Diseases

Fatty liver disease : What you need to know

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Posted By SUMIT SHARMA

Today, we will get to know about fatty liver disease. In my last blog, I explained the function of the liver. Now we will see how fatty liver disease affects your liver function.

Fatty liver disease is a widespread medical condition, and most people suffer from this problem. 

Even most of you don’t know, you already are having fatty liver disease. Fatty liver disease may decrease your lifespan and hampers the quality of life.

So, it is essential to understand the fatty liver disease. Let’s start from the basics – 

 

What is fatty liver disease?

Too much fat deposition in your liver can lead to fatty liver disease.

Normal fat in your liver is up to 5%. If it is more than 5% can become a health problem like fatty liver disease. It is also known as hepatic steatosis. Fatty liver disease

 

How many types of fatty liver are there? What are the risk factors for liver disease?

There are two main types of fatty liver disease – Alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD). 

 

Alcoholic fatty liver disease (AFLD) 

If you have ever taken too much amount of alcohol for a long time. This can be capable of damaging your liver. It is also known as alcoholic steatohepatitis.

Fatty liver disease

 

Alcohol (ethanol) is metabolized in the liver

                    Alcohol dehydrogenase

Converted into Acetaldehyde

                        Aldehyde dehydrogenase

               Acetate

 

Here, acetaldehyde is a primary culprit which stimulates Ito cells and releases fat. Then these fats accumulate in your liver. It is also toxic to the mitochondrion of hepatocytes.

The risk of AFLD is higher if you are a woman, obese, and have genetic mutations.

 

 

Non-alcoholic fatty liver disease (NAFLD) 

It is the most common type of liver disease, increasing throughout the world, especially in western countries. 

Although lifestyle changes are the most significant factor in NAFLD. 

These risk factors contribute to influencing the progression of NAFLD.

 

1. Insulin resistance  – According to an article published in JCEM reveal that Insulin resistance is strongly associated with NAFLD. If your cells of muscles, fat, and liver don’t respond to insulin. It means your glucose and insulin level is higher in the blood. This gets converted into fat in the liver and deposit in the abdomen area. 

 

2. Obesity – If your BMI (Body mass index) is 30 or greater. Waist circumference more than 40 inches in male and more than 35 inches in a female.

 

3. Uncontrolled diabetes – If your blood glucose level is higher.

 

4. Uncontrolled hypertension – If you have high blood pressure.

 

5. Increased cholesterol levels, especially triglycerides

 

6. Lack of exercise – It can be one of the biggest reasons if you are not physically active. 

 

7. Older people – As per a study, older people are more at risk of fatty liver disease because they have more chance of having hypertension, obesity, diabetes, and hyperlipidemia.

 

8. Genetic predisposition – In a study, reveals that there may be involvement of a gene called PNPLA3 to a high risk of developing NAFLD.

 

9. HepatitisHepatitis C is the most common cause of NAFLD. Some studies have reported that hepatitis B virus (HBV) infection may affect the risk of NAFLD.

 

10. Pregnancy

 

11. Drugs – There are some drugs that induced fatty liver problems. You may be at higher risk of NAFLD; If you are on glucocorticoids, anti-cancer drugs (methotrexate, tamoxifen, 5-fluorouracil, Irinotecan), amiodarone, and antiviral drugs.

 

Sometimes a moderate amount of alcohol may also contribute to risk factors in NAFLD.

 

 

How does fat deposit in the liver?

Pathophysiology of fatty liver disease

If you see the structure of a lobule in the liver. Ito cells are present in the space of Disse (a small area between hepatocytes and sinusoids).

Ito cells are fat-storing cells or vitamin A. These cells are also called hepatic stellate cells or perisinusoidal cells.

In the advanced stage of fatty liver disease, inflammatory mediators like adipokines, cytokines, etc. stimulate Ito cells

Then Ito cells lose their fat which becomes very aggressive and dangerous.

Convert into myofibroblast and start secretes collagen.

The liver will become generalized fibrotic.

This collagen constricts capillaries around sinusoids, and liver blood flow alters.

Then there is some area will get less blood flow and some are over blood flow.

 

So, Ito cells play a significant role in worsening the condition of fatty liver disease. 

 

 

What are the 4 stages of liver disease?

Credit- Signimu, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

Progression of NAFLD

It occurs in four grades – 

 

Fatty liver grade 1 – Simple fat accumulation. Only fat deposition in the liver is high

 

Fatty liver grade 2 – High-fat deposition, inflammation, and start damaging liver cells. It also releases liver enzymes SGPT/ALT and SGOT/AST. It can be a good indicator for NAFLD progression. This condition is known as NASH (Non-alcoholic steatohepatitis).

