What is Fatty Liver?

Fatty liver describes a build-up of fat around the liver. This process is known as hepatic steatosis, which is due to several processes, such as increased fatty acids and decreased breakdown of fat cells around the liver. While it may not have any apparent symptoms, fatty liver can cause more advanced liver conditions. There are two types of fatty liver disease called non-alcoholic fatty liver disease and alcoholic liver disease. As indicated by the names, fatty liver can either be caused by the consumption of alcohol or other non-alcohol related reasons. Liver disease is a significant health problem in Australia. According to the Australian Institute of Health and Welfare [1], it is the 11th leading cause of early death, which frequently impacts men over the age of 50. Modelling shows that alcoholic and non-alcoholic fatty disease will affect around 8.8 million Australians by 2030 [2].
 

What are the Symptoms of Fatty Liver?

One of the more concerning aspects of fatty liver is the lack of apparent symptoms [3]. It is incidentally picked up during imaging for other reasons for many cases. When there are symptoms, they are general and not specific to fatty liver, including:

• Pain or discomfort around the upper right area of the abdomen
• Nausea
• Changes in appetite
• Fatigue
• Weight loss

 

What Causes Fatty Liver?

Alcoholic Fatty Liver Disease Causes

Alcoholic fatty liver is typically caused by excess alcohol consumption. After consuming alcohol, the role of the liver is to filter and break them down. However, prolonged alcohol use can lead to long-term damage, inflammation and affect the ability of your liver to recover.

Non-Alcoholic Fatty Liver Disease Causes

Those with non-alcoholic fatty liver disease are not caused by excessive alcohol consumption. While the cause of the disease varies from person to person, up to 80% of those with underlying health conditions can have fatty liver [3]. Examples of conditions and risks that are associated with non-alcoholic fatty liver disease include [4]:

• Being overweight or obese
• Diabetes (click here for more information)
• Having high cholesterol (i.e. hyperlipidaemia)
• Eating too much fat and sugar
• Use of certain medications
• High blood pressure

 

Tests and Diagnosis

Imaging Assessment

Ultrasound is a non-invasive, safe and effective way to detect fat build-up around the liver. Your GP may also recommend an MRI or abdominal CT scan to help with diagnosis. These are tests that help visualise any potential changes to the liver. Before your imaging assesment, a GP referral is made to the radiologist or sonographer.

Blood Tests

Your GP may also ask for a blood test to look for specific markers that may reflect your liver's state. Not only can a blood screening help diagnose fatty liver but also other potential liver conditions, such as hepatitis and gut issues.

Biopsy

While imaging and blood tests show your liver's condition, occasionally your GP may recommend taking a biopsy of your liver to be analysed in the laboratory. This will be able to identify and help diagnose the state of your liver reliably. A doctor will take a sample of your liver's tissue during an anaesthetic for testing during this procedure.
 

Fatty Liver Disease Treatment

Lifestyle Changes

An essential part of fatty liver treatment is encouraging healthy habits and reducing the risks linked to the condition (e.g. being overweight, diabetes, etc.). Reducing your weight is the only proven treatment to help treat fatty liver. Examples of lifestyle changes that your doctor may recommend, include:

• Stopping or limiting alcohol consumption
• Controlling your smoking habits
• Following a healthy diet (e.g. reducing your calories, considering a Mediterranean diet, etc.)
• Weight management
• Exercise and increase your physical activity levels

Referrals may be made to a dietician and/or therapists to help guide you during this process.

Medications

Your GP may recommend medications that may help alleviate underlying conditions that may contribute to your fatty liver, such as high blood pressure and cholesterol (hyperlipidaemia). However, there is no single therapy or medication that is readily used to treat fatty liver [4]. Weight loss and lifestyle changes should always be encouraged alongside medications.

Referrals to a Medical Specialist

Your GP may also refer you to a medical specialist, such as an endocrinologist or gastroenterologist. Further testing and treatment options may be offered for the later stages of fatty liver.
 

Complications

If left untreated or unmanaged, fatty liver disease can worsen over time. There are four stages of fatty liver disease, including [5]:

• Simple fatty liver disease: In this stage, fat begins to build up around the liver without inflammation.
• Non-alcoholic and alcoholic fatty liver disease: As the condition progresses, fat builds up around the liver cells. Inflammation around the liver cells also becomes noticeable.
• Fibrosis: Over time, as the liver becomes more inflamed, scar tissue can develop after recovery. More of the normal liver tissue is replaced with scar tissue if this persists.
• Cirrhosis: Cirrhosis describes advanced liver damage as more of the healthy liver is replaced with scar tissue. The liver begins to stop working as effectively and even becomes permanently damaged as this occurs.

End-stage liver failure can lead to symptoms such as increased abdominal pain, jaundice, stomach swelling and vomiting. If left untreated, it can become a severe and potentially fatal condition.
 

Recovery

The outcomes are often good if the fatty liver is treated early and doesn't progress to stage 3 (fibrosis) [3]. According to John Hopkins University, treatment (e.g. weight loss, avoiding alcohol, etc.) can stop or reverse the fat build up around the liver [6]. However, if the condition is left untreated and progresses to stage 3 or 4, the condition can become severe and even fatal. Approximately 10% of those with fatty liver will develop cirrhosis [5].
 
 

Receiving quality care from highly experienced doctors is essential for a prompt diagnosis and receiving the correct medical treatment. With 24-7 MedCare, you can experience telemedicine from the convenience of your own home. Our friendly online doctors will be available 24/7 for a consultation, anytime and anywhere in Australia.

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References

1. https://www.aihw.gov.au/getmedia/a088f80f-fcdb-4c5d-aa00-ca776bd7f792/phe199-liver.pdf.aspx
2. Adams, L. A., Roberts, S. K., Strasser, S. I., Mahady, S. E., Powell, E., Estes, C., ... & George, J. (2020). Nonalcoholic fatty liver disease burden: Australia, 2019–2030. Journal of gastroenterology and hepatology, 35(9), 1628-1635.
3. Antunes, C., Azadfard, M., Hoilat, G. J., & Gupta, M. (2017). Fatty liver. Iser, D., & Ryan, M. (2013).
4. Fatty liver disease: a practical guide for GPs. Australian family physician, 42(7), 444-447.
5. https://www.msdmanuals.com/en-au/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/nonalcoholic-fatty-liver-disease-nafld
6. https://www.hopkinsmedicine.org/health/conditions-and-diseases/nonalcoholic-fatty-liver-disease