Fatty Liver Disease

Fatty liver disease starts when excess fat builds up in the liver cells. A normal liver does contain much fat, but when the quantity of fat exceeds 10% of your liver’s weight, then you have a fatty liver. A fatty liver does not cause any damage, but when the extra fat leads to inflammation of the liver, it is a progression to fatty liver disease. This condition, also called steatohepatitis, causes damage to the liver. When fatty liver disease is due to alcohol abuse, it is known as alcoholic steatohepatitis, otherwise it is called non-alcoholic steatohepatitis (NASH) or non-alcoholic fatty liver disease (NAFLD). NASH is also one of the causes of cirrhosis.

Non-alcoholic steatohepatitis is often referred to as the silent killer. It is a fairly common disease and often has no signs and symptoms. The condition is similar to alcoholic liver disease, with the difference being that it prevails in people who drink little or no alcohol. However, the disease becomes harmful if the fat accumulated causes inflammation and scarring in the liver.

Symptoms
Non-alcoholic fatty liver disease usually does not show itself in the form of signs and symptoms. In the early stages, the patients feel normal. However, as the disease progresses, they begin to experience fatigue, pain in the upper right abdomen, and weight loss. The progression of NASH can take place over a period of years, and in some people even decades. This unpredictable disease can stop and, in some cases, reverse on its own without any treatment.

Causes
The reasons for the liver's inability to break down fats is unclear. However, there is a wide range of diseases and conditions linked to non-alcoholic fatty liver disease. It is found to occur most often in people who are middle aged and overweight or obese. However, NASH also affects children and people without diabetes, who are not obese and have normal blood cholesterol and lipids.

Diagnosis
In order to diagnose non-alcoholic fatty liver disease, your doctor may ask for a blood test to be taken which will indicate your liver function. Other tests that help identify the ailment are imaging procedures such as ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI). However, the only definite way of proving NASH from simple fatty liver is by testing the liver tissue. Called a biopsy, it is done by extracting a sample of tissue from the patient's liver. The extraction of liver tissue is done by inserting a long needle into the patient's liver and removing a few liver cells. This tissue sample is then sent to a laboratory where it may show fat along with inflammation and damage to liver cells. Also, only a biopsy will tell if scar tissue has developed in the liver.

Treatment
There is no specific treatment administered for non-alcoholic fatty liver disease. In a case where a certain medication is causing fatty liver disease, the doctor will try to substitute that medicine. In most cases the doctor will ask a patient to reduce their weight if they are obese or overweight, follow a balanced and healthy diet, exercise or increase physical activity, avoid alcohol and avoid unnecessary medications. There are a few experimental approaches to dealing with this disease. One is the use of antioxidants, such as vitamin E, selenium, and betaine. Another approach is the use of newer anti-diabetic medications, even in persons without diabetes.

Prognosis
In a few cases, NASH can worsen and result in scarring or "fibrosis" to appear and accumulate in the liver. With worsening fibrosis, the liver becomes seriously scarred, hardened, and unable to function normally. This condition is called cirrhosis. Unfortunately, when the disease reaches this stage, there is almost no way to halt the progression. A patient will suffer from fluid retention, muscle wasting, bleeding from the intestines, and liver failure. For an advanced stages, a liver transplantation is the only option.

NASH affects 2 to 5 percent of Americans. Also, 10 to 20 percent Americans have fat in their liver (fatty liver), but no inflammation or liver damage.