Fatty Liver Disease

What is fatty liver disease?

Fatty liver disease is when fat accumulates in the liver.  Fat is commonly found in the liver and does not necessarily cause abnormalities or disease.  In some individuals, however, the fat present can stimulate inflammation or even scarring in the liver.  Fat can be deposited in the liver for many reasons, including alcohol abuse or even viral hepatitis.

Definitions

Fatty liver disease is the presence of fat in the liver without the coexistence of damage.  When fat leads to inflammation, the process is called steatohepatitis .  When the nidus for liver inflammation is something other than alcohol, the process is referred to as nonalcoholic steatohepatitis (NASH).  When inflammation becomes severe, scarring of the liver ensues, and this is known as cirrhosis.

Symptoms and diagnosis

Fat in the liver is most commonly asymptomatic.  If the liver swells in response to the fat, right upper abdominal pain or shoulder pain can develop.  Fatigue can also be present.  Most commonly, mild abnormalities in blood liver tests will be found.  Fat may be seen on ultrasound, CT scanning and can be quantitated by liver biopsy.  Your physician will likely eliminate other causes of liver disease before settling on a diagnosis of fatty liver disease.

What are the causes of fatty liver disease?

There are many causes of fatty liver and steatohepatitis.  The most common of these include alcohol, obesity, hepatitis C, diabetes, high cholesterol or triglycerides, and certain medications, such as corticosteroids.

What is the treatment?

The treatment of fatty liver is related to the cause. It is important to remember that simple fatty liver does not require treatment, since it does not result in damage to liver cells. Obese patients with fatty liver will have reduction or loss of excess fat in liver cells if substantial weight loss can be achieved. It is very important that weight loss be slow and controlled, however.  In alcoholic fatty liver, discontinuation or a decrease in alcohol consumption are required.  Good control of diabetes mellitus with diet, medication, or insulin also decreases the fat content in the liver.

To date, there are no proven medications to improve or cure steatohepatitis.  Preliminary data and anecdotal data suggest vitamin E and vitamin C may be helpful.  Your doctor may also suggest ursodeoxycholic acid or milk thistle.  There is hope that some anti-diabetic medications may be helpful for the disease, but research is still ongoing.


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