Your doctor has diagnosed you with a fatty liver. It’s a diagnosis many people don’t fully understand. While the condition may not be harmful in some individuals, in others it can lead to more severe forms of liver damage. It occurs when your body cannot properly process the excess calories you consume and the excess fat that is thereby generated, and fats inappropriately builds up in liver cells. A liver specialist at Gastrointestinal Specialists of Georgia will tell you how severe the condition is, based on test results, and will recommend appropriate treatment methods.
What Is Fatty Liver?
Hepatic steatosis is a buildup of fat in the liver, the body’s second largest organ. There is normally very little fat stored in the organ. It gets processed, as does everything you eat and drink and shifted out to rest of the body. Fatty liver is when there is more than 5 to 10% fat content by organ weight.1
A reversible condition, it affects about 10 to 20% of people in the U.S.,2 without any inflammation or damage. Most cases involve people from 40 to 60 years old.3 The condition is often harmless, but, if accompanied by inflammation (steatohepatitis), a form of scarring called fibrosis can develop, which can progress into cirrhosis or scarring that causes structural changes which impair the liver’s function.
The liver weighs about three pounds and is situated on the right side of the abdomen, behind the rib cage. Reddish-brown in color and rubbery in texture, it consists of right and left lobes, with the gallbladder and portions of the pancreas and intestines below it.
The liver is situated on the path of blood flow between the digestive tract and the rest of the body; in being so, it can store nutrients, detoxify chemicals, and metabolize drugs. Bile, a digestive substance found in the intestines, is produced by the liver and secreted via a series of ducts within the organ.
A few types of fatty liver exist, but your liver doctor will usually consider these two:
- Nonalcoholic fatty liver disease (NAFLD): Unrelated to alcohol, NAFLD is when over 10% of the liver consists of fatty tissue. It may only involve an accumulation of fat, but there could be fat, inflammation, and cellular damage combined (nonalcoholic steatohepatitis). The condition is linked to metabolic syndrome or abnormalities associated with problems using insulin; high blood pressure; high triglyceride levels; and excess abdominal fat. Obesity and diabetes are often associated with NAFLD.
When the liver has fat buildup but no inflammation then it is called steatosis. When there is fat with inflammation and scarring then it is called nonalcoholic steatohepatitis. With continued scarring this can lead to cirrhosis, death or liver cancer.
- Alcoholic fatty liver: Excessive alcohol consumption and genetics play a role in this condition. The earliest stage of alcohol-related liver disease, it is characterized by damage due to heavy drinking, which prevents the organ from breaking down fat. Diseases such as hepatitis C can further increase one’s chances of developing excess scarring from fatty liver. Obesity and too much iron or copper in the body can also lead to severe scarring, also called cirrhosis. Although cirrhosis can develop if one continues to drink excessively, the fat will be processed and disappear within six weeks of stopping.4
The complications of untreated fatty liver include:
About 20% of people with nonalcoholic steatohepatitis develop cirrhosis.5 Scarring develops as the liver tries to fight inflammation, and the scar tissue spreads, over time, replacingliver tissue as it does. Areas of the organ can then become non-functional, which eventually leads to liver failure. Other complications of cirrhosis include:
- A buildup of fluid in the abdomen
- Swelling of esophageal veins, which can rupture/bleed
- Hepatic encephalopathy, causing drowsiness, confusion, and slurred speech
- End-stage liver failure
- Liver cancer
Causes and Risk Factors
The most common causes your liver doctor may refer to include:
Diet: By consuming too many sugar calories, the liver’s normal ability to generate and store fat is compromised. Individuals with fatty liver have insulin resistance. Their body’s insulin is less efficient in helping breakdown glucose which makes the body generate excess insulin which in turn causes the liver to convert excess calories into fat and store it in the liver. Fat cells release fatty acids, some of which are toxic in high amounts. Which in turn inflames the liver and causes continued scarring.
Disease: Type II diabetes and hepatitis C can lead to fatty liver. Wilson’s disease a hereditary disease in which body cannot get rid of excess copper can, too. Other medical risk factors include hereditary metabolic disorders, underactive thyroid, underactive pituitary gland, and polycystic ovary syndrome. Sleep apnea has also been associated with fatty liver.
Obesity: Large quantities of body fat leads to constantly high insulin in the body. As a result, hormones and proteins are released into the blood, causing cells throughout the body to become insulin-resistant. The pancreas increases insulin production, at first, but over time it loses the ability to causing diabetes. Sugar, therefore, can’t enter cells, which then function less efficiently. Instead sugar is converted into fatty acids in the liver.
