FATTY LIVER AND CIRRHOSIS: WHAT YOU NEED TO KNOW

BY: SARAHI HERRERA-GONZALEZ
DHR HEALTH GASTROENTEROLOGIST
FOR APPOINTMENTS CALL: (956) 362-ENDO (3636)

Fatty liver, also known as Steatotic Liver Disease, refers to the deposit of fat particles within the liver that in some patients may cause chronic inflammation and if not corrected even lead to liver cirrhosis. It is present in roughly one out of every three individuals and now represents the most common indication for liver transplantation in women and patients over the age of 65, however, often remains undiagnosed. Risk factors for the development of fatty liver are metabolic diseases such as pre-diabetes, type 2 diabetes mellitus, high cholesterol, obesity, and hypertension.

WHAT ARE COMMON SYMPTOMS OF FATTY LIVER?

Most patients with fatty liver are asymptomatic, however some patients report fatigue, generalized feeling of discomfort or vague pain located in the upper right area of the abdomen. Asymptomatic patients usually are identified when routine blood work shows elevated liver enzymes or there is fatty infiltration incidentally seen on abdominal imaging.

WHO SHOULD BE EVALUATED FOR FATTY LIVER?

Patients with high risk factors for fatty liver as mentioned above or in which fatty liver has been incidentally identified on imaging studies such as a liver ultrasound, should be evaluated with laboratory-based tools (i.e FIB-4 index) in which a risk score can be obtained. If the results are normal, the FIB-4 index screening test should be repeated every 1-2 years in patients with pre-diabetes, type 2 diabetes, or 2 or more metabolic risk factors.

If the initial screening test results are abnormal, you can undergo one of many non-invasive tests to assess for the degree of fat deposits in the liver, as well as to evaluate if there already is presence of scarring, also known as fibrosis, that may be corrected to prevent the development of cirrhosis. Available non-invasive testing can be done via imaging studies (Vibration-Controlled Transient Elastography) or blood tests.

If advanced fibrosis (scarring) is identified, you may need a referral for evaluation by a liver specialist or gastroenterologist.

IF I AM DIAGNOSED WITH FATTY LIVER, HOW CAN I TREAT IT AND PREVENT THE DEVELOPMENT OF CIRRHOSIS?

The management of fatty liver is based on lifestyle changes that include regular exercise and a healthy diet that is low in fat and carbohydrates and high in fiber and unsaturated fats (Mediterranean diet). The goal is to achieve a 10% weight loss that will in turn remove those fatty deposits from the liver that are the cause of inflammation and can even reverse fibrosis.

Up until recently, there were no approved medications for the treatment of fatty liver, however that changed in March of this year with the approval of a thyroid hormone receptor agonist that helps improve advanced scarring (fibrosis) in patients without cirrhosis. There are as well medications commonly used for the management of metabolic diseases such as diabetes and obesity that have a potential benefit in fatty liver and may be considered when managing patients with said diseases.

Weight loss surgery can also be considered in patients with obesity and fatty liver that meet criteria for metabolic weight loss surgery (BMI>40 or BMI >35 with diabetes).

It is important to note that patients with fatty liver should completely abstain from the use of alcohol, as it may worsen liver disease and its progression to cirrhosis.

ABOUT DR. HERRERA-GONZALEZ

Dr. Herrera-Gonzalez is a gastroenterologist and is the only female at the DHR Health Gastroenterology Institute. She is currently accepting new patients and will see them at the DHR Health main campus in Edinburg and at DHR Health Multispecialty Clinic in Rio Grande City. She is fluent in English and Spanish and looks forward to working with adult patients of various ages and gastroenterological needs. To make an appointment with Dr. Herrera-Gonzalez call today at (956) 362-3636.

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