What is ‘Fatty Liver Disease’?
The liver performs a wide variety of functions in the body, this includes; processing what we eat and drink and filtering harmful substances from the blood. Fatty liver or ‘non alcoholic fatty liver disease’ (NAFLD), develops when the body makes too much fat or can’t metabolise fat efficiently enough. The excess fat is stored in liver cells where it accumulates and causes fatty liver disease.
Under the microscope, NAFLD looks just like alcohol-induced fatty liver disease, but it occurs in people who consume little or no alcohol. NAFLD is intimately related to conditions like diabetes and obesity. It’s also linked to an increased risk of cardiovascular disease. Understanding NAFLD and its causes, consequences, and treatment options is still a work in progress.
What are the signs and symptoms?
NAFLD usually doesn’t cause any symptoms and is often first detected by accident when an imaging study (such as an abdominal ultrasound, CT scan, or MRI) is requested for another reason. A fatty liver may also be identified on an imaging test as a part of investigating abnormal liver blood tests. When symptoms occur, they may include fatigue, weakness, weight loss, loss of appetite, nausea and abdominal pain.
Some people with NAFLD go on to develop irreversible liver damage that can result in liver failure and cirrhosis. Symptoms of advanced liver disease include spider-like blood vessels, yellowing of the skin and eyes (jaundice), itching, fluid build up and swelling of the legs (oedema), abdomen (ascites), and mental confusion.
The different stages of NAFLD
- Simple fatty liver (steatosis)- fat starts to build up on the liver.
- NASH (non-alcohol related steatohepatitis) – fat builds up and causes inflammation which can cause damage to the liver.
- Fibrosis-damage progresses and forms lasting scarrs on the liver called fibrosis.
- Cirrhosis- this increases the risk of developing life-threatening liver failure and liver cancer.
Chronic liver disease can severely affect the function of your liver, but early diagnosis can limit further damage. Your doctor will begin by asking you about your medical history and symptoms. You will also undergo a physical exam. In order to diagnose FLD and liver fibrosis, your doctor may order blood tests to evaluate liver function, including tests to assess the level of the liver enzymes ALT and AST, which can be high when the liver is fatty.
Your doctor may also order imaging tests of the liver such as:
- Abdominal Ultrasound
- Computed Tomography (CT scan) of the abdomen and pelvis
- Magnetic resonance imaging (MRI)
- Ultrasound Elastography
- MR Elastography
- Image guided biopsy
A special ultrasound technique to test for liver fibrosis. This is a technology which uses sound-waves to estimate fibrosis, based on the stiffness of the liver and also the fat content within. Fibrotic livers are stiffer and move to a greater degree, compared to normal livers.
What is the treatment of NAFLD?
Treatment for FLD and liver fibrosis varies depending on the cause. Doctors typically recommend treatment aimed at preventing or delaying progression of fibrosis. With treatment, the progression of liver disease can be slowed and may be reversed.
Therapies may include:
- Dietary changes
- Anti-inflammatory medications and medications for insulin resistance
- Cholesterol and diabetes management
- Exercise and weight loss
- Eliminating alcohol use
Your ultrasound appointment
An ultrasound is an excellent, non-invasive way for us to diagnose NAFLD. Once your doctor has identified the need for this exam, they will likely arrange an appointment for you, or provide you with a number to book. At the time of booking your appointment, you will be given instructions for your exam. For an abdominal ultrasound, you will be asked to fast and have nothing to eat or drink (except water) for 6 hours beforehand. Your scan appointment will last roughly 20-30 minutes. Try not to worry if you are asked to attend an abdominal scan; often results show little cause for concern, but the great thing is that these methods are available to put your mind at ease.