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Alcoholic and Non-Alcoholic Fatty Liver Disease – Fatty Liver

Fatty Liver is a condition in which the liver accumulates fat within the cells, mostly due to alcohol and obesity, leading to other diseases. It is a disease that can represent a risk for the patient’s life.

In this article, there will be an extensive review of the disease, and some of the most common questions will be answered by a doctor. However, for a better understanding, there will be a brief introduction to the topic. After this, you will be fully able to comprehend and take advantage of the information within this article.

By reading this, you will acquire critical insights about Fatty Liver. Like its types, stages, causes, symptoms, and further treatment. Therefore, I kindly invite you to keep reading this article.

What is Liver Steatosis or “Fatty Liver Disease”?

Liver steatosis or Fatty Liver Disease is a condition that affects the liver directly; it is the excessive fat accumulation within the liver cells. The liver disease correlates with two significant conditions, Non-Alcoholic Fatty Liver Disease, and Alcoholic Liver Disease.

However, other causes may lead to hepatic steatosis like drug-induced, metabolic, and Hepatitis C infection. There are estimates that almost half of the heavy drinkers have hepatic steatosis as well as nearly all of the obese heavy drinkers. It is a disease with a high prevalence within the population, primarily due to people with unhealthy habits. It is becoming a troublesome disease for public health, especially the non-alcoholic fatty liver disease.

The liver is a vital organ that filters the blood within the body; it receives a vast amount of blood all the time, mainly from the digestive tract. However, these mechanisms have a limit. The liver steatosis exists due to an imbalance between the acquisition and removal of the fats in the blood. The fat deposits within the liver cells and acts as a toxic substance when there is too much of it; this will lead to inflammation and liver scarring, also known as fibrosis, which has the potential to progress into cirrhosis and liver failure.

What are the stages of a Fatty Liver?

Fatty Liver Disease is a condition with variable causes; however, the liver damage progress is the same for most of them. It doesn’t matter if the reason is a viral infection, chemical injury, or an attack from your own immune system. The damage will be the same. All of them will lead to chronic liver diseases, altering liver function, and threatening life.

  1. Simple Fatty Liver (Steatosis): It is a considerable and harmless fat accumulation in the liver cells; its diagnosis could be during tests for another reason. 
  2. Inflammation: In the early stage of any liver disease, there will be a liver inflammation process. It enlarges and becomes tender. However, this may not cause any pain or discomfort as people generally do not feel it. Nonetheless, if it continues over time, it can start to hurt the liver permanently, leading to liver fibrosis.
  3. Fibrosis: The liver will begin to scar if it does not receive treatment. As it grows, the scar will replace the healthy liver tissue, but it cannot do the work of the healthy tissue. Moreover, it can rearrange the blood flow within the liver.
  4. Cirrhosis: Is the scarring of the liver as the tissue replaces healthy tissue on a big scale. If it does not receive treatment on time, this will lead to complications, including liver cancer. At this point, the therapy focuses on stopping the damage and protecting the healthy liver tissue left.

However, it can take years for fibrosis or cirrhosis to develop. Therefore, it is vital to make lifestyle changes on time in order to keep a healthy liver.

What are the forms of Fatty Liver Disease?

Fatty liver disease has two main types or forms of this disease, which correlates to its initial trigger; they can be alcoholic and non-alcoholic. However, each of these will include different subtypes of the disease; the alcoholic fatty liver includes simple alcoholic fatty liver disease and alcoholic steatohepatitis. And the non-alcoholic form of this disease will consist of simple non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, and acute fatty liver of the pregnancy.

These conditions all lead to a final common pathway when the liver tissue does not recover from the damage, which is cirrhosis. It is potentially fatal if it does not get treatment from a liver specialist. 

Alcoholic Fatty Liver Disease (AFLD) or Hepatic Steatosis

As its name says, this disease has a correlation to alcohol consumption; drinking copious amounts of alcohol, even for a few days, may lead to changes in the liver tissue. Fats will begin to accumulate after a moderate alcohol intake leading to changes in liver tissue. 

