By Howard Worman, M.D. (Fatty liver is called steatosis)
individuals can develop fatty liver. Most people who do not abuse alcohol and
have fatty liver are obese. Fatty liver is called steatosis, and fatty liver
with liver inflammation is called or steatohepatitis. Steatosis and
steatohepatitis can be caused by alcohol and other drugs and can also sometimes
occur in patients with diabetes mellitus. Steatohepatitis notcaused by alcohol
is sometimes referred to as non-alcoholic steatohepatitis or "NASH."
The factors that determine who will develop fatty liver are not known. Some
mildly obese and occasional non-obese patients will develop fatty liver while
some who are severely obese will not.
with fatty liver or steatohepatitis usually present to a physician with
unexplained elevations in the serum aminotransferase activities (liver enzyme
elevations). Serum alkaline phosphatase and gamma-glutamyltranspeptidase
activities are usually normal. The patient is usually 10% or more above his/her
ideal body weight.
diagnosis is usually suspected after other causes of hepatitis are excluded. A
careful drug and alcohol history should be taken and serological testing for
HBsAg and antibodies against the hepatitis C virus should be performed.
Metabolic diseases should be excluded by a careful family history and
appropriate testing if they are suspected. Serum protein electrophoresis and
testing for autoantibodies should be performed if autoimmune hepatitis is
suspected. Sometimes, patients with fatty liver or steatohepatitis will have
elevated serum trigyceride concentrations, however, this is not always the case.
a patient has elevations in serum aminotransferase activities for longer than
six months, he/she should have a liver biopsy to make the diagnosis the fatty
liver or steatohepatitis.
Steatohepatitis can progress to cirrhosis. Treatment (diet and exercise) may stop this progression. Steatosis and steatohepatitis will often improve with weight loss, preferably to near the patient's ideal body weight. Avoidance of alcohol and potentially hepatotoxic drugs may also be beneficial.