Fatty liver overview: Difference between revisions
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{{Fatty liver}} | {{Fatty liver}} | ||
{{CMG}} | {{CMG}}; {{AE}} | ||
==Overview== | ==Overview== | ||
Fatty liver is a type of [[liver disease]], characterized by [[inflammation]] of the [[liver]] with concurrent [[fat]] accumulation in liver ("steato", meaning fat, "[[hepatitis]]", meaning inflammation of the liver). Classically seen in alcoholics, steatohepatitis also is frequently found in people with [[diabetes]] and [[obesity]]. When not associated with excessive [[alcohol]] intake, it's referred to as [[non-alcoholic steatohepatitis]], or NASH. Steatohepatitis of either [[etiology]] may progress to [[cirrhosis]], and NASH is now believed to be a frequent cause of unexplained cirrhosis. | |||
Physicians do not well manage fatty liver<ref name="pmid37208593">{{cite journal| author=Shelley K, Articolo A, Luthra R, Charlton M| title=Clinical characteristics and management of patients with nonalcoholic steatohepatitis in a real-world setting: analysis of the Ipsos NASH therapy monitor database. | journal=BMC Gastroenterol | year= 2023 | volume= 23 | issue= 1 | pages= 160 | pmid=37208593 | doi=10.1186/s12876-023-02794-4 | pmc=10197394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37208593 }} </ref>. | |||
==Historical Perspective== | |||
==Classification== | |||
==Pathophysiology== | ==Pathophysiology== | ||
Fatty liver is the fatty degeneration of the parenchymal cells causing a yellow discoloration of the liver. It is a reversible condition where large [[vacuole]]s of [[triglyceride]] fat accumulate in [[hepatocyte|liver cells]] via the process of [[steatosis]]. Despite having multiple causes, fatty liver disease (FLD) can be considered a single [[disease]] that occurs worldwide in those with excessive [[alcohol]] intake and those who are obese (with or without effects of [[insulin resistance]]). The condition is also associated with other diseases that influence fat [[metabolism]].<ref name="reddy">{{cite journal |author=Reddy JK, Rao MS |title=Lipid metabolism and liver inflammation. II. Fatty liver disease and fatty acid oxidation |journal=Am. J. Physiol. Fatty liver disease is one of the most deadly dieases ever to be found in someone who has and its very contasious so if someons has if i were u i wouldnt be hanging around with them well thats all from me see u next time. ËĒȲȳǖGastrointest. Liver Physiol. |volume=290 |issue=5 |pages=G852-8 |year=2006 |pmid=16603729 |doi=10.1152/ajpgi.00521.2005}}</ref | Fatty liver is the fatty degeneration of the parenchymal cells causing a yellow discoloration of the liver. It is a reversible condition where large [[vacuole]]s of [[triglyceride]] fat accumulate in [[hepatocyte|liver cells]] via the process of [[steatosis]]. Despite having multiple causes, fatty liver disease (FLD) can be considered a single [[disease]] that occurs worldwide in those with excessive [[alcohol]] intake and those who are obese (with or without effects of [[insulin resistance]]). The condition is also associated with other diseases that influence fat [[metabolism]].<ref name="reddy">{{cite journal |author=Reddy JK, Rao MS |title=Lipid metabolism and liver inflammation. II. Fatty liver disease and fatty acid oxidation |journal=Am. J. Physiol. Fatty liver disease is one of the most deadly dieases ever to be found in someone who has and its very contasious so if someons has if i were u i wouldnt be hanging around with them well thats all from me see u next time. ËĒȲȳǖGastrointest. Liver Physiol. |volume=290 |issue=5 |pages=G852-8 |year=2006 |pmid=16603729 |doi=10.1152/ajpgi.00521.2005}}</ref> Morphologically it is difficult to distinguish alcoholic FLD from non alcoholic FLD and both show micro-[[Vesicle (biology)|vesicular]] and macrovesicular fatty changes at different stages. | ||
==Causes== | |||
==Differentiating Fatty liver from Other Diseases== | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Fatty liver disease is prevalent among 10%- 24% of general population in various countries<ref name="angulo"/> | Fatty liver disease is prevalent among 10%- 24% of general population in various countries.<ref name="angulo"/> However among obese individuals the condition is observed in up to 75% of people, 35% of whom, despite no evidence of excessive alcohol consumption, will lead to [[Non-alcoholic fatty liver disease|non alcoholic FLD]].<ref>{{cite journal |author=Hamaguchi M, Kojima T, Takeda N, Nakagawa T, Taniguchi H, Fujii K, Omatsu T, Nakajima T, Sarui H, Shimazaki M, Kato T, Okuda J, Ida K |title=The metabolic syndrome as a predictor of nonalcoholic fatty liver disease |journal=Ann. Intern. Med. |volume=143 |issue=10 |pages=722-8 |year=2005 |pmid=16287793 |doi=}}</ref> It is the most common cause of abnormal [[liver function test]] in the US.<ref name="angulo">{{cite journal |author=Angulo P |title=Nonalcoholic fatty liver disease |journal=N. Engl. J. Med. |volume=346 |issue=16 |pages=1221-31 |year=2002 |pmid=11961152 |doi=10.1056/NEJMra011775}}</ref> African Americans and Mexican Americans have higher frequencies of unexplained serum [[Transaminase|aminotransferase]] elevations than those reported in whites but prevalence of FLD among different racial groups is not known. | ||
