Fatty liver is the collection of excessive amounts of triglycerides and other fats inside liver cells.
Description
Also called steatosis, fatty liver can be a temporary or long-term condition, which is not harmful itself, but may indicate some other type of problem. Left untreated, it can contribute to other illnesses. It is usually reversible once the cause of the problem is diagnosed and corrected. The liver is the organ responsible for changing fats eaten in the diet to types of fat that can be stored and used by the body. Triglycerides are one of the forms of fat stored by the body and used for energy and new cell formation. The break down of fats in the liver can be disrupted by alcoholism, malnutrition, pregnancy, or poisoning. In fatty liver, large droplets of fat, containing mostly triglycerides, collect within cells of the liver. The condition is generally not painful and may go unnoticed for a long period of time. In severe cases, the liver can increase to over three times its normal size and may be painful and tender.
Causes and symptoms
The most common cause of fatty liver in the United States is alcoholism. In alcoholic fatty liver, over consumption of alcohol changes the way that the liver breaks down and stores fats. Often, people with chronic alcoholism also suffer from malnutrition by eating irregularly and not consuming a balanced diet. Conditions that can also cause fatty liver are other forms of malnutrition (especially when there is not enough protein in the diet), obesity, diabetes mellitus, and Reye's syndrome in children. Pregnancy can cause a rare, but serious form of fatty liver that starts late in pregnancy and may be associated with jaundice and liver failure. Some drug overdoses or toxic chemical poisonings, such as carbon tetrachloride, can also cause fatty liver.
Often, there are no symptoms associated with fatty liver. If there are symptoms, they can include pain under the rib cage on the right side of the body, swelling of the abdomen, jaundice, and fever. Symptoms that occur less often in alcoholic fatty liver, but more often in pregnancy related fatty liver, are nausea, vomiting, loss of appetite, and abdominal pain.
Diagnosis
During a physical examination, a doctor might notice that the liver is enlarged and tender when the abdomen is palpated (examined with the tips of the fingers while the patient lies flat). Blood tests may be used to determine if the liver is functioning properly. A liver biopsy, where a small sample of liver tissue is removed with a long needle or though a very small incision, can be used to confirm fatty liver. In pregnant women, the fatty liver condition is usually associated with another serious complication, preeclampsia or eclampsia. In this condition, the mother has seriously high blood pressure, swelling, and possibly, seizures. Laboratory abnormalities include elevations of the SGOT (serum glutamic-oxaloacetic transaminase) and SGPT (serum glutamic pyruvic transaminase). In many cases the alkaline phosphatase will be significantly elevated due to cholestasis produced by the fatty infiltration.
Treatment
Treatment involves correcting the condition that caused fatty liver and providing supportive care. In fatty liver caused by alcoholism, the treatment is to give up drinking alcohol and to eat a healthy, well balanced diet. In fatty liver associated with pregnancy, the recommended treatment is to deliver the baby, if the pregnancy is far enough along. Vitamin and mineral supplements along with nutritional support may be useful.
Prognosis
Fatty liver is usually reversible if recognized and treated. There may be some long-term tendency toward other types of liver problems depending on how long and how severe the fatty liver condition was. In pregnant women with the condition, the situation can be life threatening for both the mother and the infant. Left untreated, there is a high risk of death for both the mother and baby. Severe liver damage that may require a liver transplant can occur in the mother if the condition is not recognized early.
Prevention
Prevention consists of maintaining a well balanced diet and healthy lifestyle with moderate or no alcohol consumption. Pregnant women require good prenatal care so that symptoms can be recognized and treated as early as possible. To prevent Reye's syndrome, children should not be given aspirin to treat symptoms of the flu or other viruses.
BOOKS
"Acute Fatty Liver of Pregnancy." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
"Fatty Liver." The Merck Manual. 16th ed. Rahway, NJ: Merck Research Laboratories, 1992.
"Fatty Liver (Steatosis)." In Professional Guide to Diseases. 5th ed. Springhouse, PA: Springhouse Corporation, 1995.
Friedman, Scott L. "Cirrhosis of the Liver and Its Major Sequelae." In Cecil Textbook of Medicine, ed. J. Claude Bennett and Fred Plum. Philadelphia: W. B. Saunders Co., 1996.
Harrison's Principles of Internal Medicine. Ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
PERIODICALS
Everson, Gregory T. "Liver Problems in Pregnancy: Part 2, Managing Pre-Existing and Pregnancy-Induced Liver Disease." Medscape Women's Health 3, no. 2 (1998).
Altha Roberts Edgren
KEY TERMS
Jaundice—A condition where the skin and whites of the eyes take on a yellowish color due to an increase of bilirubin (a compound produced by the liver) in the blood.
Reye's syndrome—A serious, life-threatening illness in children, usually developing after a bout of flu or chickenpox, and often associated with the use of aspirin. In fatal cases, there is evidence of accumulation of fat in the liver.
Triglycerides—A type of fat consumed in the diet and produced by and stored in the body as an energy source.
