Non-Alcoholic Fatty Liver Disease

Signs and Symptoms

The signs and symptoms of nonalcoholic fatty liver disease (NAFLD) vary widely, depending on the stage of the condition. During the early or middle stages of the disease, patients typically have no symptoms directly related to liver disease. However, as the disease advances, patients may experience symptoms of cirrhosis, including:

• Fatigue
• Memory loss or confusion
• Fluid retention in the abdomen or legs
• Passage of tarry black stools, which suggests internal bleeding

Diagnosis

Nonalcoholic fatty liver disease (NAFLD) often is found "incidentally" as part of testing for an unrelated problem. To confirm the diagnosis of the disease, the following tests may be conducted:

• Blood Tests -- Blood tests that measure global liver function and indicate inflammatory activity will be performed, along with additional blood tests to exclude viral hepatitis.

• Liver Ultrasound -- This is a simple imaging procedure that looks for irregularities in the shape and consistency of the liver and for problems of the biliary tract, such as gallstones.

• Computerized Tomography (CT) -- Computed tomography (CT) is a method of body imaging in which a thin X-ray beam rotates around the patient, to provide a detailed view of the liver. Small detectors measure the amount of X-rays that make it through the patient or particular area of interest.

• Liver Biopsy -- In some cases, a liver biopsy may be needed to make a definite diagnosis of NAFLD. The test also helps is defining the stage of disease and severity of liver inflammation. During the biopsy, which is an outpatient procedure and performed under local anesthesia, a needle is inserted into the liver to obtain a small sample.

Treatment

Currently, the goal of treatment for nonalcoholic fatty liver disease (NAFLD) patients who are obese and/or have elevated blood lipids (fat) is weight loss. Those who are diabetic with poor control of blood sugar should work with a diabetes specialist and dietitian to control their blood sugar. All patients with NAFLD should avoid alcohol.

It is important to note that the treatment for NAFLD is evolving and rigorously being investigated in various research studies. UCSF is participating in one of the larger trials investigating NAFLD and new therapies for the condition.

Liver Transplantation

In some cases, nonalcoholic fatty liver disease (NAFLD) may progress to liver failure and requires liver transplantation. The UCSF Liver Transplant Program, which integrates the efforts of gastroenterologists and surgeons, performs over 100 transplants each year, making it one of the leading programs in the U.S. Survival statistics are among the very best in the country. The evaluation for a transplant is complex and generally requires several months. Therefore, even patients who are feeling well should be referred for a transplant at the first sign of liver failure or if they have advanced liver disease diagnosed by X-ray studies or liver biopsy.