Fatty Liver

What Is Fatty Liver ?

Fatty Liver Disease: Types and Causes
Fatty liver disease encompasses two main types:
1. Nonalcoholic Fatty Liver Disease (NAFLD):
Extremely prevalent in the U.S., affecting one in three adults, NAFLD’s cause remains unclear. However, obesity and diabetes significantly elevate the risk. Unlike its counterpart, NAFLD isn’t associated with alcohol consumption. This category further branches into two forms:
  • Simple Fatty Liver: Fat accumulates in the liver, but minimal to no inflammation or liver cell damage occurs. This usually remains stable and doesn’t pose significant risks. It’s the most prevalent form of NAFLD.
  • Nonalcoholic Steatohepatitis (NASH): Significantly more concerning than simple fatty liver, NASH involves liver inflammation. This inflammation and associated cell damage can lead to serious consequences, including fibrosis, cirrhosis (scarring), and even liver cancer. These complications can culminate in liver failure and necessitate a transplant. Approximately 20% of NAFLD cases progress to NASH.
2. Alcohol-Related Fatty Liver Disease (ALD):
Less common, impacting roughly 5% of the U.S. population, ALD directly arises from alcohol consumption. Consequently, it often improves with abstinence. Continued alcohol use, however, can lead to severe complications, including:
  • Enlarged Liver: While often asymptomatic, upper right abdominal pain or discomfort may occur.
  • Alcoholic Hepatitis: Liver swelling manifests as fever, nausea, vomiting, abdominal pain, and jaundice (yellowish skin and eyes).
  • Alcoholic Cirrhosis: Scar tissue buildup in the liver can cause similar symptoms to alcoholic hepatitis, along with:
    • Ascites: Excessive fluid accumulation in the abdomen.
    • Portal Hypertension: High blood pressure within the liver.
    • Internal Bleeding: Hemorrhages within the body.
    • Neurological Impairment: Confusion and behavioral changes.
    • Enlarged Spleen: This small organ, part of the immune system, resides within the rib cage.
    • Liver Failure: Potentially fatal.
ALD typically precedes and can progress to alcoholic hepatitis and eventually cirrhosis. If you struggle with heavy drinking, seek confidential support from your doctor. They can help you manage your alcohol intake to safeguard your health.

Causes of Fatty Liver ?

Alcohol-Related Fatty Liver Disease (ALD)
  • Obesity
  • Malnutrition
  • Chronic viral hepatitis, particularly hepatitis C
  • Sex
  • Age:
Nonalcoholic Fatty Liver Disease (NAFLD)
  • Obesity or overweight status
  • Genetics
  • Insulin resistance or type 2 diabetes
  • High levels of triglycerides or “bad” cholesterol, or low levels of “good” cholesterol
  • Age
  • Polycystic ovary syndrome
  • Sleep apnea
  • Hypothyroidism
  • Hypopituitarism
  • Malnutrition
  • Rapid weight loss
  • Exposure to specific toxins and chemicals
  • Hispanic or Asian ethnicity
  • Metabolic syndrome

Symptoms of Fatty Liver ?

With ALD and NAFLD, there are usually no symptoms. Some people may have signs such as tiredness or pain in the upper right side of the belly where your liver is.
If you have NASH or get cirrhosis, you may have symptoms such as:
  • Swollen belly
  • Enlarged blood vessels underneath your skin
  • Larger-than-normal breasts in men
  • Red palms
  • Jaundice
  • Nausea, weight loss, or loss of appetite
  • Tiredness or mental confusion

Diagnosis of Fatty Liver?

Diagnosing Fatty Liver Disease
Due to the often asymptomatic nature of fatty liver disease, diagnosis can be challenging. Various methods are employed by healthcare providers to identify FLD. These include:
Medical History and Physical Examination:
  • Alcohol Consumption Inquiry.
  • Medical History
  • Physical Examination
  • Body Mass Index (BMI) Calculation: 
  • Blood Tests
  • Liver Function and Enzyme Tests
  • Fibrosis Assessment Tests
  • Lipid Profile
  • Other Blood Tests
  • Hemoglobin A1c
Imaging Tests:
  • Ultrasound
  • CT Scans
  • MRI
  • Elastography Tests
Liver Biopsy

Treatment of Fatty Liver?

While no medications currently hold FDA approval for NAFLD, several promising options are undergoing clinical trials.

The primary treatment strategy for NAFLD is weight loss. Reducing body weight by just 3% to 5% can significantly decrease liver fat accumulation, inflammation, and scarring. For individuals with substantial weight to lose, weight loss surgery may be a viable option.

Abstinence from alcohol is crucial for preventing further liver damage and potentially reversing existing damage. If you struggle with alcohol dependence, consult your doctor about accessing support resources. Medically supervised detox programs can facilitate safe withdrawal and manage withdrawal symptoms.

In severe cases of NASH with complications like cirrhosis or liver failure, a liver transplant may be necessary. Fortunately, liver transplant recipients with NASH generally experience positive outcomes.

“Thank you for visiting Forest Hills Gastroenterology & Liver Disease, my goal is to treat my patients in a highly personalized manner and I am dedicated to give you the utmost attention and respect that you deserve. For more infromation on this disease or to schedule a consultation with me, please give us a call or book a tele-health appointment online.”

Albert Shalomov

Dr. Albert Shalomov, MD