Fatty Liver (Nonalcoholic Fatty Liver Disease, Nonalcoholic Steatohepatitis)

  • Medical Author:
    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

  • Medical Editor: Bhupinder Anand, MD

How is nonalcoholic fatty liver disease diagnosed?

As previously discussed, fatty liver generally does not cause symptoms or signs, and any symptoms and signs are more likely to be due to the accompanying diseases such as obesity, diabetes, vascular disease, etc. In anyone with obesity or diabetes, fatty liver should be suspected. In a minority of patients, abnormal liver tests are found on routine blood testing although the abnormalities usually are mild. Probably the most common method by which nonalcoholic fatty liver disease is diagnosed is by imaging studies like ultrasonography, computerized tomography (CT), and magnetic resonance imaging (MRI); that are obtained for reasons other than diagnosing nonalcoholic fatty liver disease. Nonalcoholic fatty liver disease also may be discovered when patients develop complications of the liver disease - cirrhosis, liver failure and liver cancer - due to the presence of NASH.

It is not possible to distinguish between isolated fatty liver and NASH with imaging studies. Although a combination of several blood tests has been suggested as a means of separating the two, and tests are being developed to identify NASH, biopsy of the liver is the best means to differentiate between the presence of fat, or fat and inflammation (NASH). Although the majority of individuals will have isolated fatty liver and not NASH, it is important to identify patients with NASH, because of the need to look for complications of liver disease and to enter these patients into trials of treatment with the hope of preventing progression of the liver disease. Patients with the metabolic syndrome, obesity, and diabetes are good candidates to undergo biopsy of the liver since the incidence of NASH is higher among these groups.

One of the difficulties in diagnosing NASH as the cause of severe scaring or cirrhosis is that as the scaring progresses to cirrhosis, the fat disappears. This results in a condition that is referred to as cryptogenic cirrhosis, cirrhosis in which there is no clear cause. (Specifically, in cryptogenic cirrhosis the two most common causes of cirrhosis - alcohol and viral hepatitis - are not involved.) Cryptogenic cirrhosis has puzzled physicians for many years as to its cause. However, it now appears that half of cryptogenic cirrhosis occurs in patients with obesity and/or diabetes and probably is due to NASH.

What is the treatment for nonalcoholic fatty liver disease?

Treatment for nonalcoholic fatty liver disease includes

Medically Reviewed by a Doctor on 8/5/2016
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