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 [4].

• Weight Loss

  Treatment Doctors recommend weight loss to treat nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). Weight loss can reduce fat in the liver, inflammation, and fibrosis. [niddk.nih.gov]

  But the association says more weight loss — up to 10 percent — is needed to improve more severe symptoms like inflammation in the liver. [well.blogs.nytimes.com]

  Gradual weight loss is the key, as sudden, severe weight loss can actually make the condition worse. Weight loss surgery may be recommended for some people. Exercising. [mydr.com.au]

• Fatigue

  Researchers also speculate that changes in brain chemistry and hormone production contribute to feelings of fatigue and exhaustion. [activebeat.com]

  See your provider if you begin to have unusual symptoms such as fatigue or abdominal pain. To help prevent NAFLD: Maintain a healthy weight. Eat a healthy diet. Exercise regularly. Limit alcohol consumption. Use medicines properly. [nlm.nih.gov]

  Let your doctor know if you’ve been experiencing fatigue or loss of appetite. Also, tell your doctor about any history of alcohol, medication, and supplement use. [healthline.com]

  CASE SUMMARY: A 61-year-old obese man presented with jaundice, nausea, fatigue, and an unintentional weight loss 2 weeks following initiation of metformin. Laboratory findings revealed aminotransferase values 10-15 times the upper limit of normal. [ncbi.nlm.nih.gov]

• Weight Gain

  These improvements occurred despite a 4.5-kg weight gain since starting rosuvastatin and pioglitazone. DISCUSSION: Pharmacotherapy in NAFLD is not well validated, particularly combination therapy. [ncbi.nlm.nih.gov]

  Although a fatty diet and weight gain is the main culprit, diabetes, hyperlipidemia (or elevated lipids in the blood), and alcohol abuse (with 90 to 100-percent of binge drinkers contracting fatty livers) will also increase the chances. [activebeat.com]

  Sudden weight loss or sudden weight gain will lead to fatty liver. [symptoma.com]

  Fat accumulates in the liver usually in connection with heavy use of alcohol, weight gain or diabetes. [herbalprovider.com]

• Leg Edema

  When symptoms occur, they may include fatigue, weakness, weight loss, loss of appetite, nausea, abdominal pain, spider-like blood vessels, yellowing of the skin and eyes (jaundice), itching, fluid build up and swelling of the legs (edema) and abdomen [liverfoundation.org]

• Nausea

  CASE SUMMARY: A 61-year-old obese man presented with jaundice, nausea, fatigue, and an unintentional weight loss 2 weeks following initiation of metformin. Laboratory findings revealed aminotransferase values 10-15 times the upper limit of normal. [ncbi.nlm.nih.gov]

  Nausea, vomiting, abdominal pain are rare. Liver function tests might show elevated transaminases. [symptoma.com]

  If symptoms are present, it may be non-specific type symptoms of tiredness, nausea and discomfort over the right upper abdomen. However, if NAFLD progress to cirrhosis, signs and symptoms of cirrhosis may appear. [singhealth.com.sg]

  SYMPTOMS OF FATTY LIVER DISEASE Fatty liver disease frequently shows no symptoms, or mild symptoms such as: Fatigue; Weakness; Nausea; Abdominal pain. [barnesjewish.org]

• Vomiting

  A 20-year-old woman, primigravida at 36(+4) weeks' gestation presented with malaise, vomiting for 1 week, yellowish discoloration of the eyes for 3 days and loss of fetal movements. [ncbi.nlm.nih.gov]

  Nausea, vomiting, abdominal pain are rare. Liver function tests might show elevated transaminases. [symptoma.com]

  In fatty liver of pregnancy there may be nausea, vomiting, abdominal pain and jaundice. How does fat get into the liver? Fat enters the liver from the intestines and from the tissues. [aucklandgastro.co.nz]

  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

  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]

  However, you may experience the following: Tiredness Bloatedness Loss of appetite Pain in the right upper abdomen Late symptoms relate to the complications of liver cirrhosis and include nausea, jaundice, swollen abdomen and poor concentration. [healthxchange.sg]

  Typically, NAFLD presents with few or no symptoms, [ 3 ] but possible signs include: fatigue, weakness, weight loss or loss of appetite, nausea, abdominal pain, and jaundice. NAFLD is usually confirmed via blood tests and ultrasounds. [globalhealingcenter.com]

  When symptoms occur, the most common include: Fatigue Pain in the upper right abdomen In people with NASH who have liver damage (cirrhosis), symptoms may include: Weakness Loss of appetite Nausea Yellow skin and eyes (jaundice) Itching Fluid buildup and [nlm.nih.gov]

  When the liver is very much enlarged, there will be gastro-intestinal disturbances, with loss of appetite, flatulence, nausea, and sometimes vomiting; diarrhea, 'alternating with constipation, occurs, and the stools contain mucus. [henriettes-herb.com]

• Jaundice

  Severe hepatopathy accompanied by jaundice used to be considered a rare complication. [ncbi.nlm.nih.gov]

  The differentials in the postpartum period of fever and jaundice could include sepsis which was ruled out by appropriate investigations in the index case. The viral aetiology of her jaundice was also ruled out. [sjmms.net]