==Risk Factors== | |||
==Screening== | |||
==Natural History, Complications, and Prognosis== | |||
===Natural History=== | |||
===Complications=== | |||
===Prognosis=== | |||
==Diagnosis== | ==Diagnosis== | ||
===History and Symptoms=== | |||
===Physical Examination=== | |||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
Most individuals are asymptomatic and are usually discovered incidentally because of abnormal liver function tests or hepatomegaly noted in unrelated medical condition. Elevated liver biochemistry is found in 50% of patients with simple steatosis.<ref>{{cite book | last = Sleisenger | first = Marvin | title = Sleisenger and Fordtran's Gastrointestinal and Liver Disease | publisher = W.B. Saunders Company | location = Philadelphia | year = 2006 | isbn = 1416002456 }}</ref> The serum [[Alanine transaminase|ALT]] level usually is greater than the [[AST]] level in non-alcoholic variant and the opposite in alcoholic FLD. | Most individuals are asymptomatic and are usually discovered incidentally because of abnormal liver function tests or hepatomegaly noted in unrelated medical condition. Elevated liver biochemistry is found in 50% of patients with simple steatosis.<ref>{{cite book | last = Sleisenger | first = Marvin | title = Sleisenger and Fordtran's Gastrointestinal and Liver Disease | publisher = W.B. Saunders Company | location = Philadelphia | year = 2006 | isbn = 1416002456 }}</ref> The serum [[Alanine transaminase|ALT]] level usually is greater than the [[AST]] level in non-alcoholic variant and the opposite in alcoholic FLD. | ||
===Imaging Findings=== | |||
===Other Diagnostic Studies=== | |||
==Treatment== | ==Treatment== | ||
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The treatment of fatty liver depends on what is causing it, and generally, treating the underlying cause will reverse the process of steatosis if implemented at early stage. Recent studies suggest that [[diet (nutrition)|diet]], [[exercise]], and especially [[anti-diabetic drug|antiglycemic drug]]s may alter the course of the disease. A [[randomized controlled trial]] found that [[pioglitazone]] led to metabolic and histologic improvement in subjects with nonalcoholic steatohepatitis.<ref name="pmid17135584">{{cite journal |author=Belfort R, Harrison SA, Brown K, ''et al'' |title=A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis |journal=N. Engl. J. Med. |volume=355 |issue=22 |pages=2297–307 |year=2006 |pmid=17135584 |doi=10.1056/NEJMoa060326}}</ref> | The treatment of fatty liver depends on what is causing it, and generally, treating the underlying cause will reverse the process of steatosis if implemented at early stage. Recent studies suggest that [[diet (nutrition)|diet]], [[exercise]], and especially [[anti-diabetic drug|antiglycemic drug]]s may alter the course of the disease. A [[randomized controlled trial]] found that [[pioglitazone]] led to metabolic and histologic improvement in subjects with nonalcoholic steatohepatitis.<ref name="pmid17135584">{{cite journal |author=Belfort R, Harrison SA, Brown K, ''et al'' |title=A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis |journal=N. Engl. J. Med. |volume=355 |issue=22 |pages=2297–307 |year=2006 |pmid=17135584 |doi=10.1056/NEJMoa060326}}</ref> | ||
===Prevention=== | ===Surgery=== | ||
===Primary Prevention=== | |||
Avoidance of [[alcohol abuse]], maintenance of health diet and weight helps in preventing fatty liver. | Avoidance of [[alcohol abuse]], maintenance of health diet and weight helps in preventing fatty liver. | ||
===Secondary Prevention=== | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Hepatology]] | [[Category:Hepatology]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
{{WS}} | |||
{{WH}} | |||
Latest revision as of 05:14, 2 June 2023
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Fatty liver is a type of liver disease, characterized by inflammation of the liver with concurrent fat accumulation in liver ("steato", meaning fat, "hepatitis", meaning inflammation of the liver). Classically seen in alcoholics, steatohepatitis also is frequently found in people with diabetes and obesity. When not associated with excessive alcohol intake, it's referred to as non-alcoholic steatohepatitis, or NASH. Steatohepatitis of either etiology may progress to cirrhosis, and NASH is now believed to be a frequent cause of unexplained cirrhosis.
