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Fatty
Liver (NASH)
Disease condition
Fatty liver is the accumulation
of fat in liver cells. Simple fatty liver is not a
disease, since it does not damage the liver. Another
term often used to describe this condition is fatty
infiltration of the liver.
Fatty liver is also known as NASH, which stands for
non- alcoholic steatorrhoeic hepatosis or non-alcoholic
fatty liver Disease (NAFLD). Fatty liver is the collection
of excessive amounts of triglycerides and other fats
inside liver cells. Fatty liver disease can range
from fatty liver alone (steatosis) to fatty liver
associated with inflammation (steatohepatitis).
It resembles alcoholic liver disease, but occurs occur
with the use of alcohol (alcohol-related fatty liver)
or in the absence of alcohol (nonalcoholic fatty liver
disease).
The major feature in NASH is fat in the liver, along
with inflammation and damage. Most people with NASH
feel well and are not aware that they have a liver
problem. Nevertheless, NASH can be severe and can
lead to cirrhosis, in which the liver is permanently
damaged and scarred and no longer able to work properly.
Disease Etiology:
Fat accumulates in the liver usually in connection
with heavy use of alcohol, extreme weight gain or
diabetes mellitus.
Fatty liver can also occur with poor diet and
certain illnesses, such as tuberculosis, intestinal
bypass surgery for obesity, and certain drugs such
as corticosteroids.
It most often occurs in persons who are middle-aged
and overweight or obese.
Many patients with NASH have elevated blood lipids,
such as cholesterol and triglycerides, and many
have diabetes or pre-diabetes, but not every obese
person or every patient with diabetes has NASH.
Some patients with NASH are not obese, do not have diabetes,
and have normal blood cholesterol and lipids. NASH can
occur without any apparent risk factor and can even
occur in children. Thus, NASH is not simply obesity
that affects the liver.
Symptoms
NASH is usually a silent disease with few or no symptoms.
Patients generally feel well in the early stages and
only begin to have symptoms--such as
Fatigue
Weight loss
Weakness
Once the disease is more advanced or cirrhosis develops.
The progression of NASH can take years, even decades.
The process can stop and, in some cases, reverse on
its own without specific therapy.
Or NASH can slowly worsen, causing scarring or "fibrosis"
to appear and accumulate in the liver. As fibrosis worsens,
cirrhosis develops; the liver becomes seriously scarred,
hardened, and unable to function normally.
Not every person with NASH develops cirrhosis, but once
serious scarring or cirrhosis is present, few treatments
can halt the progression. A person with cirrhosis experiences
fluid retention, muscle wasting, bleeding from the intestines,
and liver failure.
Diagnosis
NASH is a condition that can be identified by
taking a sample of liver tissue (liver biopsy) and examining
it under a microscope.
NASH is usually first suspected in a person who is found
to have elevations in liver tests that are included
in routine blood test panels, such as alanine aminotransferase
(ALT) or aspartate aminotransferase (AST).
When further evaluation shows no apparent reason
for liver disease (such as medications, viral hepatitis,
or excessive use of alcohol) and when x-rays or
imaging studies of the liver show fat, NASH is suspected.
The only means of proving a diagnosis of NASH
and separating it from simple fatty liver is a liver
biopsy.
NASH is diagnosed when examination of the tissue
under the microscope shows fat along with inflammation
and damage to liver cells. If there is fat without
inflammation and damage, simple fatty liver or NAFLD
is diagnosed.
An important piece of information learned from
the biopsy is whether scar tissue has developed
in the liver. Currently, no blood tests or scans
can reliably provide this information.
Treatment – Medical,
Surgical
Medical Treatment:
reduce their weight (if obese or overweight)
follow a balanced and healthy diet
increase physical activity
avoid alcohol
avoid unnecessary medications
Patients with NASH often have other medical conditions,
such as diabetes, high blood pressure, or elevated cholesterol.
These conditions should be treated with medication and
adequately controlled; having NASH or elevated liver
enzymes should not lead people to avoid treating these
other conditions.
Experimental approaches under evaluation in patients
with NASH include antioxidants, such as vitamin E, selenium,
and betaine.
Surgical Treatment:
Liver transplantation is the only treatment for advanced
cirrhosis with liver failure, and transplantation
is increasingly performed in people with NASH.
Life expectancy and
Quality of Life Left untreated, it can contribute
to other illnesses. It is usually reversible once
the cause of the problem is diagnosed and corrected.
Recent studies indicate that NASH can result in the
development of fibrous tissue in the liver (fibrosis)
in up to 40% of patients or cirrhosis in 5-10% of
patients. It is not certain why some NASH patients
will progress to this serious form of chronic liver
disease while others do not. Studies report that the
progression to fibrosis or cirrhosis for NASH patients
is variable but can occasionally occur in less that
20 years.
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