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  • Writer's pictureProf. Dr. Deniz Balcı

Fatty Liver Disease

Fatty Liver Disease and Non-Alcoholic Fatty Liver Disease


Having a certain amount of fat in the liver is normal and does not cause symptoms. However, in fatty liver disease, there is excessive fat accumulation in liver cells. This condition is characterized by excessive alcohol consumption or non-alcoholic causes. In both cases, if excessive fat deposition in the liver leads to an inflammatory reaction, it is called steatohepatitis. The development of steatohepatitis in the liver leads to scarring similar to healing scar tissue due to an ongoing inflammatory reaction. The structure of the liver is disrupted, leading to hardening, and this condition can progress to cirrhosis. A significant complication expected in patients with cirrhosis is an increased risk of developing liver cancer.


Medical research has shown a relationship between insulin resistance and fatty liver disease. Here, even if the body secretes enough insulin, organs cannot use it, leading to the accumulation of glucose (the main blood sugar), which is converted into fat and stored.


Causes of Fatty Liver


DIET


Excessive alcohol consumption.


DISEASES


Diabetes (Sugar)


Obesity


Hepatitis C


Wilson's Disease


MEDICAL CONDITIONS


Rapid weight loss.


Inadequate or unbalanced nutrition.


Genetic diseases


Medications


How is Fatty Liver Disease Detected?


Most patients with fatty liver disease do not have significant symptoms. Symptoms begin if inflammation due to excessive fat accumulation in the liver leads to a condition called steatohepatitis.


Initial symptoms are nonspecific, often including:


Fatigue


Weakness


Fullness and pain in the upper right side of the abdomen


Visible and inflammatory disease progresses insidiously.


These patients may develop liver cirrhosis in the advanced stage.


Conditions seen in patients with liver cirrhosis include:


Jaundice (yellowing of the eyes and skin)


Fluid accumulation in the abdomen (ascites)


Swelling in the hands and feet


Easy fatigue, bruising, and bleeding


In advanced stages; confusion, drowsiness, and liver coma.


When to See a Doctor?


Patients with complaints such as excessive fatigue, weakness, jaundice, abdominal swelling, and easy bruising should consult a doctor for further evaluation.


These complaints may not necessarily arise from fatty liver or cirrhosis. Further investigations are needed to differentiate these conditions from other diseases.


What Advanced Tests are Required for Fatty Liver Disease?


Specialist doctor evaluation:


When fatty liver disease is suspected, your doctor will try to find out the underlying causes and risk factors.


Here, mainly:


Alcohol use


Medications


Illnesses you have had (especially viral hepatitis A, B, C)


Diabetes


And other relevant conditions are asked.


Physical examination in patients includes:


Enlargement of the liver


Jaundice


Muscle wasting


Spider-like appearance in the skin veins


Liver Biopsy


It occurs by taking a small amount of liver tissue through a special biopsy needle inserted into the abdominal wall and evaluating it under a microscope. Liver biopsy is the gold standard test for evaluating liver fat accumulation.


Advanced tests and examinations


Blood tests


A series of detailed tests are required for liver fat accumulation and its differential diagnosis. The main ones include:


Liver function tests


Transaminases (AST, ALT)


Bilirubin


Alkaline phosphatase and GGT


Blood sugar and blood lipids


Cholesterol and triglycerides


Radiological examinations


Ultrasonography is an important initial examination in the evaluation of liver fat accumulation. It has the advantage of being cheap and easily accessible, but its evaluation requires experience.


Computerized tomography and magnetic resonance imaging are advanced tests that allow detailed examination of liver structure.


How Common is Fatty Liver Disease and What Conditions Accompany it?


In our country, it is estimated that the prevalence of fatty liver disease is around 20-25% in the community.


We know that in 80% of those with liver fat accumulation, no serious health problems develop. However, in 20-25% of cases, a serious form of the disease called non-alcoholic steatohepatitis (NASH) may develop.


These patients:


More than 70% are obese.


Diabetes may be present in 75% of them.


High cholesterol may be present in 50% of them.


What is the Natural Course of Fatty Liver Disease and What Complications Can it Cause?


Fatty liver disease, if it leads to non-alcoholic steatohepatitis (NASH), characterized by constant and recurrent inflammatory reaction leading to irreversible disruption of liver structure and function, can cause liver cirrhosis.


At this point, the risk of developing life-threatening complications increases.


In these patients, the development of liver cancer (hepatocellular carcinoma, HCC), which follows liver cirrhosis, which requires early detection and treatment with liver transplantation, leads to a very serious medical condition.


Liver Cirrhosis


Cirrhosis is a widespread and chronic disease characterized by inflammatory cell infiltration, connective tissue development, and regeneration nodules.


Cirrhosis is a disease in which the structure and organization of the liver are disrupted, and the liver cannot function or can only function very little. In cases where complications such as jaundice, itching, variceal bleeding, ascites, liver coma (loss of consciousness), and liver cancer develop in patients with decompensated liver cirrhosis.


Patients with decompensated liver cirrhosis should urgently apply to a liver transplantation center and undergo the necessary tests for transplantation.


How is the Monitoring and Treatment of Fatty Liver Disease Done?


The American Liver Studies Association* makes the following recommendations for monitoring and treatment of fatty liver disease.


Increasing physical activity and weight loss with a low-calorie diet reduces liver fat accumulation.


To achieve this, it is necessary to lose at least 5% of body weight. To reduce liver inflammation, at least 5-10% of body weight should be lost.


Vitamin E supplementation of 800 IU daily has been shown to be beneficial in the treatment of patients with non-alcoholic steatohepatitis (NASH). This treatment is not recommended for diabetics.


Omega-3 fatty acids (found in fish oil) can be used in the treatment of patients with high blood lipids (triglycerides).


These patients should not consume alcohol regularly and in large quantities.


Patients with non-alcoholic steatohepatitis (NASH) should be regularly screened for the development of liver cancer.


Patients with non-alcoholic steatohepatitis (NASH) should be regularly monitored by endoscopy for the development of variceal bleeding.


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