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Date Posted:05:59:42 02/22/03 Sat
Fatty Liver --- Part 2
Known Causes of Fatty Liver
* Chemicals and drugs (such as alcohol, corticosteroids, tetracyclines, valproic acid, methotrexate, carbon tetrachloride, and yellow phosphorus)
* Malnutrition and a diet that is deficient in protein
* Vitamin A toxicity
* Bypass surgery of the small intestine
* Cystic fibrosis (most likely accompanied by malnutrition)
* Hereditary defects in glycogen, galactose, tyrosine, or homocystine metabolism
* Medium-chain aryldehydrogenase deficiency
* Cholesterol esterase deficiency
* Phytanic acid storage disease (Refsum's disease)
* Reye's syndrome
Fatty liver is an excessive accumulation of fat (lipid) inside the liver cells. Sometimes the cause of fatty liver is not known, especially in newborns. In general, the known causes injure the liver in some way.
Fatty liver usually produces no symptoms. Rarely, it causes jaundice, nausea, vomiting, pain, and abdominal tenderness.
A physical examination that reveals an enlarged liver without any other symptoms suggests fatty liver. The diagnosis may be confirmed by performing a liver biopsy, in which a long hollow needle is used to obtain a small tissue sample for examination under a microscope.
The mere presence of excessive fat in the liver is not a serious problem. Treatment aims at eliminating the cause or treating the underlying disorder. Repeated liver injury from toxic substances such as alcohol may eventually progress from fatty liver to cirrhosis.
Alcoholic Liver Disease
Alcoholic liver disease is damage to the liver that results from excessive drinking of alcohol.
Alcoholic liver disease is a common, preventable health problem. In general, the amount of alcohol consumed (how much and how often) determines the risk and the degree of liver damage. Women are more vulnerable to liver damage than men. In women who drink over a period of years, the equivalent of as little as 2/3 of an ounce of pure alcohol a day (6½ ounces of wine, 13 ounces of beer, or 2 ounces of whiskey) can cause liver damage. In men who drink over a period of years, the equivalent of as little as 2 ounces a day (20 ounces of wine, 40 ounces of beer, or 6 ounces of whiskey) can cause liver damage. However, the amount of alcohol that causes liver damage varies from person to person.
Alcohol may cause three types of liver damage: fat accumulation (fatty liver), inflammation (alcoholic hepatitis), and scarring (cirrhosis).
Alcohol also provides calories without essential nutrients, decreases the appetite, and causes poor absorption of nutrients because of its toxic effects on the intestine and pancreas. As a result, people who regularly drink alcohol without eating properly develop malnutrition.
Symptoms and Diagnosis
In general, symptoms depend on how long and how much a person has been drinking. Heavy drinkers usually first develop symptoms during their 30s and tend to develop severe problems by their 40s. In men, alcohol may produce effects similar to those produced by too much estrogen and too little testosterone--shrunken testes and breast enlargement.
People with liver damage from fat accumulation (fatty liver) usually have no symptoms. In a third of these people, the liver is enlarged and occasionally tender.
Inflammation of the liver induced by alcohol (alcoholic hepatitis) may produce a fever, jaundice, an increased white blood cell count, and a tender, painful, enlarged liver. The skin may develop spiderlike veins.
A person who has liver damage with scarring (cirrhosis) may have few symptoms or the features of alcoholic hepatitis. Such a person also may have complications of alcoholic cirrhosis: portal hypertension with spleen enlargement, ascites (fluid accumulation in the abdominal cavity), kidney failure from liver failure (hepatorenal syndrome), confusion (one of the main symptoms of liver encephalopathy), or liver cancer (hepatoma). To confirm the diagnosis of alcoholic liver disease in some cases, a doctor performs a liver biopsy. In this procedure, a hollow needle is inserted through the skin and a tiny piece of liver tissue is removed for examination under a microscope.
In people with alcoholic liver disease, the results of liver function tests may be normal or abnormal. However, blood levels of one liver enzyme, gamma-glutamyl transpeptidase, may be particularly high in people who abuse alcohol. Also, the person's red blood cells tend to be larger than normal, a telltale sign. Platelet levels in the blood may be low.
Prognosis and Treatment
If the person continues to drink alcohol, liver damage will progress and probably be fatal. If the person stops drinking, some of the liver damage (except that from scarring) may repair itself, and chances are good that the person will live longer.
The only treatment for alcoholic liver disease is to stop drinking alcohol. Doing so can be extremely difficult, and most people need to participate in a formal program to stop drinking, such as Alcoholics Anonymous.
Abnormal Liver Test
When doctors cannot find a cause for a patient's abnormal liver tests, they often make a diagnosis of fatty liver. A recent report in the British medical journal, Lancet, shows that "fatty livers" should be treated because they often go on to cause permanent liver damage.
Ten years ago, it was far more common for doctors to be unable to find a cause for many cases of abnormal liver tests. Then doctors discovered the virus that causes hepatitis C. People who do not receive treatment for chronic hepatitis C infection are at increased risk for developing liver damage and they also have a 10% chance of developing liver cancer.
Doctors should do a complete evaluation of all patients who have abnormal liver tests. Even today, doctors often cannot find a cause for many cases of abnormal liver tests, so many tell these patients that they have "fatty livers" and that they do not need to worry about it. This study shows that many of these people will go on to suffer permanent liver damage.
People who have abnormal liver tests because they drink alcohol should stop drinking alcohol immediately. Those who have abnormal liver tests and high blood cholesterol or triglyceride levels/ or are overweight/ should be placed on a severely restricted low-fat, high-fiber diet.
They should be told that the diagnosis of fatty liver means that they can develop severe liver damage in the future. If they lose weight and lower their triglyceride and cholesterol levels/ and still have abnormal liver tests, they should be evaluated by a gastroenterologist.
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