How Serious Is a Fatty Liver?

A fatty liver (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 symptoms.

Symptoms in early stages of alcoholic fatty liver disease may include tiredness or aches in the upper right side of the abdomen. 

Alcoholic fatty liver disease may progress to more severe forms including alcoholic hepatitis and cirrhosis of the liver. 

Symptoms of alcoholic hepatitis include: 

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

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 cholesterol/high blood triglyceride levels
• Insulin resistance
• Certain medicines
  • Amiodarone (Corderone, Pacerone)
  • Tamoxifen (Nolvadex, Tamone)
  • Perhexiline maleate (Pexhid)
  • Steroids (e.g., prednisone, hydrocortisone)
  • Synthetic estrogens 
• Certain pesticides have also been linked to NASH

Many people who have nonalcoholic fatty liver disease have no symptoms and it is discovered when they get routine tests 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
  • Ultrasound
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan 
• Liver biopsy

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

• Lose weight if you are overweight or obese
• Manage blood sugar if you have diabetes
• Keep cholesterol and triglyceride levels in check

If you take a medication that may cause nonalcoholic fatty liver disease, your 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

Complications of nonalcoholic fatty liver disease include: 

• Cirrhosis of the liver, a condition that involves serious scarring of the liver

Complications from alcohol-related fatty liver disease can be serious and occur after years of heavy drinking and may include:

• Fluid in the abdomen (ascites)
• Bleeding from veins in the esophagus (esophageal varices)
• High blood pressure in the liver (portal hypertension)
• Enlarged spleen
• Brain disorders and coma
• Kidney failure
• Liver cancer

If fatty liver is caused by drinking, it can be prevented by avoiding alcohol consumption.