Fatty Liver Disease (cont.)
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Fatty Liver 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:
When to Seek Medical Care
Since fatty liver disease is asymptomatic until liver inflammation occurs, the diagnosis is often made incidentally. The health care practitioner may note a slightlyenlarged liver on physical examination, or screening blood tests may show mild abnormalities of liver function.
Patients who have abdominal swelling, jaundice, and easy bruising should seek medical care, though the cause may not necessarily be steatohepatitis or cirrhosis.
Fatty Liver Diagnosis
Physical Exam and Medical History
When concern exists for the presence of fatty liver disease, the health care practitioner will try to find the underlying cause and risk factors. Questions may be asked regarding alcohol consumption, medication use (both prescription and over-the-counter) and past medical history, especially concerning previous history of viral hepatitis (the most common are A, B, and C) and immunizations against infectious hepatitis. Screening for diabetes may be appropriate.
Physical examination may reveal an enlarged liver that can be palpated or felt in the abdomen below the right rib margin. Otherwise, it may require the development of cirrhosis to elicit abnormalities on physical examination. These may initially include jaundice or a yellowish tinge to the skin and eyes, muscle wasting, hair thinning, abnormal skin blood vessels called spider angiomata, and splenomegaly (enlarged spleen).
Blood tests may be helpful as screening tests for liver inflammation, although liver function studies such as serum transaminases (AST, ALT) may be normal or elevated and not necessarily related to the severity of the liver disease. Other liver tests such as alkaline phosphatase and bilirubin are often normal. Serum ferritin (a measure of iron storage) may be abnormal. In patients with NAFLD and NASH, cholesterol levels including triglycerides are often elevated.
Ultrasound of the liver can reveal patterns suggestive of fatty infiltration of the liver. Computerized tomography (CT scan) and magnetic resonance imaging (MRI scan) are also useful in the evaluation of fatty liver.
The definitive diagnosis of fatty liver disease can only be confirmed by liver biopsy, where a needle is inserted into the liver through the abdominal wall to obtain a piece of tissue which is analyzed under the microscope.
Medically Reviewed by a Doctor on 7/30/2014
Bhupinder Anand, MD
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