Compared with a normal liver (left), a fatty liver (right) appears enlarged and discolored. Tissue samples reveal fat deposits in nonalcoholic fatty liver disease, while inflammation and advanced scarring (cirrhosis) are visible in nonalcoholic steatohepatitis.
Much like hepatic steatosis (fatty liver disease), the first stages of cirrhosis of the liver do not often prompt indications to show up. Nonetheless, some signals of cirrhosis you might encounter as scarring continues to build up include: Discomfort in the abdomen. Nausea.
It takes upwards of ten years for alcohol-related liver disease to progress from fatty liver through fibrosis to cirrhosis to acute on chronic liver failure. This process is silent and symptom free and can easily be missed in primary care, usually presenting with advanced cirrhosis.
While fatty liver disease and cirrhosis both involve the liver, there are a few central distinctions. Fatty liver disease is identified by the buildup of fat in the liver; however, cirrhosis is the growth of scarring on top of healthy areas of tissue.
Chronic fatigue or weakness. Abdominal discomfort, such as cramping or nausea. Confusion or difficulty thinking. Bruising or bleeding easily, including nosebleeds.
In some cases, the liver damage stops or even reverses itself. But in others, the disease continues to progress. If you have NASH, it's important to control any conditions that may contribute to fatty liver disease.
Both groups of fatty liver disease (AFLD and NAFLD) can lead to cirrhosis when not treated in time. Both conditions take time to progress, but cirrhosis warrants a considerably more severe issue. Fatty liver disease is significantly more common.
The fourth stage of NAFLD is cirrhosis;
Most people with NAFLD have the early stage of the disease (simple fatty liver or steatosis) and only a small number develop the more serious stages. It can take several years for fibrosis or cirrhosis to develop.
On ultrasound images, steatotic livers look brighter than normal livers, and cirrhotic livers (advanced fibrosis) look lumpy and shrunken.
Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include: Fatigue. Easily bleeding or bruising.
Heavy drinkers and alcoholics may progress from fatty liver to alcoholic hepatitis to cirrhosis, and it is estimated that 10 percent to 15 percent of alcoholics will develop cirrhosis.
The condition begins as steatosis, which means there's fat in the liver but no inflammation. Up to 30 percent of patients with liver steatosis go on to develop liver inflammation, also known as non-alcoholic steatohepatitis (NASH). About 20 percent of patients with NASH go on to develop liver cirrhosis (scarring).
Patients with alcoholic fatty liver disease who continue to consume large amounts of alcohol daily have been found to have a risk of 8–30% of developing fibrosis or cirrhosis after 10 years.
However, normal LFTs do not always mean that the liver is normal. Patients with cirrhosis and bleeding esophageal varices can have normal LFTs. Of the routine LFTs, only serum albumin, bilirubin and prothrombin time (PT) provide useful information on how well the liver is functioning.
On average, life expectancy was 2.8 (95% CI = 0.4–5.6) years lower in patients with NAFLD than the general population: 2.4 (95% CI = 0.4–4.5) years for females and 3.1 (95% CI 0.4–6.6) years for males (Table 3).
People who have been diagnosed with so-called fatty liver, run an increased risk of developing cardiovascular disease and loss in life expectancy, compared to the general population. These patients have approximately a 2.8 years shorter expected survival, based on collected data from a large number of Swedish patients.
The main complication of NAFLD and NASH is cirrhosis, which is late-stage scarring in the liver. Cirrhosis occurs in response to liver injury, such as the inflammation in NASH . As the liver tries to halt inflammation, it produces areas of scarring (fibrosis).
Fatty liver is most commonly diagnosed by a routine liver function test drawn from your blood. The alanine aminotransferase (ALT) is a specific marker for liver inflammation and is typically elevated in individuals with a fatty liver.
Laboratory abnormalities often are the only sign of non-alcoholic fatty liver disease. The most common abnormal laboratory test results are elevated alanine transaminase (ALT) and aspartate transaminase (AST), usually one to four times the upper limits of normal.
Avoiding Alcohol
Moderate or heavy alcohol use can cause additional damage and fat accumulation in the liver in people with NAFLD. Therefore, patients with NAFLD should avoid alcohol entirely if possible.
Myth: It's always good to gain weight when you have cirrhosis. Fact: If your weight gain is from eating too many calories, this can lead to fat deposits on your liver, which can cause further injury. If your weight gain is due to fluid retention, it may be a sign that your liver is deteriorating.