Fatty Liver - Types, Symptoms, Stages, and Treatment

What Does Fatty Liver Mean?

The liver is the largest gland in the body. Its primary function is to process the food and drinks we consume and filter out the harmful substances. A certain amount of fat is normal if present in the liver. But due to various factors, excess fat can start accumulating in the liver. If more than 5 % of the liver is fat, it is said to be fatty. Initially, there will not be any symptoms. But, it does not affect the efficiency of the liver functions. The body has some mechanisms in place to allow the liver cells to regenerate. But, repeated damage can cause permanent scarring in the form of cirrhosis.

The cause is not known in most cases, but in some, alcoholism plays an important role (alcoholic fatty liver). If the cause is not alcohol, then it is called a non-alcoholic fatty liver (NAFL). NAFL falls under the group non-alcoholic liver disease (NAFLD), which is the most common type of liver disease. The initial stage of liver disease is the non-alcoholic fatty acid, which can be reversed, but usually goes undiagnosed. If left untreated, it can progress to non-alcoholic steatohepatitis (NASH), which is a more serious liver condition.

The fat accumulated in the liver is more in NASH, and it can lead to inflammation of the liver and cell damage. This damage can cause liver cirrhosis or fibrosis. Continuous damage to the liver cells can impair the liver function and the scaring increases the risk of liver cancer. It also increases the risk of heart and kidney disease, diabetes, etc.

Types:

• Alcoholic fatty liver disease - It is the damage caused to the liver cells due to excess alcohol consumption.

• Non-alcoholic fatty liver disease (NAFLD) - It is caused due to the other factors mentioned above in a person who does not consume too much alcohol.

What Are the Signs and Symptoms of Fatty Liver?

Initially, there are no symptoms felt by the patient. But, there is a slight enlargement of liver detected during a physical examination. Later, once there is excessive inflammation, vague symptoms may develop such as:

• Decreased appetite.

• Drastic weight loss.

• Fatigue.

• Abdominal discomfort.

• Pain in the upper right abdomen.

Further, it can progress to cirrhosis and give rise to the following symptoms:

• Jaundice.

• Ascites (abdominal swelling).

• Edema.

• Confusion.

• Increased bleeding tendency.

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The levels of liver enzymes (AST - Aspartate Aminotransferase and ALT - Alanine transaminase), insulin, and triglycerides are elevated.

Grades of Fatty Liver:

Based on the visual changes observed on the ultrasound, the fatty liver is graded into three:

1. Grade I - This is the mildest form. Here, the fat accumulates on the outside of the organ and does not affect its function.

2. Grade II - It is a moderately severe form and requires medical intervention to prevent worsening.

3. Grade III - It is the severe form of fatty liver, with the appearance of symptoms. Active treatments are required.

What Are the Causes of Fatty Liver?

1. Alcoholism.

2. Overeating as a habit.

3. Medical conditions:

   1. Diabetes.

   2. Obesity.

   3. High triglycerides.

   4. High blood pressure (hypertension).

   5. PCOS (polycystic ovary syndrome).

   6. Sleep apnea.

   7. Hypothyroidism.

   8. Hypopituitarism.

4. Certain medications (Aspirin, steroids, methotrexate, etc.)

5. Rapid weight loss.

6. Liver infections like hepatitis C.

Risk Factors:

1. People with excess belly fat - individuals with too much fat around the belly are also called viscerally obese.

2. Insulin resistance - high levels of insulin and its resistance increase the risk of fat deposition in the liver.

3. Older adults.

4. Consuming a diet rich in carbohydrates.

5. More intake of sweetened beverages and soft drinks.

6. Imbalance in gut bacteria.

Stages of Fatty Liver:

Fatty liver develops in the following stages:

1. Steatosis - It is a relatively harmless accumulation of fat in the liver. It is accidentally diagnosed while trying to diagnose other conditions.

2. Non-alcoholic steatohepatitis (NASH) - Here, the liver is inflamed.

3. Fibrosis - Chronic inflammation of the liver results in scar tissues. Scars are around the liver and surrounding blood vessels, but the liver function is normal.

4. Cirrhosis - It occurs gradually over the years and is the most severe stage. Here, the liver shrinks and looks scarred. This damage cannot be reversed.

Drastic lifestyle changes can prevent the development of cirrhosis or fibrosis.

How Does a Doctor Diagnose Fatty Liver?

In the early stages, as mentioned above, there are no symptoms. So, it is often diagnosed during routine blood tests. The doctor can palpate the abdomen area to feel for changes, and he/she may suggest tests such as the following to confirm his finding:

1) Blood tests - It includes -

• Liver function test and liver enzymes.

• Complete blood count.

• Test for hepatitis.

• Blood sugar levels.

• Hemoglobin level.

• Lipid profile.

2) Imaging tests - It includes -

• Abdominal ultrasound.

• CT or MRI.

• Magnetic resonance elastography.

• Transient elastography.

3) Liver biopsy - Here, a needle is inserted and a sample tissue is taken out for testing. This is the most certain method to detect fatty liver.

Can Fatty Liver Be Treated?

Yes, if the liver has not altered been scarred, fatty liver can be treated. The treatment options include:

1) Alcohol abstinence - It is absolutely essential to stop drinking to prevent the progression of this disease.

2) Dietary modifications:

• Avoid overeating.

• Cut back on refined carbohydrates (you can try the Mediterranean diet).

• Include monosaturated fats, whey protein, and soluble fiber.

3) Weight loss - If you are overweight or obese, lose weight with dietary modifications and exercise.

4) Diabetic control - Diabetic patients should control their blood glucose levels with the help of dietary restrictions, anti-diabetic drugs or Insulin, and exercise.

5) Triglyceride control - People with high cholesterol or triglycerides should exercise and watch what they eat.

What Are the Possible Complications of Fatty Liver?

Cirrhosis, that is late-stage scarring of the liver, is the most concerning complication of fatty liver. Cirrhosis in turn can result in:

1. Ascites - the buildup of fluid in the abdomen.

2. Hepatic encephalopathy - it is when a severe liver disease affects brain function. The symptoms include confusion and slurred speech.

3. Esophageal varices - the veins in the esophagus swells. This vein can rupture and bleed at any time.

4. Liver cancer.

5. End-stage liver failure.

Prevention:

• Healthy diet.

• Healthy weight.

• Exercise.

To know more about fatty liver, talk to our specialist through phone or video consultation now!