NON-ALCOHOLIC FATTY LIVER DISEASE

 

Let’s explore non-alcoholic fatty liver disease (NAFLD):

  • Non-alcoholic fatty liver disease is characterized by accumulation of fat in the liver.
  • It is more common in patients with diabetes.
  • Metabolic syndrome comprised of central obesity, diabetes mellitus, hypertension and hyperlipidemia are closely associated with fatty liver disease.

Signs & Symptoms

Like most chronic liver conditions, patients with NAFLD are asymptomatic until late in their illness even after progression to cirrhosis. Most patients are rather diagnosed incidentally. NAFLD’s causescould include:

  • Enlarged liver
  • Fatigue
  • Pain in the upper right abdomen

Some other symptoms include:

  • Jaundice,
  • altered consciousness,
  • fluid accumulation in the abdomen (ascites) and legs,

In the case of end stage patients, signs include:

  • blood vomit and black stools
  • Malnourishment and extreme weakness
  • presence of cirrhosis

As with non-alcoholic steatohepatitis and cirrhosis(advanced scarring), possible signs and symptoms include:

  • Abdominal swelling (ascites)
  • Enlarged blood vessels just beneath the skin's surface
  • Enlarged breasts in men
  • Enlarged spleen
  • Red palms
  • Yellowing of the skin and eyes (jaundice)

Causes

Experts are unable to determine how some people end up accumulating fat droplets with the liver cells. In the same manner, there is very less understanding how some fatty livers develop inflammation that progresses to cirrhosis. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis are often linked to:

  • Overweight or obesity
  • Insulin resistance (which means cells don't take up sugar in response to the hormone insulin)
  • High blood sugar
  • High levels of fats, particularly triglycerides, in the blood

In some people, the presence of excess fat acts as toxin to liver cells, causing liver and inflammation, which sets off a process leading to scarring and eventually cirrhosis.

Experts tend to believe that many cases of cirrhosis of unknown cause are probably due to NAFLD.

Risk Factors

A wide range of diseases and conditions can increase your risk of NAFLD, including:

  • High cholesterol
  • High levels of triglycerides in the blood
  • Metabolic syndrome
  • Obesity, particularly when fat is concentrated in the abdomen
  • Polycystic ovary syndrome
  • Sleep apnea
  • Type 2 diabetes
  • Underactive thyroid (hypothyroidism)
  • Underactive pituitary gland (hypopituitarism)

Non-alcoholic steatohepatitis is more likely in these groups:

  • Older people
  • People with diabetes
  • People with body fat concentrated in the abdomen

It is difficult to distinguish non-alcoholic fatty liver disease from non-alcoholic steatohepatitis without appropriate testing.

Prevention

To reduce your risk of non-alcoholic fatty liver disease:

  • Healthy diet: Choose a healthy plant-based diet that's rich in fruits, vegetables, whole grains and healthy fats.
  • Maintain a healthy weight: If you are overweight or obese, reduce the number of calories you eat each day and get more exercise. If you have a healthy weight, work to maintain it by choosing a healthy diet and exercising.
  • Exercise: Exercise most days of the week. Get an OK from your doctor first if you haven't been exercising regularly.
 

DIAGNOSIS

 

In most cases, as described earlier, NAFLD never shows itself until later stages. Risk factors such as obesity, diabetes, hypertension indicate the possible presence of NAFLD. Generally, doctors prescribe blood tests to pinpoint the diagnosis and indicate severity of the disease. The blood tests include:

  • Complete blood count
  • Liver enzyme and liver function tests
  • Tests for chronic viral hepatitis (hepatitis A, hepatitis C and others)
  • Celiac disease screening test
  • Fasting blood sugar
  • Hemoglobin A1C, which shows how stable your blood sugar is
  • Lipid profile, which measures blood fats, such as cholesterol and triglycerides

Blood tests in the early stage of NAFLD may show slightly elevated liver enzymes (AST and ALT) but this condition can exist even with normal liver function tests.

For further testing, doctors recommend imaging procedures. Imaging procedures used to diagnose nonalcoholic fatty liver disease include:

  • Plain ultrasound, which is often the initial test when liver disease is suspected.
  • Computerized tomography (CT) scanning or magnetic resonance imaging (MRI) of the abdomen. These techniques lack the ability to distinguish nonalcoholic steatohepatitis from nonalcoholic fatty liver disease, but still may be used.
  • Transient elastography, an enhanced form of ultrasound that measures the stiffness of your liver. Liver stiffness indicates fibrosis or scarring.
  • Magnetic resonance elastography, which combines magnetic resonance imaging with patterns formed by sound waves bouncing off the liver to create a visual map showing gradients of stiffness throughout the liver reflecting fibrosis or scarring.
  • Ultrasound abdomen is readily available, is non-invasive and inexpensive. It may show a ‘bright liver’ suggestive of fatty liver. However, it is not a sensitive test until the fat in the liver is moderate to severe and abdominal obesity reduces its accuracy. Fibroscan (transient elastography) is a new tool that measures liver stiffness. It identifies fibrosis (scarring) and also the progression of fibrosis that occurs as a consequence of NAFLD. It is simple to use, non-invasive, inexpensive and reproducible.

Finally, liver biopsy is the best test for detection and assessing the severity of fatty liver. However, it is an invasive procedure and is not commonly used. A combination of clinical parameters, liver enzymes, and ultrasound are used to diagnose fatty liver disease.

 

TREATMENT OPTIONS

 

Life style modification is the most important aspect of treatment for fatty liver disease. This involves weight loss through change in dietary habit and exercise. Weight loss of 5-10% over 6 months has been shown to improve NAFLD and obesity. Too rapid a weight loss by starvation is not recommended as it may worsen the problem. Lifestyle changes include:

  • Diet: Diet rich in carbohydrates and saturated fats should be avoided. Most fast-food and aerated soft drinks increase liver fat, worsen liver injury and should be avoided. Diets rich in fruits & vegetables with limited red meat consumption are recommended.
  • Exercise: Regular exercise such as brisk walking, jogging or swimming helps weight reduction, improvement in liver enzymes and decreases the risk of diabetes. Moderate exercise with expenditure of at least 400 calories, 3-4 times a week improves NAFLD in the short term.

Medication

  • Medications: A variety of drugs have been used to treat this condition with unimpressive results and sometimes serious side effects. Some new drugs such as Losartan and Exenetide show promise but are still under evaluation. Herbal medications for weight loss are notorious for causing further liver damage and should be avoided.

Surgical

  • Bariatric surgery: Bariatric surgery may be considered for morbidly obese (BMI>40) patients who are otherwise unable to lose weight by other measures. Most of these procedures can now be done by key-hole surgeries. However, careful evaluation of the severity and stage of liver disease is necessary as bariatric surgery is contraindicated in patients with advanced liver disease. In such patients, sudden deterioration in liver function can occur.
  • Liver Transplantation: Liver transplantation is indicated in patients with end stage cirrhosis due to fatty liver disease that develops complications such as liver failure or liver tumors.

Why RIMC

RIMC is emerging as the most sough-after destination for all medical problems concerning liver. It is touted to be one of the best know medical facility to address liver disease across the globe.

  • Advantages/ Expertise: Expert doctors who have done conducive research and have extensive experience in treating NAFLD are part of RIMC.

 

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