Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen’s University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Fatty Liver Disease Related Articles
Medical Definition of Non-Alcohol Fatty Liver Disease (NASH)
What Is the Medical Definition of Non-Alcoholic Fatty Liver Disease?
Non alcholic fatty liver disease is characterized by increased accumulation of fat, especially triglycer >
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Fatty Liver Disease Symptoms
For the majority of patients, NAFLD is a benign disease and is not associated with any symptoms. It is only when the liver manifests signs of inflammation, either NASH or alcoholic steatohepatitis, that the patient may experience symptoms. As with other types of hepatitis, the initial symptoms are non-specific and include malaise, fatigue, and upper abdominal fullness and discomfort.
If steatohepatitis progresses to cirrhosis, symptoms of liver failure may develop. Symptoms of liver failure include:
- jaundice (because of the accumulation of bilirubin),
- ascites and edema (swelling of the body) due of decreased protein production by the liver,
- increased bruising, and
- associated mental confusion.
What Causes Fatty Liver Disease? What Does the Liver Look Like (Pictures)?
Fatty liver can be classified as alcohol and nonalcohol related. Alcohol is a direct toxin to the liver and can cause inflammation. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic related steatohepatitis (NASH) are markedly different illnesses and there are many potential causes that are linked to fat accumulation in the liver.
Some of the causes of fatty liver include:
Diet: Consumption of excess calories in the diet (the excess caloric intake overwhelms the liver’s ability to metabolize fat in a normal fashion, which results in fat accumulation in the liver).
Diseases: Fatty liver is also associated with type II diabetes, obesity, and high triglyceride levels in the blood, celiac disease, and Wilson’s disease (abnormality of copper metabolism).
Medical conditions: Rapid weight loss and malnutrition.
Medications: Medications such as tamoxifen (Soltamox), amiodarone injection (Nestorone), amiodarone oral (Cordarone, Pacerone), and methotrexate (Rheumatrex Dose Pack, Trexall) are associated with NAFLD.
There is evidence to suggest the presence of an association between insulin resistance and the development of NAFLD. In this situation, although the body makes adequate insulin, the ability of cells to adequately use that insulin to metabolize glucose is abnormal. The relative excess of glucose is then stored as fat and can accumulate in the liver.
Treatment and Surgery for Fatty Liver Disease
The treatment of fatty liver disease is to decrease the potential risk exposures to the liver. For those with alcoholic liver disease, abstaining from alcohol is a must. For those with NALFD or NASH, appropriate diet, weight loss, diabetes control, and cholesterol/triglyceride control are important both for treatment and to prevent progression of the disease from NAFLD to NASH, and from NASH to cirrhosis.
Patients with celiac disease who maintain a strict gluten free diet can reverse fat accumulation in the liver.
Cardiovascular exercise can help promote weight loss and weight training can increase muscle mass. This not only improves metabolism and promotes weight loss, but the increase in muscle mass helps to sensitize the cells to insulin and reduces insulin resistance.
The patient and doctor should work together to formulate a plan that involves lifestyle changes. A balanced diet, increased in physical activity and exercise, and medication if needed to control cholesterol and blood sugar levels, can minimize the risk factors that lead to fat infiltration of liver cells.
Though there is much research underway, presently there are no medications proven to be effective in fatty liver disease; however, medications to control and lower cholesterol and triglyceride levels can be used in association with diet and exercise.
Patients with fatty liver disease should be seen routinely in follow-up visits to their doctor in order to monitor their liver function and progression to more serious liver abnormalities. Since weight loss, diet, and physical activity are the most important tools in minimizing the risk of fatty liver disease, and are the most effective treatments, consultations with a dietician and a physical trainer may be appropriate.