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Hepatic steatosis is a disease of the liver that is also known as fatty liver or fatty liver disease. It strikes approximately twenty percent of the adult population in the United States. It consists of fatty deposits that form in the liver. Although not a serious illness in itself, it can lead to complications that are more serious, including cancer, fibrosis, and cirrhosis of the liver, and so requires monitoring and care. Hepatic steatosis as such is asymptomatic. It can usually be treated with diet and exercise, as well as with reduced or eliminated consumption of alcoholic beverages where that is a factor.

Forms


Hepatic steatosis comes in two distinct forms that are called alcohol-related and non-alcoholic steatosis. The distinction, obviously enough, lies in what causes the condition; alcohol-related steatosis is caused by excessive consumption of alcohol. The progression of the two forms of steatosis and the potential complications are identical. However, the treatment is different, as it would not be of great value to reduce alcohol consumption in case of non-alcoholic steatosis, and so the focus is on other lifestyle changes such as diet, exercise, and weight control.


Causes


Other than excessive alcohol consumption, hepatic steatosis is associated with obesity, diabetes, and early stages of various liver diseases. The latter association is the main reason why fatty liver is of concern to doctors. The disease itself rarely has symptoms. It is revealed by medical imaging such as ultrasound or MRI, which shows the deposits of fat residing in the liver. Continued below....

This is usually done as a follow-up to blood tests that reveal elevated liver enzymes. Although hepatic steatosis usually has no symptoms and involves no significant impairment of liver function, as an early stage of diseases that can be very serious and even life-threatening it requires follow-up examinations and treatment, usually through lifestyle changes.


Symptoms


When hepatic steatosis does have symptoms, usually the disease has progressed to the point where a more serious diagnosis is indicated. On rare occasions fatty liver may produce a dull, chronic pain in the upper body, jaundice, fatigue, nausea, or flatulence. These are all symptoms of liver dysfunction and occur with varying degrees of severity in many different liver pathologies, but it's not common for fatty liver to produce them by itself.

The common factor in non-alcoholic hepatic steatosis is believed to be insulin resistance, associated with obesity. Other than excessive alcohol intake, obesity is the number one factor associated with fatty liver disease.

Hepatomegaly


When hepatic steatosis progresses to the point where fatty deposits are ubiquitous throughout the liver, a diagnosis of hepatomegaly or enlarged liver may be warranted. Enlarged liver can also result from poisoning, infections, and as a symptom of serious liver disease in its earlier stages (as can fatty liver). Hepatomegaly often has symptoms of liver dysfunction as described above.

Diagnosis


As noted above, hepatic steatosis is diagnosed normally not through symptoms but through tests performed with medical imaging technology, following on blood tests that reveal elevated liver enzymes. Once the diagnosis of fatty liver is made through medical imaging, the next step is to distinguish between the two types of steatosis, alcohol-related and non-alcoholic, which is simply a matter of inquiring as to the patient's typical alcohol intake: if the patient drinks excessively, the diagnosis is alcohol-related steatosis; if not, then the diagnosis is non-alcoholic steatosis.

It's also important to test the patient for the serious liver diseases of which fatty liver is sometimes an early indicator before proceeding to treatment. If the patient's steatosis is non-alcoholic, the likely cause should be pinpointed before treatment is prescribed.

Treatment


Invasive or aggressive medical procedures such as drugs and surgery are generally not warranted in treating hepatic steatosis, as the disease is not considered particularly dangerous in itself and the concern is to halt its progression before it turns into something more serious that will require aggressive treatment. The treatment normally prescribed for hepatic steatosis
involves lifestyle change. In the case of alcohol-related hepatic steatosis, this consists of reduction or elimination of alcohol consumption. The most likely prescription for non-alcoholic steatosis is gradual weight loss achieved through diet and exercise, or the treatment of a related disorder such as diabetes. In many cases, reversal of the causal factors is sufficient to reverse the condition and cause the fatty deposits in the liver to disappear over time.


Risks If Untreated


If hepatic steatosis is left untreated, the likelihood that it will progress to a more serious liver condition is fairly high. Fatty liver is an early stage of serious liver conditions such as hepatitis (inflammation of the liver -- commonly caused by viral infections, this condition is actually a symptom and not a single disease), liver fibrosis (buildup of fibrous scar tissue in the liver), and liver cirrhosis (severe scarring of the liver tissue resulting in hepatic failure).

Statistics


Hepatic steatosis is primarily a disease of the advanced world. In advanced economies, a sedentary lifestyle combines with diets high in sugar and fat to produce overweight populations that are at risk for non-alcoholic hepatic steatosis as well as other health problems.

Nonalcoholic hepatic steatosis affects an estimated ten to 24% of the world's adult population, with higher occurrence in developed countries. In the United States, approximately half the population is statistically overweight and one-quarter is statistically obese. Many of these people either already have fatty liver disease or will develop it. The occurrence of non-alcoholic fatty liver is on the increase, as are other illness associated with obesity.


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