Fatty Liver

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Fatty Liver

Maryum Firdaus

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"I was quite shocked when neither the radiologist nor the doctor explained me what this fatty liver was except that consider it near normal" said Mrs. Khan. "if this is nothing to worry or is normal then why am I having pain in my upper abdomen just below my ribs?"

This is the story of almost 80% of the patients visiting the doctors for ultrasound of their abdomen and are labelled to have fatty liver, where radiologist is the first health professional to counsel the patient regarding this normal to appear disease entity which has no drugs available for treatment and only patient can cure and prevent this disease process.

According to a survey at radiology department, out of 50 patients, who presented for ultrasound abdomen and diagnosed to have fatty liver, 38 patients were diagnosed with the fatty liver as asymptomatic incidental finding and 12 patients were symptomatic.

Fatty liver is the accumulation of abnormal amounts of fat in liver cells exceeding more than 5% of weight of liver. In Pakistan the most common cause of fatty liver is obesity and protein malnutrition while other causes include starvation, rapid weight loss, diabetes mellitus, hyperlipidemia, drugs (alcohol, steroids, OCP's and tetracycline etc.)

Three common types of this disease which must be considered in our country include:

    a)     Non alcoholic fatty liver: earliest stage of fatty liver in which abnormal amount of fat is accumulated
            in liver cells without causing damage.

    b)     Non alcoholic steatohepatitis: fat causing liver to swell and eventually scarring and liver failure.
    c)     Acute fatty liver of pregnancy.

A radiologist and general practitioners must know the symptoms and when to advise the patient to get follow up with medical specialist is very important. In fatty liver wide spectrum of symptoms is seen from asymptomatic to lethargy, nausea, vomiting, appetite loss, jaundice and pain in upper outer quadrant of abdomen.

If fat in your liver causes the liver to swell then it is called steatohepatitis i.e. inflammation of liver cells thus leading to deranged liver function tests, if left untreated, it may lead to scarring(cirrhosis), tumour (hepatocellular carcinoma) and liver failure in which patient is left with no option of treatment other than liver transplantation as an only hope for survival.

Fortunately, this disease entity is preventable as well as treatable with lifestyle modification, seldomly requiring supportive therapy, however no definite drug is available to treat fatty liver.

Changing the lifestyle is the only key to preventing, as well as treating fatty liver. Reducing the fat intake, alcohol intake is the most valuable in managing fatty liver. Increasing the amount of fresh fruits, vegetables and lean meat like fish and chicken, instead of red meat is also beneficial. Adding physical activity of one hour four times a week at least and treating the risk factors show promising results of liver regeneration.

Gradual and sustained weight loss of at least 5-10% causes reduction of accumulated fat in liver cells while more than 10% weight reduction causes liver inflammation to settle.

Fortunately, many cases of fatty liver don't end in liver failure due to the fact that liver can regenerate very well if necessary steps are taken before the development of complications. Monitoring liver function tests in such cases is a good tool to evaluate prognosis if there is associated inflammation of liver.

Currently scientists are working on drugs to treat fatty liver but till then, patients and the general population must consider preventive approach and lifestyle modifications to prevent this disease process to progress to complications. General population must be educated by putting in special efforts by the representatives of heath department to select healthy lifestyle and a diet which is well balanced with less fats and a lot of fruits and vegetables selected to meet the needs of every individual.

A professional dietician must plan a meeting with masses involved in this issue of fatty liver and discuss with them the ways to deal with their symptoms and to know the basic problems they can face with these symptoms, instead of going to quacks and get them mistreated by prescription of excessive medications like proton pump inhibitors, domeperidone etc. which can lead to worsening of symptoms in the long run.

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