Medically known as steatohepatitis, fatty liver disease is a condition in which there is an excessive amount of fat in the liver, the body’s largest internal organ.
The condition can be caused by alcohol consumption and by other factors such as obesity, elevated blood glucose, and elevated triglycerides. Fatty liver disease affects roughly twenty-five percent of the world’s population, and the incidence of the disease is increasing with the current obesity epidemic.
Since fatty liver disease often produces no symptoms in its early stages, patients may only find out they have it after undergoing routine tests for another reason.
For example, routine blood tests may show abnormal liver function. Ultrasounds, CT and MRI scans, and elastography tests are generally ordered to detect this condition. While fatty liver disease can’t currently be cured, weight loss is the major recommended treatment option.
Patients may also be given medication to lower their cholesterol, and doctors might recommend testing for diabetes. Diabetes patients who also have fatty liver disease will need to keep their blood sugar under tight control, and it is especially important to avoid alcohol with fatty liver disease.
If left untreated, the condition can cause severe scarring of the liver (cirrhosis) or liver failure, which could necessitate a liver transplant.
Signs and Symptoms of Fatty Liver Disease
The most common symptoms associated with fatty liver disease are outlined below.
1. Upper Right Abdominal Pain
Patients in both the early and late stages of fatty liver disease typically notice upper right abdominal pain. The liver is located in this area, and the pain often begins as a dull ache that comes and goes.
Some patients have described it as a sensation of fullness, and the pain may also radiate to the center of the abdomen. In the later stages of fatty liver disease, the pain becomes more severe, and patients might notice a loss of appetite or vomiting.
To assess upper right abdominal pain, doctors will normally begin with a physical examination of the entire abdomen.
First, they will listen to the abdomen with a stethoscope to detect bowel sounds, and they might then tap over certain areas. This can be useful in estimating the size of the liver itself.
Next, the doctor will press deeply in all quadrants of the abdomen to check for masses, pain, or swelling. Since upper right abdominal pain could indicate several serious conditions, imaging studies are often used to assist in the diagnostic process.
2. Enlarged Liver
An enlarged liver is usually one of the early symptoms of fatty liver disease, and it occurs due to the buildup of fat in this organ. Patients with an enlarged liver might observe enlarged blood vessels just beneath the surface of the skin.
A healthy liver is roughly seven centimeters in women and 10.5 centimeters in men. Increases as small as two to three centimeters could indicate an abnormality.
To estimate the size of the liver, doctors use percussion (tapping) techniques during a physical exam. These techniques are painless and allow the doctor to listen for changes in sound that indicate the presence of an organ.
Exact liver size can be determined with ultrasound, CT, or MRI studies, and patients who have an enlarged liver might need to have these tests repeated regularly to track their progress. Weight loss can sometimes reduce the size of the liver.
3. Chronic Fatigue
Both types of fatty liver disease may trigger chronic fatigue. Patients might notice they feel more tired than what is normal for them after regular activities, including household chores.
They may feel the need to sleep for longer than they usually do at night, and some patients find they need to take naps for several hours during the day too.
Chronic fatigue could severely impact an affected individual’s work or school, and it could result in having to take an extended absence.
Since chronic fatigue could be a sign of several potentially serious conditions, patients should see their primary care doctor if this symptom worsens or persists for longer than two weeks. Keeping a diary of sleep hours and any daytime naps could provide useful information for medical staff.
4. Enlarged Spleen
An enlarged spleen often develops in the later stages of fatty liver disease. Located in the upper left abdominal quadrant, the spleen is normally around five inches long and three inches wide.
Females tend to have smaller spleens than males, and taller individuals have longer spleens than shorter people. Although the spleen may not be felt in healthy individuals, doctors can often identify an enlarged spleen in patients who are ill.
This process generally begins with a physical examination. The doctor will tap the left side of the abdomen to estimate the size of the spleen, and these estimates can be refined with ultrasounds or other imaging studies.
The spleen size may decrease with the treatment of fatty liver disease, and regular ultrasounds can monitor the patient’s status. In rare cases, an enlarged spleen might need to be surgically removed.
Patients in the later stages of fatty liver disease may notice jaundice, a yellowing of the skin or eyes. This symptom indicates the liver is not functioning properly and can no longer filter bilirubin (a yellow liquid) effectively.
Individuals with jaundice might also experience intense itching of the skin, and they could also develop redness of the palms and abdominal swelling.
Since jaundice could be a sign of liver cancer, patients who observe any changes in their skin color should see a doctor if these do not resolve within a week, especially if skin itchiness is also present.
The doctor will do a visual inspection of the skin and the whites of the eyes, and blood tests will likely be ordered to assess liver function.
While jaundice itself does not require treatment in adult patients, determining and treating the underlying cause of this symptom typically improves symptom management, and some patients might even be able to reverse their jaundice completely.