Symptoms and Complications of Fatty Liver

Symptoms

Fatty liver has almost no symptoms, though you may sometimes feel discomfort or mild pain in the upper right abdomen. You may also feel generalized weakness or fatigue. However, in most cases, people learn about it when they visit the hospital for other reasons and have liver function tests through blood tests, or when an abnormal finding is discovered on an ultrasound exam. Therefore, people who drink a lot of alcohol should first visit a hospital for basic examination and tests. In addition, because this alcoholic fatty liver develops mostly in patients with obesity, diabetes,

hyperlipidemia, and similar conditions, those with these risk factors should undergo periodic screening for fatty liver.

Complications

Strictly speaking, fatty liver can be said to have no complications. However, fatty liver can progress to steatohepatitis, cirrhosis, and liver cancer,

and because fatty liver develops due to metabolic syndrome (obesity, diabetes, hyperlipidemia), many people also die from cardiovascular disease.

These cases could also be considered complications.

1. Steatohepatitis

This is not a study from Korea, but according to reports from other countries, about 10% of all fatty liver patients are known to have steatohepatitis. Simple fatty liver usually does not progress to cirrhosis or liver cancer, but steatohepatitis is known to progress to cirrhosis in 10–20% of cases when observed over a long period. Therefore, distinguishing between fatty liver and steatohepatitis is important. However, fatty liver and steatohepatitis cannot be differentiated by ordinary blood tests and ultrasound examinations alone; a tissue biopsy is required to determine it. Patients diagnosed with fatty liver who receive treatment for 4–6 months but show no improvement in liver function tests should be checked through a biopsy to see whether the condition has progressed to steatohepatitis. The mechanism by which fatty liver progresses to steatohepatitis has not yet been clearly identified, but it is known that fat accumulated in the liver releases substances that cause destruction of liver cells and inflammation. If steatohepatitis is diagnosed on biopsy, treatment is almost the same as for fatty liver, but more aggressive treatment is needed than for fatty liver.

2. Cirrhosis

If fatty liver or steatohepatitis is not diagnosed and the condition is diagnosed directly as cirrhosis, it is usually diagnosed as 'cirrhosis of unknown cause.' In other countries, most cases of cirrhosis of unknown cause are known to be related to fatty liver, but in Korea there are still many cases caused by latent hepatitis B virus. However, as the number of patients with diabetes and obesity has recently increased rapidly, fatty liver disease has also increased, and it is thought that the proportion of cirrhosis of unknown cause attributable to fatty liver disease will gradually rise in Korea as well. Even in cirrhosis caused by fatty liver, the course and treatment are similar to cirrhosis caused by other causes, and because the incidence of liver cancer becomes very high, periodic (every 6 months) ultrasound examinations and blood tests are necessary.

3. Liver cancer

For a long time, obesity and diabetes have been known as risk factors for liver cancer. Some studies have reported that, in association with these metabolic syndrome conditions, steatohepatitis progresses to cirrhosis and then liver cancer occurs, or that liver cancer develops directly from steatohepatitis. In a study from the United States, most of the previously unexplained cases of liver cancer (more than 90%) were reported to be related to fatty liver disease.

In Korea, there is also a study comparing the causes of liver cancer between 1993 and 1995 and the causes of liver cancer that occurred between 2000 and 2002, with a considerable time gap. It found that the proportion of liver cancer with an unknown cause increased greatly in 2000–2002 compared with the past, and most of those patients were suspected to have fatty liver disease. Therefore, liver cancer caused by fatty liver disease is expected to increase further in Korea as Westernized eating habits and lifestyle changes continue, and if you are diagnosed with fatty liver, active treatment and regular checkups are necessary.

4. Cardiovascular disease associated with fatty liver

According to recent foreign studies, the main cause of death in patients with fatty liver disease is more often cardiovascular disease than advanced liver disease (cirrhosis, liver cancer). Therefore, patients with fatty liver should also undergo regular screening for cardiovascular diseases (angina, myocardial infarction, arrhythmia, etc.).

So far, I have explained the symptoms and complications of fatty liver.

In the next part, we will look at the diagnosis of fatty liver.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal