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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).

Recently, there has been a movement to change the name to METABOLIC ASSOCIATED FATTY LIVER DISEASE, or MAFLD. This name change is being done to better reflect the understanding of fatty liver disease, realizing that the majority of these patients have "metabolic syndrome", the driving force behind many of the fatty liver cases.

Fatty liver is called steatosis, and fatty liver with liver inflammation is called NASH or steatohepatitis. Steatosis and steatohepatitis can be caused by alcohol and other drugs and can also 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.

Dr. Joe Galati's new book, EATING YOURSELF SICK, address obesity and fatty liver disease in detail.

The diagnosis is usually suspected after other causes of hepatitis are excluded. A careful medication 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.

Left untreated, fatty liver, in select cases, may progress to cirrhosos, liver cancer, and liver failure. Unfortunately, premature death is a common complication in fatty liver. In the most advanced cases, liver transplantation may be required.


Obesity and Fatty Liver Disease

Obesity, and all of its related complications, is more serious than most adults in America believe. More than one-third (34.9% or 78.6 million) of U.S. adults are obese. Obesity-related conditions include heart disease, stroke, type 2 diabetes, fatty liver disease, and certain types of cancer, are some of the leading causes of preventable death. We are seeing an increase in the number of young children and adolescents developing obesity, and all of the related complications.

The cost of obesity is staggering, with annual medical cost of obesity exceeding $147 billion in 2008 U.S. dollars. The medical costs for people who are obese were $1,429 higher than those of normal weight.

Dr. Galati and the Liver Specialists of Texas team are dedicated to evaluate, treat, and manage all aspects of obesity and non-alcoholic fatty liver disease (NAFLD and NASH), including the complication of cirrhosis and liver failure. Developing a customized plan of care for each patient they see is their objective.

Liver Transplant Resources

Dr. Galati has been involved in Liver Transplantation since 1989. As Medical Director for the Center for Liver Disease and Transplantation at Houston Methodist Hospital, Dr. Galati has cared for thousands of patients with advanced liver disease. In those with the most severe form of advanced liver disease and cirrhosis, liver transplantation is a life-saving surgery. For more information on liver transplantation, click here.

Indications for liver transplant include:

Online LIVER Second Opinion

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    From the comfort of your home, without the need to spend additional money on travel, lodging, and food, receive and expert second opinion from the expert physicians at Liver Specialists of Texas

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    There are five steps in the process of requesting a second opinion. We anticipate the steps will take you about 30-65 minutes to complete.

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    Have your medical records or those of your loved one on hand as you fill out the medical history questionnaire portion of the online process. The medical history questionnaire is detailed so having medical records to quickly reference will help make the process more efficient.

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    To start the process of an Online Liver Second Opinion, please fill out the initial contact form and fax back to our office. A representative from our office will call you for additional details.