Understanding Fatty Liver Disease.

Introduction: Fatty liver is a term used to define a condition in which too much fat is stored in the liver. Some fat in the liver is normal but if it makes up more than 5%-10% of the organ's weight, it may lead to a condition known as fatty liver disease.

Fatty liver disease is increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people.

The liver is the second largest organ in the body. The liver’s function is to process everything we eat or drink and filter any harmful substances from the blood. This process is interrupted if too much fat is in the liver.

In people who drink little or no alcohol, the condition is sometimes known as non-alcoholic fatty liver disease. 

Nonalcoholic fatty liver disease  can occur in any age group but is mostly seen in people ages 40's and 50's and in those who are at high risk of heart disease because of underlying risk factors like obesity and type 2 diabetes.

Causes: It's not clear what causes fatty liver disease but it may run in families.

It's also more likely to happen to those who are middle-aged and overweight or obese. People like that often have high cholesterol and diabetes as well.

Other causes are:

• Medications (steroids, tamoxifen, methotrexate)
• Viral hepatitis
• Autoimmune or inherited liver disease
• Fast weight loss
• Malnutrition

Some studies show that too much bacteria in the small intestine and other changes in the intestine may be linked to nonalcoholic fatty liver disease.

Risk Factors : A wide range of diseases and conditions can increase the risk of nonalcoholic fatty liver disease, including:

• High cholesterol
• High levels of triglycerides in the blood
• Metabolic syndrome
• Obesity, particularly when fat is concentrated in the abdomen
• Polycystic ovary syndrome
• Sleep apnea
• Type 2 diabetes
• Under active thyroid (hypothyroidism)
• Under active pituitary gland (hypopituitarism)

Alcoholic Fatty Liver: Alcoholic fatty liver is the earliest stage of alcohol-related liver disease. Heavy drinking damages the liver, and the liver cannot break down fats as a result. Abstaining from alcohol will likely cause the fatty liver to subside. Within six weeks of not drinking alcohol, the fat will disappear. However, if excessive alcohol use continues, cirrhosis may develop.

Clinical Features: There are often no symptoms at first. As the disease progresses , there may be mild symptoms like: 

• Feeling tired
• Loss of weight or appetite
• Weakness
• Nausea
• Confusion, poor judgment, or trouble concentrating

When there is large accumulations of fat in the liver, and there is damage to the liver cells the patient may have signs and symptoms of:

• Enlarged liver
• Fatigue
• Pain in the upper right abdomen
• Abdominal swelling (ascites)
• Enlarged blood vessels just beneath the skin's surface
• Enlarged breasts in men
• Enlarged spleen
• Red palms
• Yellowing of the skin and eyes (jaundice)

If complicated with liver cirrhosis, in later stages may have: 

• Gastrointestinal (GI) bleeding
• Mental changes (encephalopathy)

Diagnosis: Because nonalcoholic fatty liver disease causes no symptoms in most cases, it frequently comes to medical attention when tests done for other reasons point to a liver problem. This can happen if the liver looks unusual on ultrasound or if there is an abnormality detected on liver function tests. To further evaluate for the fatty liver disease following tests are indicted: 

1. Complete blood count
2. Liver enzyme and liver function tests
3. Tests for chronic viral hepatitis (hepatitis A, hepatitis C and others)
4. Celiac disease screening test
5. Fasting blood sugar
6. Hemoglobin A1C, which shows how stable your blood sugar is
7. Lipid profile, which measures blood fats, such as cholesterol and triglycerides

8. Plain ultrasound, which is often the initial test when liver disease is suspected.

9. Liver biopsy if other tests are inconclusive. 

Management: The treatment of fatty liver depends on its cause, and, in general, treating the underlying cause will reverse the process of fat accumulation if implemented at an early stage. 

1. The first line of treatment is usually weight loss through a combination of a healthy diet and exercise. 

2. Limit carbohydrate rich foods such as bread, grits, rice, potatoes, and corn in the diet and cut down on drinks with lots of sugar like sports drinks and juice.

3. Plan a regular exercise routine. 

4. Good control of blood sugar levels.

5. Managing blood cholesterol levels. 

6. Getting vaccinated for prevention  of viral hepatitis.

7. Limit or stop drinking alcohol.

8. In theory, vitamin E and other vitamins called antioxidants could help protect the liver by reducing or neutralizing the damage caused by inflammation. But more research is needed to determine its effectiveness in fatty liver disease. 

9. In patients with liver damage and cirrhosis, liver transplantation may be needed. 

Prognosis: Fortunately, many cases of fatty liver don’t develop into liver disease. The liver can repair itself, so if you take the necessary steps to treat high cholesterol, diabetes, or obesity, you can reverse your fatty liver. A liver biopsy can help your doctor identify permanent liver damage, as well as determine the severity of damage and the best way to treat it.