Fatty liver: causes and diagnosis

, Fatty liver: causes and diagnosis

A fatty liver (steatosis hepatis) is one of the most common chronic liver diseases in United States. In the process, more fats are stored in the liver. Fatty liver is usually caused by an unhealthy lifestyle, medication or as a side effect of diseases. Although it causes little discomfort at first, fatty liver can have serious consequences. Here you can read everything important about the causes, symptoms and treatment options for fatty liver.

Fatty liver: description

In fatty liver (steatosis hepatis) liver cells store increased amounts of fat (especially triglycerides). The fat content of the liver is normally less than five percent of the liver cells. Depending on the degree of fatty liver, different degrees of fatty liver severity are distinguished. In order to determine the exact extent of liver cell adiposis, a histopathological examination of a tissue sample from the liver is necessary (liver biopsy).

The following degrees of severity are distinguished:

  • Slightly fatty liver: Less than one third of the liver cells are excessively fatty-
  • Moderate fatty liver: Less than two thirds of the liver cells but more than one third are excessively fatty.
  • Severe fatty liver: More than two thirds of the liver cells are excessively fatty.

A fatty liver in itself is not dangerous at first. A suitable fatty liver diet can reduce the fatty liver. However, if fatty liver remains undetected and untreated for a long time, the liver structure changes. Inflammations can occur (hepatitis). In addition, increased connective tissue can be formed between the liver cells and scar tissue (liver cirrhosis). If this is the case, fatty liver therapy will no longer help.

A fatty liver (steatosis hepatis) is a very common liver disease in Germany. About 20 percent of the people are affected. Most of them fall ill between the ages of 40 and 60. Nevertheless, fatty degeneration of the liver can also occur in children and adolescents.

The disease is divided into an alcoholic and a non-alcoholic form according to the fatty liver causes. Alcohol, as the name suggests, is the trigger of alcoholic fatty liver (ASH). Non-alcoholic fatty liver disease (NAFLD) is also known as “affluence disease”. Women are affected slightly more often than men. Almost all patients are overweight. About every second person with fatty liver is also diabetic or has elevated blood lipid levels. In addition, fatty liver is often a side effect of the metabolic syndrome.

Fatty liver: symptoms

You can read everything important about the typical signs of fatty liver in the article Fatty liver – symptoms.

Fatty liver: causes and risk factors

Even if the question “What is fatty liver” can be answered relatively well, it is not yet fully understood how it is produced. What is clear is that there is a mismatch between calorie intake and calorie consumption. As a result, there are too many neural fats in the liver cells. These fats are produced by the liver itself, from fatty acids that are transported from the food via the blood to the liver. A certain proportion of the fatty acids are burned immediately and made available to the body as energy. If more is stored than is burned, fatty liver occurs. There are various explanations for why this imbalance occurs. On the one hand, certain transport proteins in the liver could transport too much fat into the organ. In the case of vitamin B deficiency, on the other hand, the fat contained in the liver, for example, is not processed properly, it accumulates.

Fatty liver: alcohol as cause

There is a clear connection between alcohol consumption and fatty liver. Alcohol is very high in energy and is broken down in the liver. Among other things, fatty acids are also produced and stored in the liver. If people drink alcohol constantly, this can lead to fatty liver. For women, the critical limit is 20 grams of alcohol (equivalent to 0.5 litres of beer) daily, for men 40 grams. However, these are only approximate guide values. Another decisive factor is whether other metabolic diseases such as diabetes or obesity (adiposity) are present in addition to alcohol and how long the consumption of alcohol has existed.

In addition, the liver is often damaged by the toxic effect of alcohol and its breakdown products. These substances can cause the liver to be remodeled and liver cirrhosis to develop. In addition, the liver becomes more easily inflamed with constant alcohol consumption. Even a single alcohol excess can trigger acute liver failure.

Nevertheless, not all people who drink alcohol develop fatty liver. This is due to individual sensitivity, gender, but also to the individual’s equipment with enzymes that break down alcohol.

The non-alcoholic fatty liver has numerous causes

Many people with fatty liver are often confronted with the prejudice that they drink too much alcohol. In fact, although alcohol plays a role in some cases, non-alcoholic fatty liver is much more common overall. It can also occur in people who do not drink alcohol at all.

Fatty liver: nutrition and diabetes as causes

Fatty liver patients usually have too many fats in their blood. These fats come from food and are absorbed into the blood through the intestines. Fatty liver diseases are strongly promoted by too fatty foods. The right fatty liver diet should therefore be healthy and balanced. This also improves the intestinal flora. If this is disturbed, this is also a possible trigger for fatty liver.

Diabetes can also cause fatty liver. In people with diabetes, the hormone insulin no longer works properly or is insufficiently produced. This has consequences for fat metabolism: Insulin resistance leads to an increased release of fats in the body, and as a result the liver cells absorb more free fats. These factors mean that diabetics suffer more often from fatty liver. When the body has developed a certain resistance to insulin, more iron is also deposited in the liver. This produces harmful substances (oxide radicals), which cause a faster inflammatory reaction. People with diabetes therefore also have a higher risk of liver inflammation.

