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Fatty Liver is a fairly common finding, often an incidental finding on a sonogram or on a liver biopsy done to evaluate pain, or abnormal liver function tests. It can be caused by a variety of different problems.
The most common cause of fatty liver is chronic alcoholism. Alcohol taken in large and frequent amounts is a direct liver toxin; that is, it is poisonous to the liver cells, and the cells develop large vacuoles, or bubbles filled with fat. Other toxins that can produce a fatty liver are carbon tetrachloride and the ingestion of DDT.
Poorly controlled type 2 diabetes is another common cause of fatty liver, especially in overweight diabetics. Weight loss and proper control of diabetes will generally reverse this fatty infiltration of the liver and it is seldom of clinical significance. Poorly controlled diabetics are much more likley to get into trouble from heart, kidney, eye and nerve complications of their diabetes than from fatty liver.
A third common cause of fatty liver is simply obesity and this will become increasingly true if the statistics on obesity continue to get worse. Accumulating fat elsewhere in the body is often associated with accumulation of fat in the liver cells. This is totally reversible if weight can be lost.
Other common causes of fatty liver includes long-term treatment with cortisone-type drugs or methotrexate, a drug used in some cancer chemotherapy and also commonly used in the treatment of rheumatoid arthritis. People who can't eat and are being maintained on total IV nutrition often develop fatty livers; very severe mainutrition, paradoxically, can also cause this condition.
In most cases, the fatty liver does not cause symptoms and is discovered accidentally, or while trying to determine the cause of liver function abnormalities found on routine blood testing. Mild elevations of the enzymes that make up the liver function test are often seen. These may be the alkaline phosphatase and/or the SGOT or SGPT (also know as ALT and AST) test. Mild pain under the ribs on the right are occasionally reported, but I would doubt that the severe pains would come from fatty liver.
Alcoholics who on a prolonged and severe binge may develop fatty infiltration rapidly, and the rapid swelling of the liver can be more painful, but most of the causes of this condition cause a slow infiltration of fat, and pain is minimal. In all the cases mentioned, the fatty liver can be reversed by treating the underlying condition, usually with no permanent damage to the liver, and no bad prognosis. The exception would be chronic alcoholism where a significant degree of cirrhosis has also occurred. Cirrhosis cannot be reversed, but the fatty liver can.
The development of a fatty liver and/or abnormal liver function test in a drinker, a diabetic, or an obese person should be taken as a warning sign that the condition has been allowed to progress too far, and control of the drinking, the diabetes, or the obesity needs to be achieved before other, more serious and prehaps not correctable complications begin.
Summary Fatty liver is simply the build-up of fat in the liver. Fat in the liver usually does not cause liver damage. However, certain other conditions and diseases can be associated with the development of fatty liver. Research is ongoing to uncover what processes may take place to trigger fat build-up in the liver. This condition is usually reversible when the underlying causes are treated or removed. Patients who follow the advice of their physicians can expect to reverse and control a fatty liver or steatohepatitis.
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