Fatty Liver

Liver

 The liver is the largest glandular organ in the body

and performs many vital functions to keep the body
pure of toxins and harmful substances

 It is a vital organ that supports nearly every organ

in the body in some facet

 An average adult liver weighs about three pounds

 Located in the upper-right portion of the

abdominal cavity under the diaphragm, the liver
consists of four lobes

Confidential Slide 2
 Functions of Liver

Confidential Slide 3
 What is Fatty Liver

 Fatty liver, also known as fatty liver disease (FLD), is a reversible condition wherein
large vacuoles of triglyceride fat accumulate in liver cells via the process of steatosis
(i.e., abnormal retention of lipids within a cell)

 Despite having multiple causes, fatty liver can be considered a single disease that
occurs worldwide in those with excessive alcohol intake and the obese

 The condition is also associated with other diseases that influence fat metabolism

 It is difficult to distinguish alcoholic FLD from nonalcoholic FLD and both show
microvesicular and macrovesicular fatty changes at different stages

Confidential Slide 4
 Types of Fatty Liver

Alcoholic Liver Disease Non - alcoholic Liver Disease

 More common  Although less common, it can progress

 Cause – Excess alcohol consumption to life threatening conditions such as

Cirrhosis of Liver / Liver Cell Failure

 More in associated with obesity,

the Metabolic Syndrome, Dyslipidemia,
Insulin resistance and Type 2 Diabetes

Confidential Slide 5
 Symptoms

 Fatty liver disease often has no symptoms, and therefore neglected by most

 However, one may feel tired or have pain and discomfort on the right side of the abdomen.

This pain is caused by a growing amount of fat inside the liver, which makes it expand,

stretching the sensitive membrane that covers the liver

 As fatty liver disease progresses, the liver may become scarred and develop cirrhosis

Confidential Slide 6
  If one develop cirrhosis, other symptoms may appear such as:

- swollen abdomen

- itchy skin

- nausea / vomiting and bringing up or passing blood

- bruising easily

- fatigue

- confusion or poor memory

- weakness and muscle wasting

- yellow whites of your eyes and skin (jaundice)

Confidential Slide 7
 Non Alcoholic Fatty Liver Disease
(NAFLD)

Confidential Slide 8
 Risk Factors

Fatty Liver

 Polycystic ovary syndrome  Gastric bypass surgery

 Metabolic syndrome  Underactive pituitary gland
(hypopituitarism)

Confidential Slide 9
 Four stages of NAFLD

NAFLD is very similar to alcoholic liver disease, but is caused by factors other than
drinking too much alcohol

The four stages are described below :

Stage 1 : Simple fatty liver (Steatosis)

 This is stage 1 of the condition

 Excess fat builds up in the liver cells, but is considered harmless
 Usually no symptoms

 This condition is usually detected during Checkups and can be reversed if taken care of
 Following your Physician’s advice certainly helps in preventing the progression

Confidential Slide 10
 Stage 2 : Non-Alcoholic Steatohepatitis (NASH)

 Few people with simple fatty liver go on to develop stage 2 of the condition called
Non-Alcoholic Steatohepatitis (NASH)

 NASH is a more aggressive form of the condition

 The liver becomes inflamed

(Inflammation is part of the body's response to injury, which suggests that cells in
the liver are being damaged and that some liver cells are dying)

 Dull or aching pain in the top right of their abdomen (over the lower right side of t
their ribs), although there may be no symptoms at all

 Specialist tests (Liver Function tests, Fibroscan etc) are needed to confirm the
diagnosis
Confidential Slide 11
 Stage 3 : Fibrosis

 Some people with NASH go on to develop

fibrosis

 Persistent inflammation in the liver results in

the generation of fibrous scar tissue around
the liver cells and blood vessels

 This fibrous tissue replaces some of the

healthy liver tissue, but there is still enough
healthy tissue for the liver to function normally

Confidential Slide 12
 Stage 4 : Cirrhosis

 Most severe stage, where bands of scar tissue and clumps

of liver cells develop. The liver shrinks and becomes lumpy

 Cirrhosis tends to occur following many years of liver

inflammation associated with the early stages of the disease

 People who have type 2 diabetes are at the greatest risk of

developing cirrhosis of the liver caused by NAFLD

 The damage caused by cirrhosis is permanent & can't be reversed, and may eventually
lead to Liver Cell Failure requiring Liver Transplant

 NAFLD can also lead to primary liver cancer (Hepatocellular Carcinoma)