This form of the disease has an excellent outcome, with alcohol abstinence, liver tissue usually revert to normal. It is an asymptomatic disease. However, if alcohol intake continues, it may progress to a more dangerous stage of liver disease.

Alcoholic Steatohepatitis (ASH)

Alcoholic steatohepatitis or alcoholic hepatitis is a subtype of the alcoholic fatty liver disease in which there is an inflammation of the liver. This inflammation happens when there is too much fat accumulation within the liver due to copious and continuous alcohol intake. Then liver fat causes toxicity in the cells leading to its further death. This condition generates liver scarring which, if severe, can lead to cirrhosis and liver failure. Symptoms may vary and may be nonspecific for each patient. The most common are abdominal pain, nausea, and weight loss.

Non-Alcoholic Fatty Liver Disease (NAFLD)

This type of liver disease occurs when there is an accumulation of fat in the liver cells on people who do not drink alcohol. Having several factors that may cause this disease, the most important ones are in direct relation with the food and the physical activity. It is a form of the disease in which there is no liver inflammation, as fat accumulation is still on low levels.

Non-Alcoholic Steatohepatitis (NASH)

Non-Alcoholic Steatohepatitis occurs when the fat accumulation in the liver cells reach levels beyond the limit capacity. When this happens, liver cells are affected by these fats that act as toxic agents, leading to further liver inflammation and liver scarring. However, if this clinical condition does not receive medical attention, it may progress to severe liver scarring and cirrhosis.

Acute Fatty Liver of Pregnancy (AFLP)

It is a rare, unique, and serious condition in pregnancy that may affect pregnant women in the third trimester or the early postpartum period. In this condition, a micro accumulation of fats happens in the liver cells but with no inflammation or necrosis but still generates damage to them.

On physical examination, the patient has a fever and yellowish coloration of the skin. One of the complications is a misbalance in the components of the blood that may affect the fetus. Delivery of the infant will relieve these symptoms on the mother for which delivery is always in consideration in this specific condition.

Who is at risk for Non-Alcoholic Fatty Liver Disease?

Non-Alcoholic Fatty Liver Disease is a rapidly growing silent epidemic that spreads through the world as it is the most common liver disease. It is a silent disease where anybody is at risk if people do not take care of themselves. This disease is a possible scenario for people with the following risk factors:

Basically, people with unhealthy habits and an unhealthy lifestyle are at risk of developing this disease. It does not matter the age, gender, or ethnicity. There is no solid proof that these factors correlate to the risk of developing Non-Alcoholic Fatty Liver Disease. However, people with this list of conditions are at serious risk if there are no lifestyle changes.

What causes Non-Alcoholic Fatty Liver Disease?

The causes of Non-Alcoholic Fatty Liver Disease are not entirely understood. Nonetheless, some theories may explain the causes of this specific disease thoroughly.

Several factors like genetics, environment, and dietary habits lead to Insulin Resistance or low insulin sensitivity. When this happens, tissues like muscle, fat, or liver cells have an erratic response to insulin, leading to an elevation in blood sugar levels. Obesity and a change in the intestinal flora due to the nutritional habits are key factors in the Non-Alcoholic Fatty Liver Disease progression. 

Insulin resistance will lead to an increase in the conversion of carbohydrates to fats in the liver resulting in a rise of fats within the liver cells. Also, fats from the diet will accumulate in the liver cells, acting as a toxic agent that will promote damage to the liver cell. Nonetheless, alterations in the intestinal flora will affect the small bowel allowing it to absorb more fat molecules from the diet. All of these are key factors that will result in liver inflammation and a further instauration of Non-Alcoholic Fatty Liver Disease.

How much do you have to drink to get a fatty liver?

Alcohol drinkers are at risk of developing alcoholic fatty liver disease. However, not all of the people who consume alcohol are at real risk. It depends on the amount of alcohol and how regularly the patient consumes it.

There are estimates that 40g of alcohol daily is necessary to produce pathologic changes in alcoholic hepatitis and liver scarring. For example, a beer of 12 ounces contains 14g of alcohol, a regular glass of wine of 5 ounces includes 14g as well. Studies recommend daily consumption of less than 30g of alcohol in men and less than 20 g in women.

Nonetheless, after consecutive days of moderate to heavy drinking, fats may build up in the liver cells. Still, the reversal of this process is possible. The liver will continue to work and metabolize alcohol after this intake. With alcohol abstinence, the liver will return to its normal state in a lapse of two weeks approximately.

Can stress cause fatty liver?

Poor interpersonal relationships, work and unemployment pressure, low self-esteem, and low socioeconomic status often lead to chronic psychological stress. There are several studies in which chronic mental stress has a high correlation with the incidence of Metabolic Syndrome. Metabolic Syndrome is a condition that runs with the following conditions:

Therefore, stress can lead to developing a fatty liver. Within the human body exists a system whose name is “Hypothalamic-Pituitary-Adrenal Axis”; this is a system that interconnects the brain with other organs through hormones.

When a stressful event happens, the brain, through this system, releases hormones that will activate specific responses within other organs in the body to later be shut down by the same system. If chronic psychological stress exists, the regulation of this system will not work correctly.

This latter situation will lead to the synthesis of fats in the liver and the liberation of more fats from the fatty tissue than the usual amount. It will also keep the immune system working, which will affect the liver tissue that already has more fat within the cells than average, leading to inflammation and a fatty liver.

What are Fatty Liver Disease symptoms and signs? 

The fatty liver disease typically, when on early stages, can be asymptomatic and with no signs of the disease. However, if there are symptoms, these are nonspecific symptoms like fatigue or slight weight loss that do not suggest to the physician an acute liver disease. The liver may be slightly enlarged in the physical examination, but it is not always the case.

In later stages of the disease, like ASH or NASH, there is a broader spectrum of symptoms and signs. The patient may present: 

  • Abdominal pain in the upper right quadrant of the abdomen. 
  • Weight loss
  • Fever. 
  • Nausea and vomiting.

In the physical examination, there is a palpable enlargement of the liver, yellowish coloration of the skin, and/or abdominal distension. And in severe cases, “spider angiomas” can happen, which is when veins grow bigger and become clearly visible on the abdomen. 

What are the possible complications of Non-Alcoholic Fatty Liver Disease?

Non-Alcoholic Fatty Liver Disease may run with different complications, largely due to its underdiagnosis. The liver progresses to steatohepatitis and then to cirrhosis, which occurs when the liver fibrosis produces scarring. This abnormal tissue occupies more space within the liver than healthy liver tissue leading to further complications. Among the complications of this specific disease, it can be found:

  • Ascites: The abdomen distends itself due to a significant accumulation of liquid.
  • Esophageal variceal bleeding: Due to the alteration in the liver’s blood flow, the veins in the esophagus distend themselves and receive more blood than average. This makes them more likely to a rupture, which can be fatal.
  • Encephalopathy: The liver is not able to metabolize all of the chemical products within the body. This leads to an accumulation of them that directly affects the brain, causing hallucinations and alterations of the consciousness state.
  • Liver Failure: The extensive scarring process may take all of the healthy liver tissue, causing liver failure, leading to death.
  • Liver Cancer: These liver cells’ alterations may predispose to a malignant replication of them, leading to hepatocellular carcinoma.

How is Non-Alcoholic Fatty Liver Disease diagnosed?

There are several ways to diagnose the Non-Alcoholic Fatty Liver Disease, but some variation in their specificity. It goes from blood tests to making biopsy retrieving a small piece of liver tissue and see what is happening. People with risk factors for Metabolic Syndrome are candidates for liver screening to diagnose or discard this disease. The diagnosis of this disease may be incidental in routine controls and blood tests and require more tests to know the exact stage of the disease. The following criteria are usually for the diagnosis of Non-Alcoholic Fatty Liver Disease.

