Fatty liver: Recognizing symptoms

Fatty liver symptoms are often unspecific. Some affected persons feel a feeling of pressure in the right upper abdomen or suffer from a feeling of fullness. However, patients often have no fatty liver symptoms at all. Only as the disease progresses do symptoms appear. Since the disease can have serious consequences, non-specific fatty liver symptoms should also be taken seriously. Here you can read everything you should know about fatty liver symptoms.

Fatty liver symptoms in general

People with fatty liver usually have no complaints at all. Sometimes affected persons feel a slight feeling of pressure or fullness in the right upper abdomen. These complaints occur because the liver can also be significantly enlarged (hepatomegaly) in the context of fatty liver disease and therefore exerts pressure on the surrounding organs and the abdominal wall.

Permanently elevated “liver values” in blood tests can also be indicative of fatty liver. The so-called liver values are a series of blood values that are released from the liver cells into the blood in the event of liver damage. These include the enzymes GOT (also known as AST) and GPT (also known as ALT), as well as the bilirubin value and the enzyme gamma-GT (GGT). However, elevated liver values are not specific fatty liver symptoms either, but are only a general indication of liver damage regardless of the cause.

During a physical examination, the doctor is sometimes able to palpate the enlarged liver. At the latest with abdominal ultrasound, the altered liver structure becomes visible.

Fatty liver symptoms of non-alcoholic origin

People with fatty liver are often overweight and eat unhealthy food. They prefer fatty foods and also regularly have elevated fat levels in blood tests. However, a low-protein diet and rapid weight loss can also cause fatty liver. Many of those affected are diabetics or suffer from a metabolic syndrome. Long before they develop fatty liver symptoms, blood pressure and blood lipid levels are elevated. The abdomen is thicker and there is often insulin resistance as in diabetes. If such risk factors are present, increased attention should be paid to fatty liver symptoms.

Fatty liver symptoms of alcoholic origin

Even if increased alcohol consumption is the cause of fatty liver disease, no specific fatty liver symptoms initially appear. Alcohol consumption can serve as an indicator: For women, the critical limit is 20 g of alcohol per day (contained in 0.5 litres of beer, for example), whereas for men it is 40 g per day.

Symptoms of chronic alcohol consumption can often be detected earlier than fatty liver symptoms. The breath of those affected smells of alcohol. If the alcohol addiction disease is more advanced, patients often neglect personal hygiene or do not eat enough. A resulting vitamin deficiency can damage the nerves, for example.

Fatty liver symptoms with secondary diseases

The non-alcoholic fatty liver disease leads to inflammation of the liver (hepatitis) in about one in four, the alcohol-related form even in almost one in three affected persons. The symptoms of non-alcoholic fatty liver hepatitis (NASH) and alcohol-induced fatty liver hepatitis (ASH) are not different. If the cause of fatty liver is not eliminated, cirrhosis of the liver can develop after a few years due to fatty liver. Cirrhosis of the liver is the most serious complication of fatty liver because it is an irreversible, life-threatening disease and cirrhosis of the liver also increases the risk of liver cancer enormously. It should be noted, however, that both hepatitis and cirrhosis of the liver can have causes other than fatty liver.

Symptoms of liver inflammation

In the case of fatty liver inflammation (steatohepatitis), there is a pronounced inflammatory reaction in the liver. On the one hand, this inflammatory reaction can manifest itself in severe pain in the liver area, for example in the area under the right costal arch. On the other hand, functional disorders of the liver occur due to the inflammation. For example, the blood breakdown product bilirubin can no longer be metabolized by the liver in sufficient quantities. The elevated bilirubin level in the blood is also visible externally, as the bilirubin is also deposited in the tissue, making the skin and eyes appear yellowish. This is also known as jaundice. Those affected by fatty liver hepatitis also often suffer from a lack of appetite, nausea, vomiting and occasionally fever.

Fatty liver symptoms with liver cirrhosis

If the disease progresses further, cirrhosis of the liver can develop from a fatty liver. Symptoms of this connective tissue change are very diverse, but not all of them need to occur. Among them:

• Feeling of pressure and fullness in the upper abdomen
• Nausea and vomiting
• Weight loss due to lack of appetite
• Yellowish discoloured skin and eyes (icterus) due to an increased bilirubin level in the blood
• Itching due to bilirubin, respectively not decomposed bile acids in the skin
• Spider web-like changes of the skin (Spider naevi)
• Red palms (“palmarerythem”)
• Strikingly reddened, shiny lips (“varnished lips”)
• Water retention in the legs (leg edemas) and abdomen (ascites)
• Visible blood vessels around the navel (“Caput medusae”)
• Breast formation in men (gynecomastia)
• Reduced hairiness in the abdominal area in men (“belly glands”)
• Blood coagulation disorder: for example, obviously increased nosebleeds and bruises

Fatty liver symptoms with liver failure

Many patients do not even know that their liver is fatty if no fatty liver symptoms occur. However, if the liver is already damaged, substances such as alcohol or certain drugs can cause acute liver failure more quickly. Unlike an initial fatty liver, liver failure shows symptoms that cannot be overlooked. Skin and eye white are yellowish discolored. Blood clotting is disturbed because the liver can no longer produce clotting factors. Even small impacts cause bruises. In the case of larger bleedings, affected persons can also vomit blood or have a black discoloured stool. In patients with liver failure, consciousness is impaired. They often speak slowly, have little memory or are not really responsive at all. General fatty liver symptoms can be supplemented by strongly fluctuating blood sugar levels and altered blood salts. In liver failure, the same blood values are strongly elevated as in symptomless fatty liver.

Fatty liver diseases often only become apparent when secondary diseases have already occurred. In order to prevent these consequences, non-specific fatty liver symptoms must also be taken seriously, diagnosed quickly and treated.