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Fatty Liver

 

 

What is FATTY LIVER ?  

Fatty liver or  Nonalcoholic fatty liver disease ( NAFLD) is a condition or more accurately, a spectrum of conditions in which fat deposits in the liver cells. These conditions range from something called "simple steatosis" which is a mild form of the disorder to something called NASH ( nonalcoholic steatohepatits) which can progress to cirrhosis and even liver cancer.  A liver biopsy is the only way to distinguish between simple Fatty Liver, or NASH.

                    Causes of Fatty Liver

bullet Weight gain/ Obesity
bullet Diabetes
bullet Medications - Diltiazem, Tamoxifen, Methotrexate, Nifedipine and others
bullet Poor diet
bullet Heavy alcohol intake
bullet Steroid use

NAFLD has been associated with a condition called insulin resistance which can be precursor to diabetes. While there have been no studies on this matter yet, it is conceivable that the presence of fatty liver may identify individuals who are at higher risk of developing diabetes. Such individuals would be well advised to keep their weight under control and exercise regularly to diminish their chances of developing diabetes. These measures will also decrease the amount of fat deposited in the liver.

How do I know if I have Fatty Liver

The subject of fatty liver usually comes up when a patient has routine blood work. Often times they have elevated liver enzymes, but when the doctor does additional testing he finds no evidence of viral hepatitis, alcohol abuse, drug toxicity, the accumulation of copper (Wilson’s Disease) or iron (hemochromatosis) or other diseases that can cause liver enzymes to go up. In this situation a sonogram is often done and the presence of fat in the liver will suggest the diagnosis of fatty liver. To confirm the diagnosis and differentiate between fatty liver and NASH, you may be referred to a liver specialist ( usually a gastroenterologist) who may then order  a liver biopsy.

What does this mean for my health?

 


How do you treat fatty liver?
To treat fatty liver you have to treat the underlying cause. Diabetic patients should keep tight control of their sugar, obese patients should lose weight, alcohol consumption should be limited to one drink a day. In general, fatty liver is not harmful and therefore, "treatment" should be limited to doing things that would otherwise be wise recommendations even if you did not have fatty liver.  Since some patients with fatty liver may go on to develop NASH, it is best to try and control those factors that are causing fatty liver.



What is NASH?
As mentioned above, NASH is similar to fatty liver except for the fact that there is damage to the liver cells. No one really knows why one person gets fatty liver and another gets NASH. The only way to tell the difference between the two is with a biopsy. The real problem with NASH is that it may lead to cirrhosis( permanent scarring of the liver) in 5-10% of patients.  Usually this progression from NASH to cirrhosis takes several decades.

Some studies have shown that 20% to 40% of people who are grossly overweight will develop NASH. 


How is NASH treated?
As with fatty liver, there is no specific treatment for NASH. The goal is to treat the underlying cause. Diabetic patients should keep tight control of their sugar, obese patients should lose weight, alcohol consumption should avoided.  A low fat diet is usually recommended. Sometimes medications to lower cholesterol are also recommended.