Liver cells begin to increase uptake of fatty acids, which are converted to stored fat. As it accumulates, the liver loses the ability to get rid of the very fat that it is making.
Medications: In some people, NAFLD is a side effect of taking medication. Corticosteroids and some chemotherapy drugs such as tamoxifen also can cause fatty liver. Other drugs include valproic acid, amiodarone, and methotrexate.
Medical problems: Rapid weight loss, malnutrition, and exposure to certain toxins can affect the liver and trigger a buildup of stored fat.
In addition to having concentrated abdominal fat or diabetes, risk factors for NAFLD also include age. Middle-aged and older people are more at risk. However, it’s not impossible for children to get it. Hispanic and non-Hispanic white individuals are more likely to get fatty liver than African Americans.
As previously stated, fatty liver can lead to cirrhosis. Inflammation may have been an issue for decades before it develops. However, liver injury can progress in few years, in some cases, particularly with alcohol abuse or viral hepatitis.
There are no treatments for cirrhosis, but further liver damage can be avoided (with weight loss, abstaining from alcohol, and hepatitis A and B vaccinations), preventing this disease before needing a liver specialist is your best option.
Symptoms of Fatty Liver
An enlarged liver points to NAFLD. Most patients have no physical symptoms from fatty liver. The ones you may notice in advanced cirrhosis, may that be from non – alcoholic fatty liver or other liver diseases include:
- Pain in your upper right abdomen
- Abdominal swelling
- General swelling caused by decreased liver proteins
- Enlarged blood vessels under the skin
- Susceptibility to bruising and bleeding
- Unusually dark urine
- Poor judgment
- Trouble concentrating
- Red palms
- Weight loss
- Muscle wasting
The processes behind some of the most common symptoms are explained in detail at Activebeat.com.
How Is Fatty Liver Diagnosed?
There are often no symptoms in the early stages. Given the potential for the disease to progress into serious, potentially life-threatening conditions, it’s important to get an accurate diagnosis. The methods used by a liver doctor include:
Physical exam: Doctors can detect an enlarged liver or spleen by examining the abdomen. Some signs of advanced liver disease can be seen on the skin. If any signs are detected, and symptoms such as fatigue or changes in appetite are present, they may suspect fatty liver disease.
Blood tests: High liver enzymes, although not definitive proof of fatty liver, can raise suspicion and warrant further analysis.
Imaging: Using ultrasound, doctors can detect fat as white areas in the liver. More detailed MRI and CT scans may also be performed to get a better look at the structure and pathology of the organ.
Gastrointestinal Specialists of Georgia uses a scanning technique which is not freely available called FibroScan. Also known as transient elastography, it can also identify and gauge scarring, by measuring liver stiffness, and also gauge the amount of fatty present
Biopsy: Liver biopsy is the most accurate way of diagnosing non-alcoholic steatohepatitis (NASH).
After a local anesthetic and a general sedative is administered, a long, hollow needle is inserted into the liver. Tissue is removed through this needle and studied under a microscope. The lab can confirm a (NASH) diagnosis and determine the severity.
If fatty liver or NASH is diagnosed, it can be treated by reducing the risk factors. No FDA approved medications exist to treat it. A doctor’s recommendations may include:
- Limiting or avoiding alcohol intake
- Losing weight (no more than 1 or 2 pounds/week)6
- Managing cholesterol
- Reducing sugar and saturated fatty acid intake
- Increasing omega-3 fatty acids
- Stopping fatty-liver-causing drugs
- Controlling diabetes
- Exercising regularly (30 minutes/day)
- Taking antioxidant supplements
Most important is to reduce consumption of foods with high carbohydrates, such as bread, corn, rice, and potatoes. Sports drinks, juice, and other high-sugar drinks should be reduced or eliminated from your diet. Prevention of NAFLD is possible by eating a healthy diet rich in whole grains, fruits, and vegetables; maintaining a healthy body weight; and getting exercise on most days.
GI Specialists of Georgia Can Help
GI Specialists of Georgia is focused on providing high-quality treatment of digestive tract disorders (including those of the liver and pancreas). We are staffed by physicians who can manage complex cases with the latest treatments. Our physicians work as a team, collaborating with patients’ primary care physicians. Also, cutting-edge medications and treatment plans are available, thanks to access to clinical research trials.
Our abdominal ultrasound, FibroScan, and fully equipped pathology lab enable each liver specialist to accurately diagnose patients and thoroughly plan treatments for a range of diseases. Patients are closely monitored and surveyed so we can fully utilize performance data and feedback—individualized plans and medical advances have given our liver doctor staff an edge in treating cases of varying severities and complexities. For more information or to book an appointment, submit an inquiry online or call one of our nearby locations.