Fatty Liver Disease – Definition, Types, and Symptoms.

Definition

Fatty liver disease is the accumulation of triglycerides and other fats in the liver cells. The amount of fatty acid in the liver depends on the balance between the processes of delivery and removal. In some patients, fatty liver may be accompanied by hepatic inflammation and liver cell death (steatohepatitis). Potential pathophysiologic mechanisms for fatty liver include the following:

• Decreased mitochondrial fatty acid beta-oxidation
• Increased endogenous fatty acid synthesis or enhanced delivery of fatty acids to the liver
• Deficient incorporation or export of triglycerides as very low-density lipoprotein (VLDL)

There are two main types of fatty liver disease:

• Alcoholic liver disease (ALD)
• Nonalcoholic fatty liver disease (NAFLD)

Alcoholic Liver Disease (ALD)

Alcoholic fatty liver disease is due to heavy alcohol use. Liver breaks down most of the alcohol you drink, so it can be removed from your body. But the process of breaking it down can generate harmful substances. These substances can damage liver cells, promote inflammation, and weaken your body’s natural defenses. The more alcohol that you drink, the more you damage your liver. Alcoholic fatty liver disease is the earliest stage of alcohol-related liver disease. The next stages are alcoholic hepatitis and cirrhosis.

The causes of getting ALD are:

• Hepatitis C (which can lead to inflammation in your liver)
• Too much iron in your body
• Being obese

Nonalcoholic fatty liver disease (NAFLD)

NAFLD is a type of fatty liver disease that is not related to heavy alcohol use. There are two kinds:

• Simple fatty liver, in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not get bad enough to cause liver damage or complications.
• Nonalcoholic steatohepatitis (NASH), in which you have inflammation and liver cell damage, as well as fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer.

The cause of nonalcoholic fatty liver disease is complex and not completely understood. The most important factors appear to be the presence of obesity and diabetes.

Causes

There are several identifiable causes of fatty liver that are not nonalcoholic fatty liver disease but may cause confusion. The most common are excessive alcohol consumption and hepatitis C. Other causes include

• Wilson’s disease,
• Lipodystrophy (a disease of fat storage),
• Starvation,
• Intravenous nutrition, and
• Abetalipoproteinemia (a disease of fat transport).

Several drugs also cause fatty liver, including

• Corticosteroids,
• Tamoxifen (Nolvadex), and
• Methotrexate (Rheumatrex, Trexall)

Risk factors

Factors that may increase your risk for fatty liver are:

• Excessive alcohol use
• Taking more than the recommended doses of certain over-the-counter medications, such as acetaminophen
• Pregnancy
• High cholesterol
• High triglyceride levels
• Malnutrition
• Metabolic syndrome
• Polycystic ovary syndrome
• Sleep apnea
• Type 2 diabetes
• Underactive thyroid (hypothyroidism)
• Underactive pituitary gland (hypopituitarism)

Symptoms and signs

You might have fatty liver disease and not realize it. There are often no symptoms at first. As time goes on, often years or even decades, you can get problems like:

• Feeling tired
• Loss of weight or appetite
• Weakness
• Nausea
• Confusion, poor judgment, or trouble concentrating

You might have some other symptoms, too. Your liver may get larger. You could have a pain in the center or right upper part of your belly. And the skin on your neck or under your arms may have dark, colored patches.

If you have alcoholic liver disease, you may notice that the symptoms get worse after a period of heavy drinking. You could also get cirrhosis, a scarring of your liver. When that happens, you might have:

• Buildup of fluid in your body
• Wasting of your muscles
• Bleeding inside your body
• Jaundice (yellowing of skin and eyes)
• Liver failure

Diagnosis and Testing

• Liver biopsy, a procedure where the physician inserts a needle into the liver and extracts a sample tissue, which is then examined under a microscope.
• An ultrasound of the liver can suggest the presence of a fatty liver.
• CT- Scan and MRI scan can show the fibrosis of liver.
• Blood Tests: Your doctor may find that liver enzymes are higher than normal on a routine blood test. This doesn’t confirm a diagnosis of fatty liver. Further analysis is necessary to find the cause of the inflammation.
• Physical Exam: If your liver is inflamed, your doctor can detect it by examining your abdomen.

Treatment and medications

Healthy diet and lifestyle

• Lose weight
• Eat a healthy diet
• Exercise regularly
• Stop smoking

Medications

• Insulin sensitizers: Metformin (Glucophage), Pioglitazone (Actos) and rosiglitazone (Avandia)
• Antioxidants: Vitamin E
• Pentoxifylline
• Omega-3-fatty acids
• Lipid-lowering drugs: Statins and Ezetimibe (Zetia)
• Ursodeoxycholic acid

Bariatric surgery

Bariatric surgery is surgery of the gastrointestinal tract that results in loss of weight, and there are several different types of bariatric surgery. Since obesity is believed to be an important factor in the causation of nonalcoholic fatty liver disease and loss of weight has been shown to have beneficial effects on nonalcoholic fatty

Liver transplantation

Once a liver has become cirrhotic and complications have developed, the options for treatment are either treating the complications as they arise or to replace the diseased liver with a transplanted liver.

Can fatty liver disease be prevented?

By choosing a healthy life style, you may prevent obesity – the number one reason for fatty liver disease. Please remember that a healthy diet and exercise are important components of any weight-loss regimen. The following are some suggestions for preventing fatty liver disease5:

• Choose to lead a healthy lifestyle.
• If you are overweight, strive for a gradual and sustained weight loss.
• Eat a well-balanced diet that is low in saturated fats and high in fibre.
• Minimize sugar consumption, reduce the intake of fried food
• Introduce exercise into your routine, at least four times a week. You can enjoy walking, swimming, gardening, stretching.
• Avoid alcohol.

How to cure Fatty liver cirrhosis

Luckily fatty liver is reversible.  Here are 5 ways to achieve this:

• Eat less carbohydrate
• Drink less alcohol
• Eat more vegetables, protein and the right fats
• Drink raw vegetable juices
• Take a good liver tonic
• Increase glutathione production