The liver is the most standard site for fat accumulation because it plays a central role in fat metabolism. Depending upon the cause and amount of accumulation, fatty change may be mild, moderate, or severe, producing irreversible cell injury and cell death.

By : Dr Anil Jangir

22 March 2021 5:46 PM GMT

Fatty Liver Disease is most commonly seen in the liver since it is the primary organ involved in fat metabolism. The causes include alcohol abuse (most common), protein malnutrition, obesity, diabetes mellitus, anoxia, and various toxins.

Excess accumulation of fat in the liver causes liver inflammation which causes scarring of the hepatic tissues (liver fibrosis). Severe fibrosis leads to liver cirrhosis, and in some severe cases, this can lead to hepatic failure (liver failure).

Causes - Fatty Liver Disease may result from one of the following two causes

1. Conditions with excess fat

• Obesity

• Diabetes Mellitus

• Congenital hyperlipidemia

2. Liver cell damage

• Alcoholic liver disease

• Starvation

• Protein malnutrition

• Chronic illness

• Hepatotoxins

• Drug-induced hepatic cell damage

• Hypoxia

• Acute fatty liver during pregnancy

Signs of Cirrhosis - Cirrhotic patients are mostly asymptomatic and are diagnosed incidentally. The most common symptoms are:

1. Yellowing of the eyes and skin (Jaundice): Hepatocellular dysfunction leads to jaundice, oedema, and metabolic abnormalities.

Features of hepatocellular dysfunction

• Jaundice

• Ascites

• Hepatomegaly

• Spider nevi

• Palmar erythema

• Menstrual abnormalities

• Bleeding tendency

• Hepatic encephalopathy

1. Dark urine: Patients who have jaundice have this peculiar symptom. Jaundice may be generally absent or mild initially but may become severe at later stages.

2. Swelling of the lower abdominal area (Ascites): Fibrosis and distorted vasculature may lead to portal hypertension and complications associated with it. Hepatocellular dysfunction, as well as fibrosis, may result in Ascites.

Features of portal hypertension

• Ascites

• Splenomegaly

• Hepatic encephalopathy

• Skin pigmentation

• Bleeding tendency

• Opaque nails

Other common symptoms include

• Loss of appetite

• Weakness

• Weight loss

• Skin pigmentation (yellowing of the skin and eyes)

• Abdominal pain and swelling

Types of Fatty liver disease

Fatty liver disease is mainly of two types

1. Non-alcoholic fatty liver disease:

It is not related to alcohol consumption. Simple fatty changes start occurring due to excess fat accumulation in the liver, which causes Hepatic inflammation.

2. Alcoholic fatty liver disease:

It is a spectrum of liver injury associated with acute and chronic alcoholism.

There are three stages of alcoholic liver disease

Stage 1: Alcoholic Steatosis (Fatty liver)

Stage 2: Alcoholic hepatitis

Stage 3: Alcoholic Cirrhosis

Who is at risk

Fatty liver disease is seen most commonly in people who have the following conditions

• Diabetes Mellitus

• Obesity

• Hypertension

• Metabolic disorders and syndromes

• Viral hepatitis- Hepatitis C

• Poly Cystic Ovarian Syndrome

• Pregnancy

• Insulin resistance

• Malnourishment

• Genetic

• Age- 3rd to 4th decade of life

• Hypothyroidism

• Hypopituitarism

Treatment - There are no medications for the treatment of fatty liver disease. However, there are symptomatic precautions one should take care of

• Weight loss

• Manage diabetes

• Work out- exercise

• Low cholesterol

• Medications for the underlying causes

Conclusion - The liver is the largest gland if the body has to bear all the excess accumulated fat during fat metabolism. This fatty change in the liver causes Fatty liver disease, which, when left unnoticed, progress towards liver fibrosis, liver cirrhosis, and liver failure, respectively.

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