Alcoholic fatty liver, which may occur after even moderate (about 10g per day) consumption of alcohol [1], is invariably found in people who drink heavily [2]. It is the initial stage in alcoholic liver disease when pathologic changes are reversible. Consumption of excessive amounts of alcohol over extended periods will lead to the appearance of more severe manifestations, such as alcoholic hepatitis and cirrhosis.

The buildup of fats (triglycerides) in the liver is the consequence of the metabolism of alcohol by the liver. The enzymes that oxidize alcohol to the toxic acetaldehyde and then to acetic acid also produce reduced nicotinamide adenine dinucleotide (NADH). Excess NADH inhibits the oxidation of fatty acids and promotes their synthesis, which favors their accumulation in the form of triglycerides [3]. A multitude of other molecular and cellular effects of alcohol metabolism, such as oxidative stress, and the activation of hepatic macrophages, leads to further damage, inflammation, and fibrosis.

Alcoholic fatty liver does not usually cause symptoms. Hepatomegaly may be observed and supports the diagnosis. Rare symptoms are portal hypertension and extrahepatic problems such as muscle wasting, cardiomyopathy, and pancreatitis. Cholestasis is another rare occurrence in people with fatty liver. The American Association for the Study of Liver Diseases recommends using an organized questionnaire if excessive alcohol consumption is suspected [4].

• Abdominal Pain

  However, when symptoms do occur, they may include: Fatigue and weakness Weight loss, loss of appetite, and nausea Abdominal pain Jaundice (yellowing of the skin and eyes) Itching Fluid retention or swelling of the legs and abdomen Mental confusion Prevalence [upmc.com]

  If symptoms appear, they may include: A feeling of fullness in the middle or upper right side of the abdomen Abdominal pain Loss of appetite or weight loss Nausea Weakness Jaundice (yellowing of the skin and the whites of the eyes) Swelling of the abdomen [my.clevelandclinic.org]

  These can include: appetite loss nausea vomiting abdominal pain jaundice Most cases of NASH are detected in people between ages 40 and 60, according to the American Liver Foundation. [healthline.com]

• Loss of Appetite

  However, when symptoms do occur, they may include: Fatigue and weakness Weight loss, loss of appetite, and nausea Abdominal pain Jaundice (yellowing of the skin and eyes) Itching Fluid retention or swelling of the legs and abdomen Mental confusion Prevalence [upmc.com]

  Symptoms of cirrhosis may include fatigue, bleeding easily, easy bruising, fluid accumulation in the abdomen ( ascites ), loss of appetite, nausea, swelling in the legs (edema) and weight loss. [liversupport.com]

  If symptoms appear, they may include: A feeling of fullness in the middle or upper right side of the abdomen Abdominal pain Loss of appetite or weight loss Nausea Weakness Jaundice (yellowing of the skin and the whites of the eyes) Swelling of the abdomen [my.clevelandclinic.org]

  These include fatigue, loss of appetite, weight loss, weakness, fluid retention, or bleeding. [hopkinsmedicine.org]

• Jaundice

  In addition to jaundice and marked hepatomegaly, the patient presented with hypocalcemic crisis associated with hypomagnesemia, low plasma 1,25(OH)2-vitamin D and undetectable plasma parathyroid hormone (PTH) concentration. [ncbi.nlm.nih.gov]

  Your doctor weighs you and checks your body for signs of liver problems such as an enlarged liver or jaundice. Blood tests. [webmd.com]

  However, when symptoms do occur, they may include: Fatigue and weakness Weight loss, loss of appetite, and nausea Abdominal pain Jaundice (yellowing of the skin and eyes) Itching Fluid retention or swelling of the legs and abdomen Mental confusion Prevalence [upmc.com]

• Hepatomegaly

  In addition to jaundice and marked hepatomegaly, the patient presented with hypocalcemic crisis associated with hypomagnesemia, low plasma 1,25(OH)2-vitamin D and undetectable plasma parathyroid hormone (PTH) concentration. [ncbi.nlm.nih.gov]