Confidential Slide 13
 Diagnosis of NAFLD

Blood tests

 Liver function tests : levels can help to diagnose NASH and differentiate NASH from
Alcoholic Hepatitis. Levels of two liver enzymes (Aspartate Aminotransferase
[AST] and Alanine Aminotransferase [ALT]) are elevated in about 90 percent of
people with NASH

 Other blood tests : Additional blood tests are useful for ruling out other causes of
liver disease. These usually include tests for viral hepatitis (hepatitis A, B, or C),
and may include tests for less common causes of liver disease

Confidential Slide 14
 Imaging procedures

 Ultrasound (USG) – Helps in diagnosing Fatty Liver, has some diagnostic accuracy in detecting
steatosis

 Computerized Tomography (CT) Scan -- may be helpful to monitor the course of the disease

 Magnetic Resonance Imaging (MRI) -- Helps in diagnosis & grading of Fatty Liver

 Imaging studies may help with diagnosing fatty infiltration of the liver, but they do not help in
distinguishing between Fatty Liver, Steatohepatitis and Steatohepatitis with fibrosis.

Confidential Slide 15
 Fibro scan
 It is a noninvasive test that uses ultrasound to determine how "stiff"
the liver is
 This stiffness can then be used to estimate how much scarring there
is in the liver and to determine if cirrhosis has developed
 It is used to :
-- estimate the existing degree of liver damage
-- monitor disease progression or regression via serial measurements
-- guide prognosis and further management, including treatment

Liver Biopsy
 The only way to confirm a diagnosis of fatty liver disease is with a
liver biopsy
 This is usually done once other causes have been ruled out
 Only method to distinguish NAFL from NASH with certainty
 Provides information on the stage of the disease (ie, the degree of
fibrosis)

Confidential Slide 16
 Management of NAFLD
 No standard treatment for nonalcoholic fatty liver disease exists

 Instead, doctors typically work to treat the risk factors that contribute to your liver
disease i.e. treated primarily by lifestyle alterations

 Lose weight
 Decrease triglyceride levels through food and exercise, or medication, or both
 Avoid unnecessary medications as advised by your doctor
 Manage diabetes, if you have it
 Eat properly
 Exercise more
 Maintain a regular schedule of check-ups with a doctor specializing in liver care

Confidential Slide 17
 Prognosis of NAFLD

 For most people with NAFLD, the condition may not progress beyond simple fatty liver or NASH

 However, fatty liver may progress to NASH in some people and NASH may progress to Cirrhosis

which may can lead to Liver failure and be fatal

 It is estimated that, on average:

 About 2 in 100 people with simple fatty liver progress to cirrhosis over 15-20 years

 About 12 in 100 people with NASH (i.e. almost 12%) progress to cirrhosis over about 8 years

 NAFLD has become very common in recent years (probably because of the epidemic in Obesity),

and therefore has become a common cause of Cirrhosis

 However, early stages of NAFLD – Fatty Liver and NASH, may reverse and even go away by

weight loss (if you are overweight or obese) or with good control of diabetes (if diabetes is the

cause)

Confidential Slide 18
 Prevention of NAFLD

 Lose weight
If you're overweight or obese, reduce the number
of calories you eat each day and increase your
physical activity in order to lose weight. This helps
in by reducing the amount of fat in your liver cells –
this helps to heal inflammation

 Choose a healthy diet

Eat a healthy diet that's rich in fruits, vegetables
and whole grains

 Exercise and be more active

Aim for at least 30 minutes of exercise
most days of the week

Confidential Slide 19
  Control your diabetes
Follow your doctor's instructions to stay in control
of your diabetes. Take your medications as directed
and closely monitor your blood sugar.

 Lower your cholesterol

A healthy plant-based diet, exercise and medications
can help keep your cholesterol and your triglycerides
at healthy levels.

 Protect your liver

Avoid things that will put extra stress on your liver.
For instance, don't drink alcohol.
Follow the instructions on all medications and over-the-counter drugs

Confidential Slide 20
 Liver damaging food

 White bread

 White rice

 Candy / doughnuts

 Fast-fat foods

 Chicken with skin

 Full-fat dairy products

 Ice cream

 Carbonated drinks

 Processed meats

 Fried foods

 Red meats

Confidential Slide 21
 Liver friendly food
 Legumes
 Garlic
 Tomatoes
 Beets
 Cabbage
 Broccoli
 Beans
 Vitamin E- and vitamin C-enriched fruits
 Whole grain breads
 Brown rice
 Lean white meats
 Nuts (almonds, cashews, walnuts)
 Soy milk
 Tofu
 Salmons/Sardines

Confidential Slide 22
Thank you