Fatty liver: rare causes

However, not always too fatty food or alcohol are to blame for fatty liver. Longer periods of hunger, pronounced weight loss, long-term sugar infusions (for example in the case of pancreatic defects) or artificial nutrition can also trigger fatty liver.

Certain drugs can also make the liver fatty, such as tamoxifen, synthetic estrogens or steroids. In addition, there are operations on the small intestine, liver and pancreas, which result in increased fat deposits in the liver. Furthermore, inflammatory bowel diseases or inflammation of the colon are rare but possible causes of this disease.

In very rare cases (approximately one in a million pregnancies), acute pregnancy fatty liver occurs. In the late pregnancy, usually after the 30th week of pregnancy, a sudden fatty liver occurs. The disease is very threatening and can lead to death in 30 to 70 percent of cases. It is unclear how the acute pregnancy fatty liver develops. It is possible that a genetic enzyme defect is responsible for this.

Fatty liver: examinations and diagnosis

Anyone suspected of suffering from fatty liver should consult their family doctor or an internist. In order to be able to make a diagnosis of fatty liver, the doctor first asks about symptoms and existing diseases (anamnesis). He could ask the following questions:

  • Do you drink alcohol and if so, how much?
  • How do you eat?
  • What medication are you taking?
  • Do you suffer from an increased feeling of fullness or is it pressing in the upper abdomen?
  • Are you known to have diabetes?
  • How much do you weigh?

An enlarged liver (hepatomegaly) can often be palpated during a physical examination. In the absence of other symptoms, this is a clear indication of fatty liver. However, liver enlargement can have many other causes and is not specific to fatty liver. In order to make a diagnosis of fatty liver, further examinations are necessary.

Further investigations

A number of examinations are possible to confirm the diagnosis. For one thing, a blood analysis is helpful. Blood is taken and the liver values Gamma-GT, GPT and GOT are determined. The iron storage value ferritin, the protein albumin and blood clotting can also give clues. On the other hand, an ultrasound examination of the upper abdomen makes a fatty liver visible.

However, the most important examination to detect fatty liver is an ultrasound (sonography) of the upper abdomen. Typically, the liver of a fatty liver can be seen much brighter in the ultrasound image because fatty liver tissue is denser and therefore reflects the sound more strongly.

In order to determine the exact extent of fatty liver and, if necessary, to obtain information about the cause, a so-called liver biopsy must be performed. The doctor uses a thin hollow needle under local anaesthetic to take a small tissue sample from the liver. The tissue sample is then examined finely (histopathologically) under the microscope.

Fatty liver: searching for the cause

Once a diagnosis of fatty liver has been established, it is important to find out the causes. This sometimes requires further tests such as the determination of blood sugar. It is also important for the doctor to obtain truthful information about alcohol consumption in order to determine the cause of fatty liver. If cirrhosis of the liver is suspected, an additional laparoscopy is often necessary.

Fatty liver: treatment

What to do about fatty liver? There is no specific drug therapy for fatty liver. Rather, the aim is to eliminate the triggering causes. Fatty liver can be reduced with a targeted lifestyle change. This means that those affected reduce their overweight (but not too quickly, this even favours a fatty liver), do more sport and avoid alcohol altogether. Those affected should also pay attention to a low-fat diet for fatty liver. In addition, it is important to have the blood sugar, blood pressure and blood fat values correctly adjusted by the doctor. If the fatty liver is due to medication, it may be possible to find an alternative preparation.

Fatty liver treatment also includes regular check-ups (“liver values” and ultrasound) in order to quickly detect any progression of the disease into liver inflammation or cirrhosis.

If the disease is already more advanced and the liver cells have remodeled into connective tissue (liver cirrhosis), fatty liver therapy consists primarily of treating any complications that may arise. The liver should be examined regularly to detect liver cancer at an early stage. If the liver tissue is completely destroyed, fatty liver cannot be cured. A liver transplant is the last possible treatment for fatty liver. If a suitable donor is found, the liver of another person can be used and the lost liver function can be resumed.

Fatty liver: course of disease and prognosis

In case of steatosis hepatis, the prognosis depends on the time of its discovery and whether it is an alcohol-fatty liver or not. If alcohol is the cause, the prognosis is somewhat worse. Nevertheless, it is initially a benign disease. If those affected can quickly do something about the causes of their fatty liver, the disease can be completely cured, as the liver is one of the most regenerative organs.

However, if fatty liver develops into liver cirrhosis, severe complications can occur, including liver failure. Unlike fatty liver, the liver cannot recover from cirrhosis. This is because the liver cells are destroyed and replaced by non-functional scar tissue. To prevent this from happening, it is advisable to treat fatty liver as soon as possible.

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Sandra Eades
Hello I am Sandra Eades, physician, researcher and author from Australia. I am working currently as researcher for a private institution. I have studied in Britain and Australia, where I currently reside. I write about research topics in the organization of the public health government agencies. For the iMS I write about general medical conditions. I also research scholar sources to provide information to writers of other articles. I also check the citations of scholar papers. Finally, I read other articles before they are published. I am also a mother of three children!