Fatty Liver

Some individuals can develop fatty liver. Most people who do not abuse alcohol and have fatty liver are
obese. The term that has been accepted is non-alcoholic fatty liver disease (NAFLD). Fatty liver is called steatosis, and fatty liver with liver inflammation is called or steatohepatitis. Steatosis and steatohepatitis can be caused by alcohol and other drugs and can also sometimes occur in patients with diabetes mellitus. The factors that determine who will develop fatty liver are not known. Some mildly obese and occasional non-obese patients will develop fatty liver while some who are severely obese will not. There is a direct relationship between the metabolic syndrome and NAFLD.

Patients with fatty liver or steatohepatitis usually present to a physician with unexplained elevations in the
serum aminotransferase (ALT/AST) activities. Serum alkaline phosphatase and gamma-glutamyltranspeptidase (GGTP) activities can also be elevated. The patient is usually 10% or more above his/her ideal body weight.

The diagnosis is usually suspected after other causes of hepatitis are excluded. A careful drug and alcohol
history should be taken and serological testing for hepatitis B and C should be performed. A careful family history and appropriate testing if they are suspected should exclude metabolic diseases. Serum protein electrophoresis and testing for autoantibodies should be performed if autoimmune hepatitis is suspected.

Sometimes, patients with fatty liver or steatohepatitis will have elevated serum triglyceride concentrations, however, this is not always the case. If a patient has elevations in serum aminotransferase activities for longer than six months, he/she should have a liver biopsy to make the diagnosis the fatty liver or steatohepatitis. Steatohepatitis can progress to cirrhosis. Treatment (diet and exercise) may stop this progression. Steatosis and steatohepatitis will often improve with weight loss, preferably to near the patient's ideal body weight.

Avoidance of alcohol and potentially hepatotoxic drugs may also be beneficial.
The presence of diabetes mellitus needs to be rules out. In many situations, patients are “glucose
intolerant”, which can be considered a pre-diabetic state. Screening with a four-hour glucose tolerance test
may be scheduled through our office.

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