Fatty Liver, Cirrhosis, and Related Disorders

Fatty liver, cirrhosis, primary biliary cirrhosis, primary sclerosing cholangitis, and alpha 1 antitrypsin deficiency are all disorders  that result from  an injury to the liver. Injury can be caused by toxins, including alcohol, some drugs, impurities in foods, and the abnormal buildup of normal substances in the blood. Injury to the liver can also be caused by infection or by a disease in which the body attacks its own tissues. Sometimes it can be idiopathic.

Fatty Liver

Fatty liver is an excessive accumulation of a triglyceride inside the liver cells.

In the US and other western countries, the most common causes of fatty liver are alcoholism, obesity, diabetes, and elevated serum triglyceride levels. Other causes include malnutrition, hereditary disorders of metabolism (such as glycogen storage disease), and drugs (such as corticosteroid, tetracycline, and aspirin).

The mechanism by which these diseases or factors cause fat to accumulate within liver cells is not known. Simply eating a high-fat diet, for example, does not produce a fatty liver. One possible explanation is that these diseases or factors slow the rate at which fat is processed (metabolized) and excreted by the body. The resulting buildup of fat within the body, according to this theory, is then stored inside the liver cells.

Sometimes the cause of fatty liver is not clear, especially when it occurs in newborns; however, it is likely to be a defect in the mitochondria of the liver cells.

In some people, a fatty liver does not due to alcohol abuse or drugs and toxins but associated with obesity, diabetes mellitus, and raised serum triglycerides will progress to scarring (fibrosis) and cirrhosis, possibly because of underlying inflammation. This type of fatty liver is sometimes referred to non-alcoholic steatohepatitis.

Symptoms and Diagnosis

Fatty liver usually produces no symptoms. In rare cases, however, it results in jaundice, nausea, vomiting, pain, and abdominal tenderness.

A physical examination that reveals an enlarged liver without any other symptoms suggests fatty liver. Liver function tests are also performed to determine if there is a liver abnormality, such as inflammation, which sometimes accompanies the extra fat in the liver cells and can be associated with the development of cirrhosis in nonalcaholic steatohepatitis.

Excess fat in the liver can be detected on abdominal ultrasound. The diagnosis may be confirmed by a liver biopsy, in which a doctor inserts a long hollow needle through the skin to obtain a small piece of liver tissue for examination inder a microscope.

Fatty Liver from CT scan

Diffuse lower density compared to spleen
Click on image for larger image

Image taken from http://radiology.med.sc.edu/

Prognosis and Treatment

Although excessive fat in the liver may not in itself be a serious problem (the fat can disappear, for example, if the person stops drinking), its underlying cause might be. For example, repeated liver injury from toxic substances such as alcohol may be eventually progress from fatty liver to cirrhosis (severe scarring of the liver). Therefore, treatment of fatty liver aims at minimizing or eliminating the underlying cause of the disorder.

Next week Article : Liver Cirrhosis