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What is Fatty Liver?

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What is Fatty Liver?
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What is Fatty Liver?

Fatty liver is the accumulation of more than normal fat in the liver due to alcohol or non-alcoholic reasons. It is predicted that fatty liver disease due to obesity will increasingly emerge as the most common cause of chronic liver diseases in the world and in our country. 

What Causes Fatty Liver?

Nowadays, obesity is a very serious problem and the rate of fatty deposits in the liver has increased. In addition to diseases such as diabetes and hypertension, fatty liver disease is also very common in overweight individuals. The severity of fatty liver is generally directly proportional to excess weight. Diabetes is one of the leading risk factors for fatty liver. Obesity and excess weight, especially around the belly, are also among the most important causes of fatty liver. Apart from these, alcohol is also responsible for serious fatty liver. With the increase in the prevalence of obesity and diabetes, fatty liver has become an important public health problem for our country. It is estimated that one in every three people in our country has fatty liver.

What are the Symptoms of Fatty Liver?

Unfortunately, obvious signs indicating that a person has fatty liver are not observed at the initial stage of the disease. The absence of symptoms in the early period also makes it difficult to detect. It is observed that obvious complaints increase as the disease progresses. 
Among the complaints stated in the early period; These  include a constant feeling of fatigue, a feeling of sluggishness and fullness, and pain or discomfort in the upper right area of the abdomen. 
More prominent complaints observed as the disease progresses are listed as follows: 
• Unexplained weight loss
• Loss of appetite
• Abdominal swelling
•  Nausea
• Edema and swelling in the legs and feet
• Darker than normal urine
• Yellowing of the skin and whites of the eyes may be a sign of serious deterioration in liver function.
However, although rare, patients may feel fullness in the right upper quadrant and sometimes pain in the right upper quadrant due to stretching of the liver. As the table progresses, the findings become more evident in the stages where fibrosis and cirrhosis develop; In men, hair loss and some changes in the skin may occur. When the disease reaches a higher stage, ascites may develop due to accumulation of fluid in the abdominal cavity and changes in the skin and venous network.
 

Fatty Liver Stage 1 Symptoms

Stage 1 Simple Fat: 

This stage is characterized by slight fat accumulation in the liver. It usually does not cause symptoms and does not affect the general health of the patient. Liver cells are filled with fat droplets. But inflammation or damage is not obvious. This stage is the earliest stage of obesity seen in people who do not consume alcohol.

Fatty Liver Stage 2 Symptoms

Stage 2 (Non-Alcoholic Steatohepatitis): 

Stage 2 is a more serious stage. In addition to fat accumulation in the liver, mild to moderate inflammation and cellular damage are also seen. Symptoms may include fatigue, abdominal pain, or weakness. As it progresses, the risk of liver damage increases.

Fatty Liver Stage 3 Symptoms

Stage 3: 

This stage is characterized by an increase in connective tissue called fibrosis in the liver. Changes occur in the structure of the liver and the damage is more evident at this stage. Liver functions may begin to be seriously affected. Symptoms of fatty liver stage 3 usually include symptoms such as increased fatigue, weight loss along with abdominal pain.

Fatty Liver Stage 4 Symptoms

Stage 4 (Cirrhosis): 

Cirrhosis, the most serious stage, is the result of advanced fatty tissue causing inflammation and hardening of the liver. Tissue integrity has been disrupted in a large part of the liver and normal functions have almost disappeared. Cirrhotic liver can lead to complications such as fluid accumulation in the abdomen (ascites). Progression of this stage may require liver transplantation.
However, these are the clinical stages of fatty liver. It is important not to confuse these with ultrasonographic staging. The stages of fatty tissue detected by ultrasound indicate the following:
Stage 1 steatosis: 1/3 of the liver cells are fatty
Stage 2 steatosis: About half of the liver cells are fatty
Stage 3 steatosis: 2/3 of the liver cells are fatty
If more fat is visible in the liver on ultrasound and if this fat continues for years, the risk of conversion to cirrhosis increases. 

How to Treat Fatty Liver?

