Fatty liver is the accumulation of triglycerides and other fats in the hepatocytes. It is commonly associated with alcohol, drugs, overnutrition or metabolic syndrome.
Fatty liver will induce slow and increasing malaise, weakness and anorexia. Hepatomegaly is seen in cases of fatty liver. Jaundice will be seen in around 20% of the patients. Discomfort in the upper abdomen is commonly seen. Nausea, vomiting, abdominal pain are rare.
Liver function tests might show elevated transaminases. Fatty liver is reversible in the initial stages of the liver pathology, but continued alcohol consumption may result in alcoholic hepatitis or cirrhosis .
Laboratory investigations include liver function tests which tend to be abnormal. Serum alanine levels are higher than serum aspartate levels in non alcoholic variant of fatty liver whereas it is the opposite in the alcoholic variant.
Fasting insulin and glucose levels might be done to look out for underlying diabetes and treat accordingly.
Ultrasound of abdomen reveals a brighter echogenicity of the liver along with hepatomegaly. Fatty liver has lower density than spleen and hence can be easily identified on CT scans. A series of scans are helpful in evaluating the progress of fatty liver.
Increased serum ferritin levels are commonly seen along with decreased transferrin saturation levels. These indicate that simply reducing dietary iron will help reverse the increase in size of the liver.
Many a times a complete overall picture shows that there is obesity along with increased serum transaminases and also hypertriglyceridemia. All these when put together gives a diagnosis of fatty liver .
Histology reveals signet ring appearance of the liver cells with nucleus pushed on to the periphery of the liver cell. Macrocytosis is commonly seen in all patients with fatty liver and hence it is almost 75% specific.
Proper diet along with curtailment of alcohol intake is the mainstay of treatment for fatty liver. There is no medicine that can reverse the fatty liver. Medications are indicated to control certain pathologies which lead to fatty liver. Alcohol abstinence will help to control fatty liver as it is the most important causative factor of fatty liver .
Vitamin E should be taken at dosage of 800mcg/day and Vitamin C 60mg/day, if given in high risk patients, will reduce the chances of fatty liver and will also postpone the formation of fat globules in the cells of the liver .
Metformin may be indicated in patients who show hypertriglyceridemia and insulin resistance. Weight loss in obese patients will help in reducing the amount of fatty liver and progressively will return back to normal.
Fatty liver is a reversible condition . It is considered to be a benign condition wherein changes can be reversed if there is weight loss and withdrawal of alcohol. The histologic changes return back to normal within 4 to 6 weeks.
If a patient continues to have alcohol despite having fatty liver, there are increased chances of him suffering from cirrhosis or alcoholic hepatitis . This change in pathology will increase both morbidity and mortality.
There are many causes giving rise to the fatty liver :
Fatty liver is also called as steatosis and is seen in approximately 25 to 35 % of the population. Fatty liver develops in 90% of the heavy alcohol drinkers. People of all age group can have fatty liver.
Females are more easily affected than males. Females will be seen with fatty liver changes with lesser amount of alcohol intake over a shorter duration of time. Fatty liver is the commonest cause of abnormal liver tests in the United States.
Fatty liver change is a slow and reversible process seen in the liver. It is basically seen due to imbalance between the fatty acid production and fatty acid oxidation. Initially, there are fat droplets being deposited around the nucleus of the liver cells. This process is called microvesicular fatty liver change . There are plenty of fat droplets being placed around the nucleus and there is no displacement of the nucleus and hence, this stage is reversible.
Later on, there is progressively increasing fatty droplet deposition and there is displacement of the cell nucleus such that it is seen at the cell’s periphery. This is known as macrovesicular fatty liver change. On examination under the microscope, the fat vesicles are washed off and there is appearance of ‘signet ring’ like liver cells with the nuclei being pushed to the periphery . Optically, the liver cell appears empty.
The only way to prevent fatty liver is to avoid alcohol completely or indulge only rarely. The other causes like diabetes are not truly preventable. Maintaining good Body Mass Index (BMI) and having a well-balanced, low fat diet are important to prevent diabetes and thereby metabolic syndrome and fatty diabetes which are important associations of fatty liver.
Fatty liver is collection of triglycerides and fats in the cells of the liver. The fatty acids are normally maintained within normal limits by striking a balance between accumulation and removal of fatty acids. Fatty liver is seen as a result of two processes namely deficient fatty acid beta oxidation and simultaneously, increased production of fatty acid .
Both these processes lead to increased endogenous fatty acid deposits causing precipitation of fatty liver.
Fatty liver is commonly seen in alcoholic patients, those consuming over 60g alcohol each day for a period of more than 1 year. Fatty liver is a reversible pathology usually seen as a result of increased alcohol consumption.
Fatty liver is infiltration of fats in liver cells. When there is imbalance between fatty acid oxidation and fatty acid intake in the body, it leads to accumulation of fats in the liver cells.
Sometimes this fatty liver may be caused by ingestion of drugs, obesity, hypertriglyceridemia (increased levels of triglyceride in the blood), starvation, prolonged parental nutrition (dietary intake by nasogastric tube), prolonged intake of alcohol etc. Alcohol intake is the most common cause for fatty liver.
Females will be affected with lesser levels of alcohol as compared to males. A minimum quantity of 20gm of alcohol per day for a prolonged period will cause fat deposition in the liver. The liver cannot function when there is excess of fat accumulated in the liver cells, leading to a rise in the titres of the enzymes produced by liver.
Liver function will be abnormal and there will elevated levels of transaminases and bile. All these changes will cause nausea (feeling of vomiting), anorexia (loss of appetite), discomfort in the upper abdomen, weakness and prostration and enlargement of the liver. There is hepatomegaly (increased size of the liver) in almost 70% of the cases.
This condition of fatty liver can be diagnosed by blood tests like liver function test, Ultrasonography, CT scan and MRI. This is otherwise a very benign condition that can be reversed easily. If a person stops drinking alcohol there will be reversal of fatty liver in a period of 4 to 6 weeks. Complete abstinence of alcohol is the best way to treat fatty liver. Secondly, proper diet and nutrition will help obese persons reduce weight and will help reduce the excess fat in the liver cells. Prognosis is very good if cirrhosis and hepatitis does not set in.