Fatty liver overview

# Overview
Fatty liver is a type of liver disease, characterized by inflammation of the liver with concurrent fat accumulation in liver ("steato", meaning fat, "hepatitis", meaning inflammation of the liver).  Classically seen in alcoholics, steatohepatitis also is frequently found in people with diabetes and obesity.  When not associated with excessive alcohol intake, it's referred to as non-alcoholic steatohepatitis, or NASH.  Steatohepatitis of either etiology may progress to cirrhosis, and NASH is now believed to be a frequent cause of unexplained cirrhosis.
Physicians do not well manage fatty liver.

# Historical Perspective

# Classification

# Pathophysiology
Fatty liver  is the fatty degeneration of the parenchymal cells causing a yellow discoloration of the liver.  It is a reversible condition where large vacuoles of triglyceride fat accumulate in liver cells via the process of steatosis.  Despite having multiple causes, fatty liver disease (FLD) can be considered a single disease that occurs worldwide in those with excessive alcohol intake and those who are obese (with or without effects of insulin resistance). The condition is also associated with other diseases that influence fat metabolism. Morphologically it is difficult to distinguish alcoholic FLD from non alcoholic FLD and both show micro-vesicular and macrovesicular fatty changes at different stages.

# Causes

# Differentiating Fatty liver from Other Diseases

# Epidemiology and Demographics
Fatty liver disease is prevalent among 10%- 24% of general population in various countries. However among obese individuals the condition is observed in  up to 75% of people, 35% of whom, despite no evidence of excessive alcohol consumption, will lead to non alcoholic FLD. It is the most common cause of abnormal liver function test in the US. African Americans and Mexican Americans have higher frequencies of unexplained serum aminotransferase elevations than those reported in whites but prevalence of FLD among different racial groups is not known.

# Risk Factors

# Screening

# Natural History, Complications, and Prognosis

## Natural History

## Complications

## Prognosis

# Diagnosis

## History and Symptoms

## Physical Examination

## Laboratory Findings
Most individuals are asymptomatic and are usually discovered incidentally because of abnormal liver function tests or hepatomegaly noted in unrelated medical condition. Elevated liver biochemistry is found in 50% of patients with simple steatosis. The serum ALT level usually is greater than the AST level in non-alcoholic variant and the opposite in alcoholic FLD.

## Imaging Findings

## Other Diagnostic Studies

# Treatment

## Medical Therapy
The treatment of fatty liver depends on what is causing it, and generally, treating the underlying cause will reverse the process of steatosis if implemented at early stage. Recent studies suggest that diet, exercise, and especially antiglycemic drugs may alter the course of the disease. A randomized controlled trial found that pioglitazone led to metabolic and histologic improvement in subjects with  nonalcoholic steatohepatitis.

## Surgery

## Primary Prevention
Avoidance of alcohol abuse, maintenance of health diet and weight helps in preventing fatty liver.

## Secondary Prevention