Fatty liver and abnormal liver tests.

Liver Health

Is your liver paying the price of your lifestyle? Read about fatty liver, the causes and diagnosis of this lifestyle related liver disease.


Helen Marsden

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Liver tests are amongst our best-selling health screens and have been growing in popularity over the last 24 months as we wake up to the fact that our lifestyles have a big part to play in our liver health. Whether we’re routinely drinking over the recommended limits, eating badly or carrying more weight than we should, our liver can pay the price, as consultant gastroenterologist Mike Webberley explains. 

Fat should not really occur in the liver but is probably the commonest cause of abnormal liver tests that your GP might encounter. It is usually accompanied by a mild elevation of the liver enzymes and also a very specific test called the gamma GT. Under the microscope globules of fat can be clearly seen sitting in the liver cells and more frequently than not they sit there causing no harm at all but just occasionally can provoke an inflammatory reaction in the liver cells (hepatitis) which can cause scarring and over years, even cirrhosis.

Fat in the liver is easily seen with modern ultrasound machines where the liver appears unusually ‘bright’.

One of the commonest causes of fatty liver is excess alcohol consumption and certainly over years this may lead to cirrhosis. Although the liver has absolutely amazing regenerative properties, once scarring occurs (which is only really early cirrhosis), the liver cells find themselves encased in a latticework of unforgiving fibrous tissue and are no longer able to reproduce themselves and this is what causes cirrhosis. An idea of how good the liver is in regenerating itself is nicely demonstrated in the liver transplantation programme where sometimes only segments of livers are transplanted and within a few months the liver has returned to a normal size.

In alcoholic patients, abstinence reverses the inflammatory changes but not the scarring and in these patients’ fat may disappear from the liver altogether.

The other main cause of fatty liver is NASH. This stands for ‘Non-Alcoholic Steato-Hepatitis’ so as you might imagine accounts for all the other causes of fatty liver which aren’t directly related to alcohol.

This is a very mixed bag with multiple potential causes. These include;

  • General obesity (if you have fat on the outside it’s not really surprising you might have it on the inside too!)
  • Diabetes, particularly type 2 which goes hand in hand with obesity
  • Hypertension
  • High cholesterol and abnormal fat profile
  • Certain drugs
  • Rare causes of liver disease

The majority of people with NASH come to no real harm but the occasional few may develop liver cirrhosis – the problem is, we can’t predict who. Also there is no real way at the moment to stop that process occurring other than deal with the primary problem, namely getting rid of the fat in your liver.

Therefore patients with NASH are told to lose weight, bring their diabetes under control with diet and medication, their hypertension better controlled with medication, their cholesterol reduced with lipid lowering drugs, avoid alcohol etc etc. With these strategies an improvement in the liver function tests is usually seen and the danger of developing liver cirrhosis largely averted.

Early signs of liver damage include inflammation and raised liver enzymes. Our Liver Check Test looks at levels of liver enzymes as well as Gamma GT which can build a picture of whether your liver being harmed by your lifestyle. We recommend a regular liver check for anyone who knows that their lifestyle could predispose them to a fatty liver.

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