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The liver is the largest organ in the body. It is found high
in the right upper abdomen, behind the ribs. It is a very complex
organ and has many functions. They include:
- Storing energy in the form of sugar (glucose)
- Storing vitamins, iron, and other minerals
- Making proteins, including blood clotting factors, to keep
the body healthy and help it grow
- Processing worn out red blood cells
- Making bile which is needed for food digestion
- Metabolizing or breaking down many medications and
alcohol
- Killing germs that enter the body through the intestine
The liver shoulders a heavy workload for the body and almost
never complains. It even has a remarkable power to regenerate
itself. Still it should not be taken for granted. Certain
conditions that develop, such as fatty liver and steatohepatitis,
may be signs of liver injury that can lead to permanent liver
damage.
What is Fatty Liver
Fatty liver is just what its name suggests: the build-up of
fat in the liver cells. Although this is not a normal condition,
fat in the liver usually causes no damage by itself. However, on
some occasions it can be a sign that other more harmful
conditions are at work. Fatty liver may be associated with or may
lead to inflammation of the liver. This can cause scarring and
hardening of the liver. When scarring becomes extensive, it is
called cirrhosis, and this is a very serious condition.
Therefore, it is important that a physician thoroughly examine a
patient with fat in the liver.
Cause
It would seem logical that eating fatty foods would cause a
fatty liver, but this is not the case. The liver does play an
important role in the metabolism or breakdown of fats. Something
goes wrong in this process of metabolism, but it is still not
known what does cause fat to build-up in the liver. It is known
that fat accumulates in the liver with a number of conditions.
The most common is obesity. Fatty liver is also associated with
diabetes mellitus, high blood triglycerides, and the heavy use of
alcohol. It may occur with certain illnesses such as tuberculosis
and malnutrition, intestinal bypass surgery for obesity, excess
vitamin A in the body, or the use of certain drugs such as
valproic acid (trade names: Depakene/Depakote) and
corticosteroids (cortisone, prednisone). Sometimes fatty liver
occurs as a complication of pregnancy.
Symptoms and Diagnosis
There are usually no symptoms that are noticeable to the
patient. In fact, fatty liver is frequently uncovered during a
routine physical examination. There may be a rise in certain
liver enzymes found in the blood, and sometimes the liver is
slightly enlarged. Fatty liver may also be discovered while the
physician is evaluating a patient for other illnesses. For
example, an ultrasound exam of the abdomen done for other reasons
may show fat in the liver. To be certain of a diagnosis of fatty
liver, the physician may recommend a liver biopsy. Under local
anesthesia, a slender needle is inserted through the right lower
chest. A small piece of liver tissue is taken out with the needle
and examined under a microscope.
What is Steatohepatitis?
The term hepatitis means inflammation of and damage to the
liver cells. Steato (pronounced stee-at'-toe) refers to fat.
Therefore, steatohepatitis is inflammation of the liver related
to fat accumulation. Heavy alcohol use can lead to fatty liver
and inflammation, usually called alcoholic hepatitis.
Steatohepatitis resembles alcoholic hepatitis, but it can and
does occur in people who seldom or never drink alcohol. In this
instance, it is often called nonalcoholic steatohepatitis or
NASH. Both alcoholic hepatitis and steatohepatitis can lead to
serious liver damage and cirrhosis.
Studies have shown that many people who are significantly
overweight have developed, or will develop, steatohepatitis. It
can also occur with rapid weight loss. Steatohepatitis has been
connected to estrogen hormones in some women.
In the case of diabetes rnellitus, researchers believe
steatohepatitis may develop only in those patients whose diabetes
is not properly controlled.
Treatment
In most instances, treatment of fatty liver and
steatohepatitis requires control of the under lying conditions.
This may include reduction of high blood triglycerides, good
control of diabetes, or not drinking alcohol. In some cases,
surgical reversal of intestinal bypass for obesity is
required.
Since being overweight is by far the most critical factor,
weight loss is the key to ridding the liver of fat. This is
especially necessary if damage to the liver is occurring, and
early signs of scarring are present on biopsy. High blood
triglycerides and diabetes are also worse with obesity. So, when
steatohepatitis is present with these conditions, people gain
even greater benefits from losing weight. Losing weight can be
difficult. However, it must be done because the alternative may
be eventual cirrhosis and the need for a liver transplant.
Currently, studies are underway on certain drugs such as
Actigall. This drug appears to reduce liver damage in cases of
steatohepatitis. At this time, however, it is not certain how
heIpful these drugs will be. To repeat the point, losing weight
is by far the most important treatment.
Liver Transplantation
Liver transplantation is now an accepted form of treatment for
chronic, severe liver damage. Advances in surgical techniques and
the use of new drugs to suppress rejection have dramatically
improved the success rate. Steatohepatitis is one of the more
uncommon reasons for a liver transplant. However, every
transplant center does a few each year as a result of this
disease. Survival rates at transplant centers are well over 90%
with a good quality of life after recovery.
Summary
Fatty liver is simply the build-up of fat in the liver. Fat in
the liver usually does not cause liver damage. However, certain
other conditions and diseases can be associated with the
development of fatty liver. Research is ongoing to uncover what
processes may take place to trigger fat build-up in the liver.
This condition is usually reversible when the underlying causes
are treated or removed. Patients who follow the advice of their
physicians can expect to reverse and control a fatty liver or
steatohepatitis.
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