 

Fatty liver grade 3 – It starts very rapidly damaging liver cells. Develop fibrosis, stiffness, and loss of liver function.

 

Fatty liver grade 4Liver cirrhosis (Liver failure)

 

Progression of AFLD

 

Initially, in the first stage, continue heavy drinking get to fatty liver stage or steatosis (acute liver damage)

In the second stage, it leads to alcoholic hepatitis (inflammation and degeneration of the liver)

Last stage, Liver cirrhosis (develop scars)

 

 

What are signs your liver is bad? How serious is a fatty liver?

Fatty liver disease is a silent disease; it comes with no signs and symptoms.

Initially, you may feel pain at the upper right side of the abdomen and tiredness. Its symptoms and complication may increase as per the progression of the disease.

You may get many more severe complications as per the progression of the disease because it havocs your function of the liver-

Fatty liver disease

 

1. Ascites and bacterial peritonitis 

When your liver is not working correctly. Then it won’t filter your blood because it accumulates in the peritoneal cavity of the abdomen and causes bacterial infection. 

 

 2. Portal hypertension

It is a leading complication of an advanced stage of fatty liver disease. Your liver takes all the blood which comes from the digestive tract, spleen, and pancreas by the portal vein. 

Fatty liver disease resists your blood flow and puts stress on the portal vein. 

This causes increase blood pressure called portal hypertension.

 

4. Jaundice

If your disease is in progress, you may experience yellowish skin and urine. It means your liver is not accepting bilirubin, and it goes back to the bloodstream resulting in jaundice

 

5. Hepatic encephalopathy

Usually, the liver converts ammonia into urea by the urea cycle. Your liver removes this urea from the body in urine. 

If your liver is not able to convert urea due to fatty liver disease. Then it increases the ammonia level in the bloodstream and crosses the blood-brain barrier. 

You might have confusion, loss of brain function, thinking problems, etc.

 

5. Esophageal varices

If your blood vessels to the liver are blocked by scar tissue. Then, the tiny capillaries start to leak and rupture. As a result, it causes severe bleeding in the esophagus that can be life-threatening complications.

You may get pale/black color stool and blood in vomiting.

 

6. Red palms

It is caused by dilated capillaries in the palm. Since your liver is not producing clotting factors. Thus, you may get microscopic bleeding and redness on the surface of your palms.

 

 

 

How your gastroenterologist investigates fatty liver disease?

 

Physical exam – Your doctor may determine hepatomegaly (enlargement of the liver) by physical examination.

 

Imaging 

  • Ultrasound – It gives information on fat deposition in the liver.
  • Fibro scan – It is also a specialized type of ultrasound that gives more accurate information. It determines the percentage of fat and texture or stiffness of the liver.
  • MRI (Magnetic resonance imaging)– Highly accurate information even in mild fatty liver disease. It also determines to quantify fat in the liver.

 

Blood test 

A liver function test will provide you with information about your liver enzymes. If SGPT/ALT and SGOT/AST levels increase, there could be a problem with your liver.

 

Liver biopsy 

To collect the tissue of liver cells which determine the abnormal cells of the liver. 

 

 

How do you fix fatty liver?

Although, there is no such proper medicine available for fatty liver disease. You need to manage your risk factors to prevent fatty liver disease.

You should STOP DRINKING ALCOHOL in any type of liver disease.

You should also change your lifestyle for NAFLD and add the fatty liver diet.

  • Weight loss
  • Regular exercise
  • Low calorie and low-fat diet
  • Low salt to control hypertension (↓fluid, ascites, and edema)
  • Low sugar to prevent diabetes
  • Eat fruits and vegetables
  • Avoid junk foods

 

Researchers found that regular caffeine intake significantly reduces hepatic fibrosis in NAFLD.

Some of the studies reveal that vitamin E act as liver protective. It is a potent antioxidant that helps to reduce oxidative stress in NAFLD.

In the advance stage, your gastroenterologist can provide you with certain drugs to manage risk factors – 

  • Diuretics – to prevent ascites and edema
  • Vitamin K – to improve coagulopathy
  • L-ornithine L-aspartate (LOLA) – good evidence in hepatic encephalopathy
  • Antibiotics – to prevent infections
  • Antidiabetics – to control blood glucose level
  • Antihypertensive – to control blood pressure
  • Hypolipidemic agents or lipid-lowering drugs

 

If there is 90-95% liver damage, then a liver transplant is the only way. 

 

 

Take home message

It is always better to stop the fatty liver disease early because if it worsens, it will give you many serious complications that can be fatal.

So, this was the information on liver disease. I hope you like it. If you found this post informative, please share it on social media.

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