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Fatty Liver Diagnosis

By Dr Ananya Mandal, MD

Fatty liver disease is also referred to as Nonalcoholic Fatty Liver Disease (NAFLD) or Nonalcoholic Steatohepatitis (NASH). This is a group of conditions where there is accumulation of excess fat deposits over the liver seen among patients who consume little or no alcohol.

Symptoms of fatty liver disease

Around 50 to 100% patients with fatty liver disease have no symptoms of the condition. Detection of the disease is more often than not an incidental finding on routine blood tests.

Some of the other symptoms that may be present include:-

  • Obesity
  • Enlarged liver
  • Fatigue and weakness
  • Vague pain over the right upper side of the abdomen
  • Rarely there may be intense itching
  • Anorexia or loss of appetite
  • Nausea and sometimes vomiting
  • Severe cases may lead to jaundice and development of fluid within the abdomen in a condition called ascitis
  • Bleeding in the gastrointestinal tract
  • Muscle wasting in advanced cases
  • Presence of surface blood vessel prominences called spider naevi and palmar erythema
  • Liver failure leading to hepatic coma or loss of consciousness or confusion due to advanced liver disease

Diagnosis

  • Routine blood tests show mild to moderate elevation of serum aminotransferases including Aspartate transaminase (AST) and Alanine transaminase (ALT).
  • Some patients have no raised liver enzymes in routine blood tests and thus these are not always indicative of fatty liver disease. Further there is no direct association between rise of serum aminotransferases and severity of inflammation of the hepatic cells.
  • Patients with fatty liver usually have an AST/ALT ratio less than 1. The AST/ALT ratio rises with the development of cirrhosis.
  • Other tests show mild rise in Serum alkaline phosphatases, bilirubin levels etc. The level of blood protein albumin is lowered. Blood coagulation or clotting profile shows lengthened prothrombin time. This however is seen only in very advanced cases.
  • In patients with metabolic syndrome there are additional rises in blood glucose, cholesterol, triglycerides etc.
  • Ultrasonography of the abdomen is one of the commonest imaging studies for diagnosis of fatty liver. This involves creation of images of organs within the abdomen using high frequency sound waves. Ultrasound images show fat deposits over the liver.
  • Other imaging studies include computed tomography (CT), and magnetic resonance imaging (MRI).
  • Magnetic resonance spectroscopy is one of the newer imaging techniques that gives a better picture of the fatty infiltration of the liver.
  • To confirm the diagnosis a small sample of liver tissue may be taken using a long thin hollow needle under the guidance of an imaging technique commonly ultrasound. The tissue sample or the biopsy sample is stained with appropriate dyes and is examined under the microscope for infiltration of liver cells with fat.

Reviewed by , BA Hons (Cantab)

Further Reading

Last Updated: Jul 15, 2013

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