Fatty liver (also called steatosis), a common clinical finding, is the accumulation of triglycerides and other fats in hepatic cells. In severe fatty liver, fat constitutes as much as 40% of the liver's weight (as opposed to 5% in a normal liver), and the weight of the liver may increase from 3 1/3 lb (1.5 kg) to as much as 11 lb (5 kg).
Minimal fatty changes are temporary and asymptomatic; severe or persistent changes may cause liver dysfunction. Fatty liver is usually reversible simply by eliminating the cause; however, this disorder can result in recurrent infection or sudden death from fat emboli in the lungs.
The most common cause of fatty liver is alcohol abuse. This form is called alcoholic steatosis. All other forms are called non-alcoholic steatohepatitus (NASH), and are caused by conditions including malnutrition, obesity, diabetes mellitus, and Reye's syndrome in children. There is a rare, but serious, form of fatty liver that begins late in pregnancy and may cause jaundice and liver failure. Fatty liver may also be caused by certain drug overdoses or toxic chemical poisonings, such as carbon tetrachloride. All these causes injure the liver in some way that makes the liver cells accumulate fats.
Signs and Symptoms
Clinical features of fatty liver vary with the degree of lipid infiltration; many patients are asymptomatic.
The patient's history may uncover predisposing factors, such as alcoholism, malnutrition, biliary stasis, hepatic necrosis, diabetes mellitus, and obesity.
The patient may complain of right upper quadrant pain (with massive or rapid infiltration). Less common symptoms are nausea or vomiting and, rarely, menstrual disorders.
Inspection may reveal jaundice, edema, and ascites. With ascites, the patient may also have an emaciated chest and thin extremities. Rarely, inspection may disclose transient gynecomastia or spider angiomas. Abdominal palpation may reveal a large, tender liver (hepatomegaly) and splenomegaly, indicating cirrhosis.
A liver biopsy confirms excessive fat in the liver.
The following results in liver function studies support the diagnosis:
Other diagnostic findings may include anemia, leukocytosis, elevated white blood cell count, albuminuria, hyperglycemia or hypoglycemia, and deficiencies of iron, folic acid, and vitamin B12.
Management is essentially supportive and consists of correcting the underlying condition or eliminating its cause. For instance, when fatty liver results from I.V. TPN, decreasing the rate of carbohydrate infusion may correct the disease. In alcoholic fatty liver, abstinence from alcohol and a proper diet can begin to correct liver changes within 4 to 8 weeks. Such correction requires comprehensive patient teaching.
Your best defense against nonalcoholic fatty liver disease is to maintain a healthy weight and normal cholesterol and blood sugar levels. This strategy, along with avoiding excess alcohol and other substances that could be harmful to your liver, can help reduce your risk of liver disease.
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