Fatty Liver (cont.)
Bhupinder Anand, MD
In this Article
How is nonalcoholic fatty liver disease diagnosed?
Fatty liver generally does not cause symptoms, and any symptoms if present 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 NAFLD is diagnosed is by imaging studies - ultrasonography, computerized tomography (CT), magnetic resonance imaging (MRI)--that are obtained for reasons other than diagnosing NAFLD. NAFLD 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 50% of cryptogenic cirrhosis occurs in patients with obesity and/or diabetes and probably is due to NASH.
Reviewed by Bhupinder Anand, MD on 3/14/2013
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Fatty Liver - Symptoms Question: The symptoms of fatty liver can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
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