  Hepatomegaly may be observed and supports the diagnosis. Rare symptoms are portal hypertension and extrahepatic problems such as muscle wasting, cardiomyopathy, and pancreatitis. Cholestasis is another rare occurrence in people with fatty liver. [symptoma.com]

  Most individuals are asymptomatic and are usually discovered incidentally because of abnormal liver function tests or hepatomegaly noted in unrelated medical conditions. Elevated liver biochemistry is found in 50% of patients with simple steatosis. [en.wikipedia.org]

  Characteristic ultrasonographic findings include a hyperechoic liver with or without hepatomegaly. Computed tomography (CT) and magnetic resonance imaging (MRI) can readily detect cirrhosis. [clevelandclinicmeded.com]

Patient history is extremely important because fatty liver can occur in obese patients and in conditions of hyperlipidemia, insulin resistance, and malnutrition, and can be caused by various drugs. However, patient history may not be accurate, and single biomarkers (for example, amino acid transferase or gamma-glutamyl transpeptidase levels) do not distinguish efficiently between alcoholic and non-alcoholic hepatic steatosis. However, a combination of results of diagnostic markers can differentiate between the two types of conditions reliably [5] [6].

In alcoholic liver disease, laboratory studies show elevated aminotransferases (aspartate aminotransferase and alanine aminotransferase) in about 30% of the patients, with aspartate aminotransferase being higher than alanine aminotransferase. Bilirubin concentrations may also be elevated because of hemolysis.

Liver biopsy is not usually performed for fatty liver but may be useful to exclude more advanced disease (steatohepatitis or fibrosis), or other unrelated conditions that cause liver damage. The biopsy of fatty liver will show fat accumulation in the hepatocytes, which tends to be macrovesicular, consisting of a single or very few large lipid droplets resulting in the displacement of the nucleus to a peripheral position. Microvesicular lipid accumulation is sometimes observed, which leads to foamy degeneration of hepatocytes [7]. Fatty deposition most often affects the centrilobular part of the acinus, but in advanced cases of fatty liver, the whole acinus is affected [8].

Ultrasonography, computed tomography, and magnetic resonance imaging can demonstrate the condition of steatosis in a patient. Ultrasonography shows a diffusely echogenic liver in alcoholic steatosis.

• Liver Biopsy

  Liver biopsy remains the criterion standard for the diagnosis of nonalcoholic steatohepatitis. Noninvasive tests are available and may reduce the need for liver biopsy. [aafp.org]

  Subsequent computerized tomographic scan and liver biopsy showed the presence of severe fatty liver. [ncbi.nlm.nih.gov]

  These tests can help show if there’s any fat in your liver. But they can’t tell whether you have simple fatty liver or NASH Liver biopsy. Not everyone with NAFLD needs to have a liver biopsy. [webmd.com]

Unfortunately. there are no clearly effective treatments for these patients. [medicinenet.com]

At present, there is no guideline for treatment of hyperlipidaemia associated with tamoxifen-induced NASH. [doi.org]

Treatment for NAFLD There are no medical treatments yet for NAFLD. Instead, treatment focuses on addressing the risk factors, like making lifestyle changes. [upmc.com]

There are limited data on transplant survival in patients transplanted for acute alcoholic hepatitis, but it is believed to be similar to that in nonacute ALD, non-ALD, and alcoholic hepatitis with MDF less than 32. [20] Prognosis [ edit ] The prognosis [en.wikipedia.org]

C 2, 13, 17 Liver biopsy is the criterion standard for diagnosis and prognosis of nonalcoholic fatty liver disease. [aafp.org]

The long-term prognosis. Am J Gastroenterol 1971; 56(6):515–525. Bonis PA, Friedman SL, Kaplan MM. Is liver fibrosis reversible? N Engl J Med 2001; 344(6):452–454. Romano DR, Jiménez C, Rodriguez F, et al. [clevelandclinicmeded.com]

Once cirrhosis develops, prognosis partly depends on whether or not you continue drinking. Those who continue to drink will feel sicker and die sooner. [drinkaware.co.uk]

Abstract Nonalcoholic fatty liver disease (NAFLD) is a burgeoning health problem of unknown etiology that varies in prevalence among ancestry groups. [dx.doi.org]