The most important step in treatment is weight loss. As the belly circumference decreases, the severity of fatty liver begins to decrease. In this context, diet and exercise are indispensable for treatment. It has been shown that walking for 30-45 minutes every day is effective in controlling blood pressure, sugar and weight. However, continuity of diet and exercise is important. When done regularly and for a long time, fatness regresses. While improvement in liver enzymes responds faster to treatment, ultrasonic recovery is slower. Here too, one should not be impatient or hopeless. 
The effectiveness of some drug treatments and drugs to break insulin resistance has been proven in patients with high liver enzymes. 
Drug treatments and liver transplantation are used in patients with cirrhosis, and treatment methods such as liver transplantation, chemotherapy and embolization are used in patients with liver cancer.

Frequently Asked Questions About Fatty Liver 

This disease is often detected while investigating another disease. Detection of fatty liver can be done by ultrasonography or abdominal tomography. The amount of fat may be mild, but over time it may cause the cells in the liver, which we call hepatocytes, to lose their function. It can lead to a process that can lead to fibrosis, cirrhosis and even cancer.

Western diet rich in fatty foods and foods containing plenty of protein and carbohydrates increase the risk. Sugar and sugary beverages play an important role in gaining fat. The only nutritional method whose effectiveness has been proven to extend life and reduce the occurrence of diseases is the Mediterranean diet. This diet also includes plenty of vegetables and fruits, fish and olive oil.

If a person has concomitant hepatitis, alcohol use, and other liver diseases, the risk of cirrhosis increases exponentially along with obesity. For example, it is possible to say that the possibility of cirrhosis increases significantly when hepatitis B hits the liver first and the second blow is caused by fatty tissue.

In the initial stages, the patient has no symptoms, the disease progresses insidiously for years, and with the transition to the second and third stages, abdominal pain, weakness, fatigue, and an increase in liver enzymes begin. Later, fluid accumulation (ascites and edema) occurs in the abdomen and legs.

 

As fatty liver continues for years, the body begins to react to it and attack the liver cells. As the attack becomes more severe, liver damage and cirrhosis develop. Cancer cells form in the liver on the basis of cirrhosis. After this stage, liver transplantation or chemotherapy appear as treatment options.  With the imaging method called Fibroscan, more detailed information is obtained about the severity of the fat and whether it is progressing towards cirrhosis. This method is a new method that is performed outside the skin, like ultrasound, and takes approximately 5-10 minutes, is easy, painless, but gives good results. It provides very important information about the liver structure. Although it is not as effective as a liver biopsy, it can eliminate the need for a biopsy in a few patients.

Since similar factors are responsible for fatty liver and gallbladder stones (obesity, diet rich in fatty foods, diet), the coexistence of these two diseases is common.

It is observed that fatty liver has reached an important point in children as well. The increase in obesity in the mentioned age range also brought about an increase in fatty liver. The sooner the body encounters this situation, the sooner the damage to the liver cells will begin, and then fibriosis (scarring of the liver) or cirrhosis will develop.

Fatty liver does not cause any symptoms in the early stages. However, although rare, patients may feel fullness in the right upper quadrant. Sometimes, one may feel pain in the right upper quadrant due to stretching of the liver. As the table progresses, the findings become more evident in the stages where fibrosis and cirrhosis develop; In men, hair loss and some changes in the skin may occur. When the disease reaches a higher stage, it manifests itself with the development of ascites due to the accumulation of fluid in the abdominal cavity and changes in the skin and venous network.

Obesity plays an important role in fatty liver. Nowadays, obesity is a very serious problem and the rate of fatty deposits in the liver has increased. Although the rate of non-alcoholic fatty liver varies depending on population, the average is around 30 percent. Not all fatty liver cases result in cirrhosis, but early diagnosis and follow-up of patients is of great importance in this sense. As long as obesity, which is a chronic disease, continues, fatty liver will continue. On the other hand; Fatty liver may occur due to conditions in which the fibers in the blood increase, which we call hyperlipidemia, hypertension diseases, chronic hepatitis carriers, after obesity surgery and many other reasons.  Therefore, diagnosis and follow-up of patients is important.

We call fatty liver when 5 out of 100 liver cells or 5 percent of the liver's weight become fatty. Fatty liver is a clinical condition that occurs due to alcohol-related or non-alcoholic reasons. In case of fatty liver disease that develops due to alcohol-related reasons, daily alcohol consumption of 20 grams for women and 30 grams or more for men must be consumed

This content was prepared by Yeditepe University Hospitals Medical Editorial Board.

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