Fatty Liver

This is an abnormal build-up of fat in hepatocytes (hepatic steatosis). There are two main types as distinct from fatty liver of pregnancy or alcoholic disease.

• Non-alcoholic fatty liver disease (NAFLD)—common, usually benign—may progress to cirrhosis

• Non-alcoholic steatohepatitis (NASH)—uncommon, inflammation and potentially serious with cirrhosis and possibly hepatocellular carcinoma

Causes

The big two: obesity, diabetes mellitus. Other: crash diet, dyslipidaemia, starvation (protein ↓), hypertension, drugs, e.g. steroids, tetracycline, methotrexate

Clinical

Usually asymptomatic with abnormal LFTs, may be fatigue/malaise, hepatomegaly

Investigations

LFTs (typically ↑ AST, ALT in NAFLD), fibrosis score, fibroscan

Management

Lifestyle modification, treat cause, e.g. diabetes, obesity (incl. bariatric surgery). Surveillance for cirrhosis and cardiovascular disease. Refer if evidence of cirrhosis, very abnormal LFTs, ↑ ↑ levels ferritin.