Fatty liver - symptoms, causes, treatment | Find the right doctor

06.11.2023
Leading Medicine Guide Editors
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Leading Medicine Guide Editors

Fatty liver (technical term: steatosis hepatis) is characterized by increased fat storage in the liver cells. It is particularly common in western industrialized countries. Fatty liver disease is usually caused by chronic alcohol abuse, malnutrition or diabetes mellitus. Fatty liver occurs particularly in alcoholics and people who are overweight. A fatty liver usually causes no or only uncharacteristic symptoms. These include, for example, a slight feeling of pressure in the right upper abdomen as well as nausea and loss of appetite.

You can find all the information about fatty liver and recommended specialists for the treatment of fatty liver here.

ICD codes for this diseases: K76.0

Recommended specialists

Brief overview:

  • What is a fatty liver? A pathological change in the liver that can later develop into liver cirrhosis or liver cancer.
  • Frequency: It is a common liver disease in industrialized countries, estimated to affect at least 20-30% of the population.
  • Causes: Excessive alcohol consumption, metabolic syndrome(obesity, type 2 diabetes and elevated blood lipid levels), lipid metabolism disorders and other pre-existing conditions as well as medication.
  • Symptoms: With increasing fatty degeneration of the liver, uncharacteristic symptoms may occur, such as slight pain, a feeling of pressure in the right upper abdomen and others.
  • Diagnosis: Medical history, physical examination, blood test, ultrasound. If suspected, elastography and a liver biopsy are performed.
  • Treatment: Fatty liver is merely a symptom of a pre-existing condition. If this is treated, the fatty liver can also be contained.
  • Prognosis: The prognosis is generally good if the causes are eliminated as quickly as possible.

Article overview

Definition: What is a fatty liver?

Fatty liver (medical term: steatosis hepatis) is a pathological change in the liver. It occurs when the body produces or receives more fats from outside than it can break down or remove from the liver.

Certain fats (triglycerides) are then increasingly deposited in the liver tissue, which leads to a gradual fatty degeneration of the liver cells (hepatocytes). Doctors also refer to this excess fat in the liver as fatty liver disease or steatosis.

The transition from a healthy liver to a fatty liver is fluid. Doctors only speak of a fatty liver when

  • more than 50 percent of the liver cells have fat deposits or
  • the proportion of fat in the liver accounts for more than 10 percent of the total weight of the liver.
Fettleber

Transition from a healthy liver to a fatty liver © crevis | AdobeStock

Depending on the extent of fatty liver disease, doctors differentiate between three different degrees of severity:

  • Grade 1: mild or mild fatty liver
  • Grade 2: moderate fatty liver
  • Grade 3: severe fatty liver

A distinction is also made between two different forms of fatty liver disease, depending on the cause:

  • alcoholic fatty liver and
  • non-alcoholic fatty liver.
Fettleber

Fatty liver is often caused by obesity © Kateryna_Kon | AdobeStock

Frequency of fatty liver

Fatty liver is particularly common in western industrialized countries. There, fatty liver is one of the most common liver diseases. In Germany, for example, an estimated 20 to 30 percent of the population suffer from non-alcoholic fatty liver disease. In diabetics, the incidence is said to be as high as 50 percent.

Overall, fatty liver is responsible for around 10 to 20 percent of liver cirrhosis and hepatocellular carcinomas(liver cell cancer).

Causes of fatty liver

In most cases, the cause of fatty liver in western industrialized countries is too frequent and excessive alcohol consumption and metabolic syndrome. The latter is a combination ofbeing overweight(obesity), type 2 diabetes mellitus and elevated blood lipid levels.

The amount of alcohol at which alcoholic fatty liver disease develops varies from person to person. The critical upper limit is a daily consumption of 10 grams of alcohol for women and 20 grams of alcohol for men. This corresponds to an eighth or a quarter of a liter of wine or one or two glasses of beer (0.3 liters).

Leberschäden durch Alkohol

Alcohol as the main cause of liver damage such as fatty liver © Henrie | AdobeStock

Other possible causes of fatty liver are other diseases such as

Other possible risk factors for the development of a fatty liver include

  • long-term use of liver-damaging medication (such as cortisone, acetylsalicylic acid, tetracyclines, amiodarone, methotrexate),
  • poor diet and
  • stressful situations for the body (such as prolonged starvation or artificial nutrition).
ungesunde Ernährung

Unhealthy diet as a risk factor for the development of a fatty liver © happy_lark | AdobeStock

A fatty liver can also occur, particularly in the last few months of pregnancy. However, this is usually harmless. However, patients with an acute fatty liver during pregnancy require clinical care.

In addition to unknown causes, genetic factors (such as variants of the PNPLA3 gene product) also appear to play a role in some cases. They may be responsible for the development of fatty liver and in particular for the progression to liver fibrosis, liver cirrhosis and liver cell cancer.

Symptoms of a fatty liver

A liver with only small amounts of fat does not cause any symptoms. With increasing fatty degeneration, the liver becomes larger. The rather uncharacteristic symptoms that can occur with a fatty liver include

Fever and yellowing of the skin (jaundice) are also possible symptoms of fatty liver disease. However, these symptoms usually only occur when the fatty liver turns into fatty liver inflammation (fatty liver hepatitis or steatohepatitis).

