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Fatty Liver and Steatohepatitis

Explanation of liver function

The liver is the main warehouse for nutrients absorbed from the small intestine. Its job is to store, package and change these nutrients according to the needs of the body and then supply them to the blood stream for delivery to the various organs. The liver is a very large organ located in the upper right quadrant of the abdomen protected by the rib cage. It also produces bile that is stored in the gallbladder. Bile is necessary for the digestion and absorption of fat in the diet.

Definition of Fatty Liver

Fatty Liver is a very common cause of abnormal liver blood tests. Although fatty liver is often benign, in some individuals, it can cause hepatitis and even advance to cirrhosis

Cause

If fat accumulates inside liver cells, these cells may become irritated or inflamed. This may produce raised or abnormal liver enzymes. This can advance to longer lasting liver damage. Certain conditions such as being overweight, having diabetes mellitus, high cholesterol or fat content in the blood may be risk factors for fatty liver.

Symptoms and Diagnosis: Most people with fatty liver feel well and are not aware that they have a liver problem. Fatty liver is usually first suspected in a person who is found to have elevations in liver tests that are included in routine blood test panels.

Explanation of Steatohepatitis

Nonalcoholic steatohepatitis or NASH is a common, often “silent” liver disease. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly.

Diagnosis

NASH is usually first suspected in a person who is found to have elevations in liver tests that are included in routine blood test panels, such as alanine aminotransferase (ALT) or aspartate aminotransferase (AST). When further evaluation shows no apparent reason for liver disease (such as medications, viral hepatitis, or excessive use of alcohol) and when x rays or imaging studies of the liver show fat, NASH is suspected. The only means of proving a diagnosis of NASH and separating it from simple fatty liver is a liver biopsy. NASH is diagnosed when examination of the tissue with a microscope shows fat along with inflammation and damage to liver cells. If the tissue shows fat without inflammation and damage, simple fatty liver or NAFLD is diagnosed. An important piece of information learned from the biopsy is whether scar tissue has developed in the liver. Currently, no blood tests or scans can reliably provide this information.

Treatment

For a liver biopsy, a needle is inserted through the skin to remove a small piece of the liver. Currently, no specific therapies for NASH exist. The most important recommendations given to persons with this disease are to

  1. Reduce their weight (if obese or overweight)
  2. Follow a balanced and healthy diet
  3. Increase physical activity
  4. Avoid alcohol
  5. Avoid unnecessary medications

Summary

Although NASH has become more common, its underlying cause is still not clear. It most often occurs in persons who are middle-aged and overweight or obese. Many patients with NASH have elevated blood lipids, such as cholesterol and triglycerides, and many have diabetes or pre-diabetes, but not every obese person or every patient with diabetes has NASH. Furthermore, some patients with NASH are not obese, do not have diabetes, and have normal blood cholesterol and lipids. NASH can occur without any apparent risk factor and can even occur in children. Thus, NASH is not simply obesity that affects the liver.

Organizations

  1. American Gastroenterological Association - www.gastro.com
  2. American College of Gastroenterology - www.acg.gi.org
  3. American Liver Foundation - www.liverfoundation.org

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