  The absence of jaundice, ascites, and splenic enlargement, would also render the diagnosis more positive. Prognosis .—This depends upon the condition. [henriettes-herb.com]

  Patients who have abdominal swelling, jaundice, and easy bruising should seek medical care, though the cause may not necessarily be steatohepatitis or cirrhosis. [emedicinehealth.com]

• Hepatomegaly

  Furthermore, these cases of hepatomegaly and fatty liver have been also in the context of concomitant extrahepatic side effects. [ncbi.nlm.nih.gov]

  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. [symptoma.com]

  Hepatomegaly has been reported in a minority of patients. Elevated liver enzymes (such as AST/ALT) may be present, especially with NASH. [radiopaedia.org]

  Examination Hepatomegaly is very common. Splenomegaly with or without portal hypertension may occur with cirrhosis. Signs of chronic liver disease may be seen in patients with cirrhosis (ascites, oedema, spider naevi). [patient.info]

  […] likely ‡ Criteria for nonalcoholic fatty liver disease: consumption of ethanol less than 20 g/day for women and 30 g/day for men [21] Most individuals are asymptomatic and are usually discovered incidentally because of abnormal liver function tests or hepatomegaly [en.wikipedia.org]

• Hypertension

  Causes Diabetes Obesity (BMI>25 kg/m2 in Asian people) Increased belly fat (Central obesity) »» waistline >90cm in Asian men or >80cm Asian women Cholesterol problems Hypertension Metabolic syndrome Other associated conditions like Obstructive Sleep Apnea [singhealth.com.sg]

  Patients with fatty liver display features of metabolic syndrome (MetS), like insulin resistance (IR), glucose intolerance, hypertension and dyslipidemia. [ncbi.nlm.nih.gov]

  Obesity, and medical conditions such as hypertension, hypercholesterolemia, and diabetes, are risk factors for the development of NAFLD. [hopkinsmedicine.org]

• Advanced Bone Age

  It is characterized by a lack of adipose tissue throughout the body from birth, muscular hypertrophy, advanced bone age, fatty liver, and insulin resistance. [ncbi.nlm.nih.gov]

Broadly the disease may be differentiated from alcoholic Hepatitis, alcoholism, autoimmune hepatitis and cirrhosis [7]. 

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 [8].

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.

• Hypoketotic Hypoglycemia

  hypoglycemia; the mother had a history of acute fatty liver in a previous pregnancy leading to fetal death at 34 weeks of gestation. [ncbi.nlm.nih.gov]

• Treponema Pallidum

  Our findings suggest that the occurrence of fatty liver can exacerbate the damage to the hepatic parenchyma due to a Treponema pallidum infection. [Indexed for MEDLINE] Free full text [ncbi.nlm.nih.gov]

• Small Liver

  Liver biopsy[edit] A small quantity of tissue is sampled from the liver when doing a biopsy, which is then examined under a microscope A liver biopsy (tissue examination) is the only test widely accepted (gold standard) as definitively diagnosing and [en.wikipedia.org]

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 [9].

A balanced, low-carb and low fat diet should be taken by the patient. Sudden weight loss or sudden weight gain will lead to 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 [10]. 

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 [5]. 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 [6]. This change in pathology will increase both morbidity and mortality.

There are many causes giving rise to the fatty liver [3]:

1. Alcohol intake beyond 60 grams per day.
2. Diabetes which gives rise to insulin resistance and eventually, there is lipid deposition and storage in the liver.
3. Impairment or inhibition of receptor molecules of fatty acids as well as imbalance of enzymes which monitor fatty acid oxidation.
4. Obesity
5. Genetic predisposition
6. Corticosteroid intake
7. Deranged metabolism of fatty acids and hence, increased formation along with decreased uptake.
8. Drugs like tamoxifen, methotrexate, amiodarone.
9. Metabolic abnormalities like glycogen storage diseases, galactosemia, tyrosiunemia.
10. Nutritional status like total parental nutrition or starvation diet.

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 [2]. 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 [4]. 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 [1].

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.

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2. Reddy JK, Rao MS. Lipid metabolism and liver inflammation. II. Fatty liver disease and fatty acid oxidation. Am J Physiol Gastrointest Liver Physiol. 2006 May;290 (5): G852–8.
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5. Daniel J. DeNoon (September 26, 2008) et al. Fatty Liver Disease: Genes Affect Risk. WebMD. Retrieved April 6, 2013.
6. Hamaguchi M, Kojima T, Takeda N, Nakagawa T, et al. The metabolic syndrome as a predictor of nonalcoholic fatty liver disease. Ann Intern Med. 2005 Nov 15;143 (10): 722–8.
7. Qian Y, Fan JG. Obesity, fatty liver and liver cancer. Hepatobiliary Pacreat Dis Int. 2005 May; 4 (2): 173–7.
8. Adams LA, Lymp JF, St Sauver J, Sanderson SO, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005 Jul;129 (1): 113–21.
9. Sleisenger M. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Philadelphia: W.B. Saunders Company. 2006
10. Adams LA, Angulo P, Lindor KD, et al. Nonalcoholic fatty liver disease. CMAJ. 2005 Mar 29; 172 (7): 899–905.