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◉ What is fatty liver disease?
Fatty liver disease, also know as steatosis, is a prevalent disorder resulting from the accumulation of surplus fat in the liver.
Most individuals experience no symptoms, and it typically does not result in severe issues for them. However, in certain instances, it has the potential to induce liver harm.
Fortunately, the condition is frequently preventable or reversible through adjustments to one's lifestyle.
◉ Types of Fatty Liver Disease
Nonalcoholic fatty liver disease (NAFLD)
Nonalcoholic fatty liver disease (NAFLD) is a liver disease that affects people who consume very little or no alcohol. It tends to develop in people who are overweight or obese, especially if they have a lot of fat around their waist.
Nonalcoholic steatohepatitis (NASH)
More serious than NAFLD, NASH disease is characterized by inflammation of the liver accompanied by scarring (fibrosis).
Alcoholic steatohepatitis
Alcoholic steatohepatitis, as the name suggests, is a buildup of fat in the liver due to alcohol consumption. From a biological and histological point of view, it can be difficult to differentiate from non-alcoholic steatosis.
◉ Causes and risk factors
Fat accumulation in the liver can occur due to various factors. The most common reasons include
- Overweight
- Diabetes type 2, Insulin resistance
- High blood pressure.
- Dyslipidemia.
- Medications usage (e.g., tamoxifen, glucocorticoids, amiodarone, methotrexate).
- Metabolic syndrome (e.g., glycogen storage disorders, homocystinuria).
- Alcohol consumption.
- Wilson's disease
- Nutritional status (e.g., total parenteral nutrition, severe malnutrition, excessive calorie intake, or extreme dietary restrictions).
- Rapid weight loss.
- HELLP or Reye syndrome.
- Chronic viral hepatitis, Celiac disease.
Advanced age, being of African-American or Hispanic race, and being male are additional risk factors associated with an increased likelihood of developing fatty liver disease.
◉ Symptoms
Symptoms of fatty liver disease are typically absent in the early stages and often become noticeable as the disease advances toward cirrhosis. Symptoms include:
- Abdominal pain or a sensation of fullness in the upper right part of the abdomen (belly).
- Nausea, reduced appetite, or unexplained weight loss.
- Yellowish discoloration of the skin and the sclera of the eyes (jaundice).
- Swelling in the abdomen and legs (edema).
- Profound fatigue or mental confusion.
- Weakness.
- Itchy skin
◉ Complications
- Cirrhosis
- Liver failure
- Hepatocarcinoma
- The association with hepatitis C or HIV worsens the prognosis and reduces responses to treatment.
- Ascites
- Esophageal varices
◉ Diagnosis and Tests
Diagnosing fatty liver disease can be challenging since it often doesn't present with noticeable symptoms. Instead, it's frequently discovered during routine health check-ups or when investigating other medical concerns.
Health history and physical examination
The healthcare provider collects information about symptoms, risk factors, lifestyle, and family history and a physical examination is conducted to detect any signs associated with fatty liver disease, such as abdominal tenderness.
Blood Tests
These include various blood tests to assess different aspects of your health and rule out other conditions. These tests may encompass:
- A CBC blood test: is a test that counts the cells that make up your blood: red blood cells, white blood cells, and platelets.
- Iron studies to measure the iron content in your blood and cells.
- Liver enzyme and liver function tests, such as: AST, ALT, ALP, GGT.
- Tests for chronic viral hepatitis, such as hepatitis A and hepatitis C.
- Serum ceruloplasmin (Wilson disease).
- autoimmune analysis and protein electrophoresis (autoimmune hepatitis)
- Screening for celiac disease.
- Serum alpha-1-antitrypsin.
- Fasting blood sugar levels.
- Hemoglobin A1C, which indicates blood sugar stability.
- Lipid profile to measure cholesterol and triglycerides in the blood.
Imaging Procedures
Several imaging tests can aid in the diagnosis of fatty liver disease. These may include:
- The abdominal ultrasound is often the first test to be done when liver disease is suspected.
- Magnetic resonance imaging (MRI) or computerized tomography (CT) scans, which are more sensitive in detecting mild liver fibrosis but cannot distinguish between non-alcoholic steatohepatitis (NASH) and non-alcoholic fatty liver disease (NAFLD).
- Transient elastography (FibroScan).
- Magnetic resonance elastography (MRE).
Liver Biopsy
When other tests suggest advanced liver disease, or when the results are inconclusive, a liver biopsy may be recommended. This procedure involves removing a small tissue sample from the liver. The obtained tissue sample is then examined in a laboratory to identify signs of inflammation and scarring
◉ Conclusion
Fatty liver disease is a prevalent but frequently asymptomatic condition characterized by the accumulation of fat in the liver. If left unaddressed, it can result in severe health consequences.
Diagnosis involves a series of tests, including blood work, imaging, and, when necessary, a liver biopsy, to evaluate the extent of liver damage and rule out other conditions. The management and treatment of fatty liver disease primarily center around lifestyle.
Given the significant global impact of fatty liver disease, it's crucial to enhance awareness, conduct routine screenings, and provide comprehensive patient education. Addressing risk factors and promoting a healthy lifestyle are essential in addressing this health concern.