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