Fatty liver affects as many as 1 in 3 people in the United States and in rare instances can progress to serious liver disease. Yet it is a condition that is still not known to many people. Fatty liver is not just a problem for people who misuse alcohol. The condition has become more common in the past few decades in line with the obesity epidemic sweeping across developed nations. It is likely that most people with fatty liver do not even know that they have the condition as it rarely causes any symptoms.
How To Spot Fatty Liver
As mentioned, fatty liver usually does not cause any signs or symptoms. Even when symptoms arise it may be vague and not immediately associated with a fatty liver. Therefore there is no definitive way to spot fatty liver disease without running diagnostic tests like a blood test or ultrasound scan. However, fatty liver should be suspected in people with one or more of the following risk factors:
- Excessive alcohol consumption.
These are the two main risk factors. However, a host of other conditions can also contribute to a fatty liver, including:
- Viral hepatitis
- Certain medication
- High blood lipids (cholesterol or trigylcerides)
- Type 2 diabetes
- Underactive thyroid or pituitary gland
- Polycystic ovarian syndrome (PCOS)
- Sleep apnea
- Gastric bypass surgery
- Rapid weight loss
- Other types of liver disease
- Excessive iron
It is important to note that a fatty liver may not occur even in the presence of these conditions. However, the majority of cases are associated with obesity or excessive alcohol consumption.
What does fatty liver mean?
The medical term for fatty liver is hepatic steatosis. It is literally an accumulation of fat in the liver cells. The quantity of fat within the cells vary depending on how much is deposited and removed. Some fat accumulation in the liver is not uncommon but with fatty liver the presence of fat is above 5% to 10%. Although the fat does not cause any major problem in the liver for most people, sometimes it can cause inflammation and death of the liver cells.
There are two main types of fatty liver which can be categorized as alcoholic fatty liver and non-alcoholic fatty liver disease. A third minor type is known as acute fatty liver of pregnancy. As the name suggests, this type of fatty liver arises with pregnancy. It can pose a risk to both mother and baby. However, fatty liver of pregnancy is a rare condition and the exact reason why it arises is unclear.
Read more on fatty liver disease.
No Signs and Symptoms
Most cases of fatty liver disease, both alcoholic and non-alcoholic, are silent (asymptomatic). In other words there are no signs and symptoms. Eventually symptoms do arise but it is large non-specific. This means that the symptoms do not conclusively point to fatty liver disease or any other liver condition. Many people will never experience symptoms in their lifetime. Fatty liver is reversible in most instances. If circumstances change then the fatty liver may resolve with a person being totally unaware of having fatty liver disease at some point.
Fatigue is one of the early symptoms of fatty liver disease. However, fatigue can occur with many other diseases and is one of the most common symptoms. Therefore most people will not associate the fatigue with fatty liver disease. Non-specific symptoms like fatigue should be considered along with other symptoms, particularly liver-specific symptoms, before a diagnosis of fatty liver is reached. It must also be supported by diagnostic tests.
Anorexia and Weight Loss
Loss of appetite is another non-specific symptom that is difficult to attribute to fatty liver without supporting diagnostic evidence. The degree of the appetite loss varies among individuals and the severity of fatty liver. The reduced calorie intake can also contribute to other symptoms like fatigue and unintentional weight loss. Often weight loss is not an early symptom of fatty liver and more likely to occur with severe cases.
Right Upper Abdominal Pain
Right upper quadrant (RUQ) abdominal pain is one of the more specific symptoms of fatty liver disease. Most of this quadrant is occupied by the liver, which also crosses the midline to extend slightly to the left. The liver sits largely under the right rib cage. It is important to note that liver pain can occur with certain causes of fatty liver, like viral hepatitis. The pain is also more likely to occur with severe cases, particularly where there is inflammation.
Read more on liver pain.
Abdominal distension can arise for several different reasons in liver disease. It may vary in severity and with pre-existing obesity it may be difficult to identify this abdominal enlargement. Contrary to popular belief it is not due to the swelling or enlargement of the liver (hepatomegaly). Instead it is due to fluid accumulation in the abdominal cavity (ascites) and there may also be edema (swelling) elswehere like in the legs.
Yellowing of the skin and eyes is known as jaundice. This is a specific sign of liver disease but can occur with various liver problems and not just fatty liver. However, it is a late sign and usually arises when fatty liver progresses into other more serious liver conditions like alcoholic hepatitis or cirrhosis. Sometimes the jaundice may precede the onset of fatty liver like in viral hepatitis which may lead to fatty liver disease.
- Nausea and vomiting
- Spider angiomas
Reverse Fatty Liver
In most cases fatty liver is reversible. This requires removing the causative factor. Since alcohol abuse and obesity are the two main causes of fatty liver, reversal focuses on these factors. Stopping alcohol consumption can reverse fatty liver disease as early as 4 to 6 weeks. It needs to be sustained and therefore counselling, support groups and rehabilitation facilities may be necessary. However, with obesity the reversal may require a longer period of time.
Weight loss needs to be moderate and steady as rapid weight loss can worsen fatty liver. Exercise and dietary changes are crucial for weight loss. It should be supervised by a doctor and in consultation with a dietitian. Fad diets must be avoided as it can contribute to other causes of fatty liver, such as increasing blood cholesterol/triglyceride levels and worsening diabetes.