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Fatty Liver Disease

Fatty liver is also known as NASH, which stands for Non- Alcoholic Steatorrhoeic Hepatosis or Non-Alcoholic-Fatty-Liver-Disease (NAFLD) but don't be put off by these big terms - they just mean that your liver is being invaded with fat! Fatty liver or NASH, is very common in overweight persons, over the age of 30.

Steatosis, or fatty liver, is the accumulation of triglycerides and other fats in liver cells. In severe fatty liver, fat constitutes as much as 40% of the liver's weight (as opposed to 5% in a normal liver); the liver's weight may increase from 3.3 lb (1.5 kg) to as much as 11 lb (4.9 kg).

Minimal fatty changes are temporary and asymptomatic; severe or persistent changes may cause liver dysfunction. Fatty liver is usually reversible by simply eliminating the cause.This disorder may result in recurrent infection or sudden death from fat emboli in the lungs.

Causes

The most common cause of fatty liver in the United States and Europe is chronic alcoholism, with the severity of liver disease directly related to the amount of alcohol consumed. Other common, non-alcohol related causes include acquired immunodeficiency syndrome, drug toxicity, and pregnancy.

Signs and symptoms

Clinical features of fatty liver vary with the degree of lipid infiltration, and many patients are asymptomatic. The most typical sign is a large, tender liver (hepatomegaly). Common symptoms include right upper quadrant pain (with massive or rapid infiltration), ascites, edema, jaundice, and fever (all with hepatic necrosis or biliary stasis).

Nausea, vomiting, and anorexia are less common. Splenomegaly usually accompanies cirrhosis. Rarer changes are spider angiomas, varices, transient gynecomastia, and menstrual disorders.

Diagnosis

Typical clinical features - especially in patients with chronic alcoholism, malnutrition, poorly controlled diabetes mellitus, or obesity - suggest fatty liver. A liver biopsy confirms excessive fat in the liver. The following findings on liver function tests support this diagnosis:

• albumin - somewhat low
• globulin - usually elevated
• cholesterol- usually elevated
• bilirubin - elevated
• alkaline phosphatase-elevated
• transaminase-usually low (< 300 units)
• prothrombin time-possibly prolonged.

Other findings may include anemia, leukocytosis, albuminuria, hyperglycemia or hypoglycemia, and deficiencies of iron, folic acid, and vitamin B12.

Treatment

The treatment for fatty liver is essentially supportive and consists of correcting the underlying condition or eliminating its cause. Fatty liver that results from TPN may be ameliorated or prevented by giving choline.

In alcoholic fatty liver, abstinence from alcohol and a proper diet can begin to correct liver changes within 4 to 8 weeks. This requires comprehensive patient teaching.

Depending on the degree of severity, the patient may need to undergo liver transplantation.

Self-care tips

You can prevent fatty liver by maintaining a well-balanced diet and limiting alcohol consumption. Good prenatal care will help to recognize the symptoms of fatty liver in pregnant women before the condition becomes serious. To prevent Reye's syndrome, children should never be given aspirin to treat colds and viruses.

Prevention

Prevention consists of maintaining a well balanced diet and healthy lifestyle with moderate or no alcohol consumption. Pregnant women require good prenatal care so that symptoms can be recognized and treated as early as possible. To prevent Reye's syndrome, children should not be given aspirin to treat symptoms of the flu or other viruses.