. It is advised to consult both doctors for an accurate diagnosis and faster recovery. The hepatologist attempts to preserve the remaining liver condition only after examining the risk factors thoroughly. For this, a proper diagnosis must be made in the following manner. 
Physical Examination: During a routine physical test, a doctor will conduct various exams to identify and better understand the symptoms. Further testing may be recommended if suspected fatty liver or abnormal liver test results are noted. The hepatologist and gastroenterologist will ask about the patient's medical history, lifestyle, and family history. The doctor should also be informed about the patient's medication. 
Blood Tests: Once NAFLD is suspected, a blood test is the best way to determine liver enzyme levels. This includes detecting alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Usually, the blood test for NAFLD is scored as APRI/FIB-4. This combination helps predict the significant possibilities of fibrosis and cirrhosis of the liver. 

Other tests include:
Complete blood count (CBC) test
Liver function test (LFT)
Tests for chronic viral hepatitis A and hepatitis C
Screening of celiac disease
Blood sugar test (Fasting)
Haemoglobin A1C test 
Lipid profile test 
Imaging Tests

During the diagnosis of any liver disease, an imaging test is one of the primary procedures followed. This includes an abdominal ultrasound, computerised tomography (CT) scanning, and magnetic resonance imaging (MR) of the abdomen area. However, the processes cannot differentiate between NAFLD and NASH. 

Abdominal Ultrasound: An ultrasound of the abdomen area is the primary test for diagnosing fatty liver diseases. This test examines various parameters such as deep beam attenuation, parenchymal brightness, gallbladder wall definition and liver-to-kidney contrast. The qualitative grades can range from mild to moderate or severe (grade zero to three), with zero being the normal range. 
CT Scan or MRI: CT scanning or MRI imaging of the abdomen is also recommended, although they cannot distinguish between NASH and NAFLD. Although inefficient in detecting mild steatosis, the quantitative assessment done by these limited diagnostic measures can identify advanced or severe cases. A CT scan can determine pre-cirrhotic liver fibrosis with parameters like decreased hepatic veins diameter and caudate-to-right-lobe ratio.
Magnetic Resonance Elastography: MRE or MR elastography is one of the best non-invasive measures for detecting the stages of liver fibrosis. The process combines MRI images with sound waves and produces an elastogram or visual map. This helps doctors understand the stiffness of the body tissues. The testing method of MRE is similar to a FibroScan but more accurate. 
Transient Elastography: Transient elastography is another non-invasive imaging procedure for checking liver stiffness (LSM). This is done to examine the possibility of hepatic fibrosis via LSM in the NAFLD patient. Transient elastography also allows the determination of the histologic stage of fibrosis of the liver and aids in treating chronic liver diseases with greater accuracy. 
Liver Biopsy: A liver biopsy or liver tissue test is done when all the above tests return non-inclusive results. A sample tissue is removed from the liver using a thin needle and sent to the laboratory for further testing. This procedure is done to check for signs of scarring and inflammation and determine the level of liver damage. The test can cause discomfort to patients, and subtle risks are involved as a thin needle is inserted into the abdominal wall of the liver. 

Treatment:

Home Care: Certain home remedies may ease the symptoms of fatty liver disease. The simplest way to recover from alcoholic fatty liver disease is to stop consuming alcohol. However, for NAFLD, making changes in the diet may be necessary since not all diets will suit the patient. But it is essential to consult a hepatologist or gastroenterologist before making any changes. Losing excess weight (about seven to ten per cent of body weight) can improve the condition. 
 

Medication: Unfortunately, there is no FDA-approved treatment for fatty liver disease. The two best drug options for biopsy-proven NASH, according to the American Association for the Study of Liver Diseases, are vitamin E (an antioxidant) and pioglitazone (a diabetes treatment). A choline supplement may help reduce your risk of fatty liver disease. Choline is the most popular for pregnant women and helps prevent the occurrence of any neural tube defect in the offspring. However, only a licensed medical practitioner can prescribe these medications. 

Surgical Treatment: Since fatty liver disease is primarily associated with obesity, bariatric surgery, gastric bypass, or sleeve gastrectomy return sustained weight loss results. 

Additional Information 

Diabetes due to fatty liver: Fatty liver disease (FLD) does not always cause significant symptoms; they are usually discovered later on. However, when the liver's fat content exceeds 10%, patients are more likely to develop type 2 diabetes. This is because the liver regulates blood sugar. The fat buildup in the organ disrupts this flow, rendering the body insulin-resistant. This puts a lot of strain on the pancreas' beta cells, worsening type 2 diabetes.
Impact of smoking on fatty liver: Patients are advised to stop smoking to recover from many liver problems, not just fatty liver disease. Smoking produces various toxic effects in the body, which can directly or indirectly impact the functioning of the liver. These effects can also be immunological and oncogenic. The cytotoxic potential of smoking cannot be ignored when considering the possibility of necroinflammation and fibrosis of the liver.