Fatty liver
Fatty liver, also known as steatosis, is a common clinical finding consisting of accumulated triglycerides and other fats in liver cells. In severe fatty liver, fat comprises as much as 40% of the liver’s weight (as opposed to 5% in a normal liver), and the weight of the liver may increase from 3.31 lb (1.5 kg) to as much as 11 lb (4.9 kg). Minimal fatty changes are temporary and asymptomatic; severe or persistent changes may cause liver dysfunction. Fatty liver is usually reversible by simply eliminating the cause; however, this disorder may result in recurrent infection or sudden death from fat emboli in the lungs.
Causes
Chronic alcoholism is the most common cause of fatty liver in the United States and in Europe, with the severity of hepatic disease directly related to the amount of alcohol consumed. (Fatty liver can occur in people who consume as little as 10 oz of alcohol per week.) Other causes include malnutrition (especially protein deficiency), obesity, diabetes mellitus, jejunoileal bypass surgery, Cushing’s syndrome, Reye’s syndrome, pregnancy, large doses of hepatotoxins such as I.V. tetracycline, carbon tetrachloride intoxication, prolonged parenteral nutrition, and DDT poisoning. Whatever the cause, fatty infiltration of the liver probably results from mobilization of fatty acids from adipose tissues or altered fat metabolism.
Signs and symptoms
Clinical features of fatty liver vary with the degree of lipid infiltration, and many patients are asymptomatic. The most typical sign is a large, tender liver (hepatomegaly). Common signs and symptoms include right upper quadrant pain (with massive or rapid infiltration),ascites, edema, jaundice, and fever (all with hepatic necrosis or biliary stasis). (See Massive ascites in fatty liver.) Nausea, vomiting, and anorexia are less common. Splenomegaly usually accompanies cirrhosis. Rarer changes are spider angiomas, varices, transient gynecomastia, and menstrual disorders.
Diagnosis
Typical clinical features — especially in patients with chronic alcoholism, malnutrition, poorly controlled diabetes mellitus, or obesity — suggest fatty liver.
CONFIRMING DIAGNOSIS A liver biopsy confirms excessive fat in the liver. These liver function tests support this diagnosis:
❑ Albumin: somewhat low
❑ Globulin: usually elevated
❑ Cholesterol: usually elevated
❑ Total bilirubin: elevated
❑ Alkaline phosphatase: elevated
❑ Transaminase: usually low (less than 300 U)
❑ Prothrombin time: possibly prolonged.
Other findings may include anemia, leukocytosis, elevated white blood cell count, albuminuria, hyperglycemia or hypoglycemia, and iron, folic acid, and vitamin B12 deficiencies.
Treatment
Treatment of fatty liver is essentially supportive and consists of correcting the underlying condition or eliminating its cause. For instance, when fatty liver results from parenteral nutrition, decreasing the rate of carbohydrate infusion may correct the disease. In alcoholic fatty liver, abstinence from alcohol and a proper diet can begin to correct liver changes within 4 to 8 weeks. Such correction requires comprehensive patient teaching.
Special considerations
Providing support to the patient and his family is an important element in the care of the patient with steatosis.
❑ Suggest counseling for the alcoholic patient and provide emotional support for his family.
❑ Teach the patient with diabetes — and his family — about proper care, such as the purpose of insulin injections, diet, and exercise. Refer him to home health nurses or to group classes, as necessary, to promote compliance with treatment. Emphasize the need for long-term medical supervision and urge him to report any changes in his health immediately.
❑ Instruct an obese patient and his family about proper diet. Warn against fad diets, which are usually nutritionally inadequate. Recommend medical supervision for a patient who’s more than 20% overweight. Encourage attendance at group diet and exercise programs and, if necessary, suggest behavior modification programs to correct eating habits. Be sure to follow up on his progress and provide positive reinforcement for any weight loss.
❑ Assess for malnutrition, especially protein deficiency, in the patient with chronic illness. Suggest dietary changes and refer the patient to a dietitian.
❑ Advise patients receiving hepatotoxins and those who risk occupational exposure to DDT to watch for and immediately report signs of toxicity.
❑ Inform the patient that fatty liver is reversible only if he strictly follows the therapeutic program; otherwise, he risks permanent liver damage.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
Other Book Chapters Related to Liver symptoms
Read excerpts from these other book chapters related to Liver symptoms:
Medical Books Excerpts
- JAUNDICE
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- JAUNDICE
- "Differential Diagnosis in Primary Care" (2007)
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- Jaundice
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- Jaundice
- "A Pocket Manual of Differential Diagnosis" (1999)
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- Fatty liver
- "Professional Guide to Diseases (Eighth Edition)" (2005)
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- Hepatomegaly
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Hepatomegaly
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Jaundice
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Jaundice
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Hepatomegaly
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- Jaundice
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- JAUNDICE
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Liver symptoms
» Next page: Liver abscess (Professional Guide to Diseases (Eighth Edition))
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