The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol. 2003;98:960-7. [revistas.proeditio.com]

^ "Fatty Liver: Overview, Pathophysiology, Etiology". 2017-01-25. ^ Buchman AL, Dubin MD, Moukarzel AA, Jenden DJ, Roch M, Rice KM, Gornbein J, Ament ME (November 1995). [en.wikipedia.org]

Epidemiology 2nd edn (W. B. Saunders, Philadelphia, 2000). 15 Foster, M. W. & Sharp, R. R. [dx.doi.org]

"The epidemiology of non-alcoholic fatty liver disease". Liver International. 37 : 81–84. doi : 10.1111/liv.13299. PMID 28052624. ^ a b c Angulo P (April 2002). "Nonalcoholic fatty liver disease". [en.wikipedia.org]

The epidemiology and demographic characteristics of NAFLD vary worldwide, usually parallel to the prevalence of obesity, but a substantial proportion of patients are lean. [doi.org]

^ "Fatty Liver: Overview, Pathophysiology, Etiology". 2017-01-25. ^ Buchman AL, Dubin MD, Moukarzel AA, Jenden DJ, Roch M, Rice KM, Gornbein J, Ament ME (November 1995). [en.wikipedia.org]

In addition, daily drinking, as compared with binge drinking, appears to be more harmful. 5 Back to Top Pathophysiology The liver and, to a lesser extent, the gastrointestinal tract, are the main sites of alcohol metabolism. [clevelandclinicmeded.com]

From pre-diabetes to type 2 diabetes in obese youth: pathophysiological characteristics along the spectrum of glucose dysregulation. Diabetes Care. 2010 ; 33 ( 10 ): 2225 – 2231. 31.. [academic.oup.com]

Ahima, Pathophysiology of lipid droplet proteins in liver diseases, Experimental Cell Research, 10.1016/j.yexcr.2015.10.021, 340, 2, (187-192), (2016). Markus H. [dx.doi.org]

Progress in the understanding of the pathogenesis of alcoholic fatty liver and its progression to inflammation and fibrosis has resulted in prospects for their better prevention and treatment. [ncbi.nlm.nih.gov]

How to prevent fatty liver disease? Fatty liver disease can usually be prevented by following the same lifestyle advice that is given to people with the disease. [mydr.com.au]

Prevention Maintaining a healthy weight through eating a well-balanced diet and taking regular exercise is the best way to prevent NAFLD. The health risks from being overweight or obese can impact on your physical, social and emotional well being. [britishlivertrust.org.uk]

1. Savolainen VT, Liesto K, Männikkö A, Penttilä A, Karhunen PJ. Alcohol consumption and alcoholic liver disease: Evidence of a threshold level of effects of ethanol. Alcohol Clin Exp Res. 1993;17(5):1112-1117.
2. Grant BF, Dufour MC, Harford TC. Epidemiology of alcoholic liver disease. Semin Liver Dis. 1988 Feb;8(1):12-25.
3. Lieber CS. Alcoholic fatty liver: its pathogenesis and mechanism of progression to inflammation and fibrosis. Alcohol. 2004 Aug;34(1):9-19.
4. O'Shea RS, Dasarathy S, McCullough AJ; Practice Guideline Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology. Alcoholic liver disease. Hepatology. 2010 Jan;51(1):307-328.
5. Wang J, Li P, Jiang Z, et al. Diagnostic value of alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index combined with γ-glutamyl transferase in differentiating ALD and NAFLD. Korean J Intern Med. 2016 May;31(3):479-487.
6. Dunn W, Angulo P, Sanderson S, et al. Utility of a new model to diagnose an alcohol basis for steatohepatitis. Gastroenterology. 2006 Oct;131(4):1057-1063.
7. Uchida T, Kao H, Quispe-Sjogren M, Peters RL. Alcoholic foamy degeneration--a pattern of acute alcoholic injury of the liver. Gastroenterology. 1983 Apr;84(4):683-692.
8. [No authors listed]. Alcoholic liver disease: morphological manifestations. Review by an international group. Lancet. 1981 Mar 28;1(8222):707-711.