Signs of a Fatty Liver?

A fatty liver (hepatic steatosis) refers to conditions that involve a buildup of fats in the liver, such as:

• Nonalcoholic fatty liver disease (NAFLD) is not caused by consumption of alcohol
• Nonalcoholic fatty liver (NAFL): there is fat buildup in the liver, but it is not inflamed
• Nonalcoholic steatohepatitis (NASH): there is fat buildup in the liver, and it is inflamed
• Alcohol-related fatty liver disease is caused by excessive consumption of alcohol 
• Most people with nonalcoholic and alcoholic fatty liver disease have no signs or symptoms.

Signs and symptoms in the early stages of alcoholic fatty liver disease may include:

• Tiredness 
• Aches in the upper right side of the abdomen
• Alcoholic fatty liver disease can progress to more severe forms including alcoholic hepatitis and cirrhosis (scarring) of the liver. 

Symptoms of alcoholic hepatitis include: 

• Nausea
• Vomiting
• Loss of appetite
• Abdominal pain
• Weight loss
• Fatigue
• Fever
• Liver tenderness
• Enlarged liver (hepatomegaly)
• Malnutrition

Symptoms of cirrhosis include those of alcoholic hepatitis, as well as:

• Fluid in the abdomen (ascites)
• High blood pressure in the liver (portal hypertension)
• Bleeding from veins in the esophagus (esophageal varices)
• Behavior changes 
• Confusion
• Enlarged spleen

What Causes a Fatty Liver?

Alcohol-related fatty liver disease is caused by excessive consumption of alcohol.

The cause of nonalcoholic fatty liver disease (NAFLD) is unknown but it occurs more frequently in people with certain conditions, such as: 

• Overweight/obesity
• Diabetes
• High blood sugar (hyperglycemia)
• High cholesterol/high blood triglyceride levels
• Insulin resistance
• Certain medicines
• Amiodarone (Cordarone, Pacerone)
• Tamoxifen (Nolvadex, Tamone)
• Perhexiline maleate (Pexhid)
• Steroids (e.g., prednisone, hydrocortisone)
• Methotrexate (Trexall)
• Valproic acid (Depakote)
• Synthetic estrogens 
• Certain pesticides have also been linked to NASH
• Quick weight loss
• Pregnancy
• Genetics

How Is a Fatty Liver Diagnosed?

Many people who have nonalcoholic fatty liver disease have no signs or symptoms and it is diagnosed during routine testing for other conditions. If nonalcoholic fatty liver disease is suspected, or alcohol-related liver disease is suspected based on a patient’s history of alcohol abuse, tests may include: 

• Blood tests
• Imaging tests of the liver
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI) scan 
• Ultrasound
• Liver biopsy

What Is the Treatment for a Fatty Liver?

Nonalcoholic fatty liver disease is treated by addressing medical conditions that are often associated with NASH:

Weight loss in patients who are overweight or obese

Managing blood sugar in patients who have diabetes

Keeping cholesterol and triglyceride levels in check

If a certain medication may cause nonalcoholic fatty liver disease, a doctor may switch medications (never stop taking a prescribed medication without first talking to your doctor)

Alcohol-related fatty liver disease is treated with:

Abstinence from alcohol

Nutrition therapy

Medications to help reduce liver inflammation

Steroid treatment with prednisolone is usually the first-line medication

Pentoxifylline, if steroids don’t work

Liver transplant for patients with advanced alcoholic cirrhosis