Physicians do not well manage fatty liver[1].
Historical Perspective
Classification
Pathophysiology
Fatty liver is the fatty degeneration of the parenchymal cells causing a yellow discoloration of the liver. It is a reversible condition where large vacuoles of triglyceride fat accumulate in liver cells via the process of steatosis. Despite having multiple causes, fatty liver disease (FLD) can be considered a single disease that occurs worldwide in those with excessive alcohol intake and those who are obese (with or without effects of insulin resistance). The condition is also associated with other diseases that influence fat metabolism.[2] Morphologically it is difficult to distinguish alcoholic FLD from non alcoholic FLD and both show micro-vesicular and macrovesicular fatty changes at different stages.
Causes
Differentiating Fatty liver from Other Diseases
Epidemiology and Demographics
Fatty liver disease is prevalent among 10%- 24% of general population in various countries.[3] However among obese individuals the condition is observed in up to 75% of people, 35% of whom, despite no evidence of excessive alcohol consumption, will lead to non alcoholic FLD.[4] It is the most common cause of abnormal liver function test in the US.[3] African Americans and Mexican Americans have higher frequencies of unexplained serum aminotransferase elevations than those reported in whites but prevalence of FLD among different racial groups is not known.
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Most individuals are asymptomatic and are usually discovered incidentally because of abnormal liver function tests or hepatomegaly noted in unrelated medical condition. Elevated liver biochemistry is found in 50% of patients with simple steatosis.[5] The serum ALT level usually is greater than the AST level in non-alcoholic variant and the opposite in alcoholic FLD.
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
The treatment of fatty liver depends on what is causing it, and generally, treating the underlying cause will reverse the process of steatosis if implemented at early stage. Recent studies suggest that diet, exercise, and especially antiglycemic drugs may alter the course of the disease. A randomized controlled trial found that pioglitazone led to metabolic and histologic improvement in subjects with nonalcoholic steatohepatitis.[6]
Surgery
Primary Prevention
Avoidance of alcohol abuse, maintenance of health diet and weight helps in preventing fatty liver.
Secondary Prevention
References
- ↑ Shelley K, Articolo A, Luthra R, Charlton M (2023). "Clinical characteristics and management of patients with nonalcoholic steatohepatitis in a real-world setting: analysis of the Ipsos NASH therapy monitor database". BMC Gastroenterol. 23 (1): 160. doi:10.1186/s12876-023-02794-4. PMC 10197394 Check
|pmc=value (help). PMID 37208593 Check|pmid=value (help). - ↑ Reddy JK, Rao MS (2006). "Lipid metabolism and liver inflammation. II. Fatty liver disease and fatty acid oxidation". Am. J. Physiol. Fatty liver disease is one of the most deadly dieases ever to be found in someone who has and its very contasious so if someons has if i were u i wouldnt be hanging around with them well thats all from me see u next time. ËĒȲȳǖGastrointest. Liver Physiol. 290 (5): G852–8. doi:10.1152/ajpgi.00521.2005. PMID 16603729.
- ↑ 3.0 3.1 Angulo P (2002). "Nonalcoholic fatty liver disease". N. Engl. J. Med. 346 (16): 1221–31. doi:10.1056/NEJMra011775. PMID 11961152.
- ↑ Hamaguchi M, Kojima T, Takeda N, Nakagawa T, Taniguchi H, Fujii K, Omatsu T, Nakajima T, Sarui H, Shimazaki M, Kato T, Okuda J, Ida K (2005). "The metabolic syndrome as a predictor of nonalcoholic fatty liver disease". Ann. Intern. Med. 143 (10): 722–8. PMID 16287793.
- ↑ Sleisenger, Marvin (2006). Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Philadelphia: W.B. Saunders Company. ISBN 1416002456.
- ↑ Belfort R, Harrison SA, Brown K; et al. (2006). "A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis". N. Engl. J. Med. 355 (22): 2297–307. doi:10.1056/NEJMoa060326. PMID 17135584.