Gelbsucht bei Leberschaden

Jaundice indicates liver damage such as fatty liver © Daria | AdobeStock

Around 30 percent of patients with fatty liver have signs of fatty liver inflammation. In obese patients with fatty liver, this is even the case in 50 percent.

Complications of fatty liver can include damage to the cardiovascular system, which can manifest itself in vascular calcification, high blood pressure and circulatory disorders. These in turn can lead to serious illnesses.

Diagnosis of a fatty liver

A fatty liver is usually diagnosed on the basis of

  • the patient's medical history (anamnesis),
  • a physical examination,
  • a blood test and
  • an ultrasound examination of the abdomen.

When taking the medical history, the doctor first asks the patient questions about

  • the complaints,
  • existing illnesses,
  • dietary habits and
  • alcohol consumption.

During the physical examination, the doctor will palpate the abdomen to determine whether the liver is abnormally enlarged.

Tastuntersuchung Bauch

Palpation of the right upper abdomen © pressmaster | AdobeStock

The following values are determined as part of the laboratory diagnostic blood test:

  • Liver values (gamma-GT, GOT, GPT, alkaline phosphatase)
  • Blood lipid values (triglycerides, cholesterol, HDL and LDL cholesterol)
  • Other blood values (such as bilirubin, fasting blood sugar or HbA1c)

However, laboratory values alone cannot be used to detect a fatty liver. This is because liver values are not necessarily elevated in patients with a fatty liver, for example. However, certain molecular markers (e.g. M30, M65, adiponectin) can also indicate liver damage.

Laborwerte Blutuntersuchung

Evaluation of a laboratory diagnostic blood test © Stockfotos-MG | AdobeStock

An ultrasound examination of the abdomen shows the changes typical of a fatty liver. In some cases, magnetic resonance imaging can provide further helpful information.

If there is a suspicion that liver fibrosis or cirrhosis has already developed, the doctor can perform elastography. This is a diagnostic procedure that can be used to determine the stiffness and possibly the fat content of the liver.

To confirm the diagnosis of fatty liver and determine the causes and extent of the fatty liver, a puncture of the liver (liver biopsy) is necessary. The doctor takes a small tissue sample from the liver under local anesthesia using a special hollow needle. This is then examined under a microscope in the laboratory.

Leberbiopsie

Liver biopsy © SciePro | AdobeStock

A so-called PNPLA3 gene marker can now be used to assess the risk of the fatty liver developing into liver fibrosis, liver cirrhosis and liver cell cancer as the disease progresses.

Treatment of fatty liver

Specific treatment of the fatty liver itself, for example with medication, is not yet possible.

Rather, the treatment of fatty liver is about counteracting the progression of the disease or reversing the fatty degeneration of the liver. This involves

  • to eliminate or reduce the causes of fat accumulation in the liver,
  • change lifestyle habits and
  • treat the underlying disease.

Depending on the cause of the fatty liver, this usually means that those affected have to give up alcohol and, if they are overweight, change their diet and lose weight. A balanced, low-fat and low-sugar diet with plenty of protein and sufficient exercise is important.

Alkoholabstinenz

An alcoholic fatty liver can regress with abstinence from alcohol © Pormezz | AdobeStock

Diabetics should also make sure that their blood sugar levels are well controlled. Those affected should also have any existing lipometabolic disorders treated, if necessary by taking lipid or cholesterol-lowering drugs.

Bariatric surgery may be necessary for patients who are severely overweight and for whom conservative weight loss measures have not been successful. Bariatric surgery procedures such as gastric bypass or gastric banding are available for this purpose.

Patients with liver cirrhosis should undergo an ultrasound examination at least every 6 months. The doctor examines the liver for a developing hepatocellular carcinoma.

Prognosis for a fatty liver

The prognosis for fatty liver is generally good. Most fatty liver disease can usually be reversed and cured. The prerequisite is that the causes are eliminated as quickly as possible and the underlying diseases are adequately treated.

In principle, a fatty liver can regress within around 2 to 3 months, provided the person affected abstains from alcohol and eats a balanced, low-fat diet.

However,if no countermeasures are taken, a fatty liver can develop into fatty liver inflammation. Under certain circumstances, it can also develop into cirrhosis of the liver and then into hepatocellular carcinoma. These diseases can no longer be reversed. A complete cure is then no longer possible.

References

Quellen

  • Deutsche Leberhilfe (2017) Nicht-alkoholische Fettleber - NAFL und NASH. Deutsche Leberhilfe e.V., Köln
  • Rau M et al. (2016) Nichtalkoholische Fettlebererkrankung (NAFLD). In: H. Lehnert et al. (Hrsg.), DGIM Innere Medizin, Springer Reference Medizin. DOI 10.1007/978-3-642-54676-1_153-1
  • Roeb E et al. (2015) Nicht-alkoholische Fettlebererkrankungen. S2k Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) AWMF-Registernummer 021-025
  • Roeb E et al. (2017) Fettlebererkrankungen. Ratgeber. Deutsche Gesellschaft zur Bekämpfung der Krankheiten von Magen, Darm und Leber sowie von Störungen des Stoffwechsels und der Ernährung (Gastro-Liga), Gießen
  • Roeb E (2018) Fettleber mit Komplikationen. Pharmazeutische Zeitung 34 (8)
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