  • Liver Function Test: In this test, the physician can see the liver enzymes levels like Aspartate Aminotransferase and Alanine Aminotransferase. In the Non-Alcoholic Fatty Liver Disease, there is a mild alteration of these levels. However, these alterations are not specific from this disease like viral hepatitis, autoimmune hepatitis, and other liver diseases that can run with elevated liver enzymes.
  • Liver Ultrasound: It is a first-line diagnostic test due to its cost and its availability. It is a test that cannot detect inflammation of the liver. Still, it can detect steatosis, which is very important in the initial screening of the liver.
  • Transient Elastography: After there is a diagnosis of steatosis through ultrasound, the transient elastography is the next step. This imaging test, also known as fibroscan, can measure the stiffness of the liver. It can detect cirrhosis and liver fibrosis.
  • Liver Biopsy: It is a test in which the physician takes a small portion of the liver to see under a microscope what is happening in the cells. This is the gold-standard test as it gives an indication of the overall severity of the disease.   

How is Non-Alcoholic Fatty Liver Disease treated?

There is no effective treatment for Non-Alcoholic Fatty Liver Disease to date. In the absence of effective therapy, the physician must follow a multi-disciplinary approach that involves a combination of drugs and changing risk factors. Within this multi-disciplinary approach, the physician may include the following:

  • Weight loss, dietary modification, and changes in lifestyle.
  • Insulin Sensitizers: Non-alcoholic fatty liver disease has a direct correlation with metabolic syndrome and insulin resistance. Bearing this in mind, the physician will include drugs like metformin that will improve insulin sensitivity. 
  • Lipid-lowering agents: These drugs, like Ezetimibe, look forward to reducing the reabsorption of fats from the small bowel.

If none of these therapies affect the patient, other therapeutic options are more invasive but can lead to a better prognosis. However, these depend on the severity of the disease as well, the therapeutic options are:

  • Bariatric Surgery: It is an option mostly for patients who are morbidly obese and a non-cirrhotic liver due to Non-Alcoholic Fatty Liver Disease. However, it is not the first election of treatment as this procedure may lead to liver failure postoperatively.
  • Liver Transplant: Liver transplantation is an option that takes relevance only when the patient is at end-stage liver disease. Nonetheless, this is not a permanent cure. Studies demonstrate that Non-Alcoholic Fatty Liver Disease recurs in the post-transplant liver.

What are some lifestyle changes that can help with Fatty Liver Disease?

Among the lifestyle changes that can help with Fatty Liver Disease, dietary changes, and regular exercise are the most important. All of these changes are with the final objective of losing weight and reduce the number of fats within the blood and insulin resistance. The dietary changes should include the following:

  • Reduce the consumption of saturated fats that can be found in red meat and other animal products.
  • Initiate a diet rich in plant-based foods and legumes, including vegetables, fruits, and grains.
  • Avoid alcohol intake.
  • Reduce the consumption of refined carbohydrates, which can be found in sweets, white bread, white rice, and other refined grain products.
  • Avoid Trans fats that are present in snacks and processed foods.

For exercise, the recommendation is to do at least 30 minutes of exercise or more five days of the week. This will lead to an improvement of the cardiovascular condition and an increase in the calorie burn rate. However, weight loss should be gradual. Very rapid weight loss has a direct relation with a worsening of the steatohepatitis and an elevation of the risk for developing liver failure.

Does fatty liver go away?

It depends on the stage. If it is in the early stages of the disease with some lifestyle changes like losing weight and dietary habits, it can go away. Reducing the amount of fats and promoting a healthy lifestyle will help the liver and reduce the stress in which it is due to the fatty liver.

However, if it is at later stages of the disease like liver fibrosis, the damage cannot go away, but these changes can reduce and ultimately limit the disease’s progression.

What can I do if I am having symptoms of it?

This tool is a fatty liver symptoms checker. It gathers the most important risk factors, signs, and symptoms of this condition. Importantly, by determining how likely it is for somebody to has fatty liver disease. It would aid in its prevention. It is free, and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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