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Fatty Liver Disease (Hepatosteatosis): Diagnosis

What is Fatty Liver Disease (Hepatosteatosis)

Fatty liver (also reffered to as hepatic steatosis or hepatosteatosis), is an accumulation of fat in the liver. While the term is attributed to numerous conditions, it’s most commonly used in reference to fatty liver disease.

In general, a healthy liver should contain little to no fat. For most people, a small amount of fat in the liver causes no major problems. High levels of fat in the liver, however, can lead to diabetes, heart attack, and stroke. In late-stage fatty liver disease, cirrhosis (an advanced stage of liver damage) can occur, which drastically increases the risk of developing liver cancer.

How is Fatty Liver (Hepatosteatosis) Diagnosed

The most common imaging procedures used to diagnose hepatic steatosis include ultrasound, CT, MRI, firbroscan, and transient elastography. In inconclusive cases, a biopsy may be necessary.

Ensuring an Accurate Fatty Liver Disease Diagnosis

Fatty liver can be treated and even reversed when caught early – which is extremely important because, while fatty liver may not be a huge threat in early stages, it can develop into cirrhosis and put you in danger of liver cancer or failure. But fatty liver disease can be tricky to diagnose. Ensuring an accurate diagnosis will prevent false-positives and ensure those with the disease are properly treated.

80% of liver cancers occur in cirrhotic livers.

If you’ve been diagnosed with fatty liver or are concerned that you might be at risk, you can get a second opinion on your imaging scans from an abdominal subspecialty radiologist through DocPanel.

A subspecialist will have extensive experience in the condition and can help:

A. Ensure the degree of fat in the liver has been accurately staged.

Familiarity with the way different patterns of fat accumulation appear in radiographic images is essential for correct evaluation and staging of hepatic steatosis. This comes from specific training and experience.

B. Help catch a misdiagnosis.

Distinguishing the difference between fat deposition and fatty liver in radiographic imaging can be challenging. The mischaracterization of fatty liver as ‘fatty infiltration’ is another possible diagnostic pitfall.

Liver lesions should also be taken into consideration during image interpretation. Hepatic adenomas, hepatocellular carcinomas, and, occasionally, focal nodular hyperplasias may have microscopic fat content, which can cause confusion for the reading radiologist if they do not have the proper training.

C. Provide peace of mind by confirming a diagnosis.

Being diagnosed with fatty liver disease can be stressful. Knowing that a highly trained specialist has reviewed your scans and confirmed diagnosis can help reduce anxiety and provide you with confidence to begin appropriate treatment.

Fatty Liver Disease Prevelance

Nearly one-third of Americans have fatty liver disease. But because fatty liver (hepatosteatosis) is typically asymptomatic in the early stages – most of them are unaware they have it.

In fact, the majority of fatty liver cases are found incidentally, during medical imaging tests for unrelated conditions. Unfortunately, this means many cases are not discovered until the late stages, when it’s harder to treat and cirrhosis has already developed.

Fatty Liver Ultrasound

There are two main indicators of hepatic steatosis (fatty liver) in a liver ultrasound:

  • the liver echogenicity exceeds that of renal cortex and spleen
  • there is attenuation of the ultrasound wave, loss of definition of the diaphragm, and poor delineation of the intrahepatic architecture

To avoid false-positivess, a hepatic steatosis diagnosis should only be given via ultrasound alone if both indicators are present. A second opinion on an ultrasound can also help confirm an accurate diagnosis.

Types of Fatty Liver Disease (Hepatosteatosis)

Fatty liver disease can be split up into two types: alcoholic hepatic steatosis (alcoholic fatty liver disease) and nonalcoholic hepatic steatosis (nonalcoholic fatty liver disease).

Alcoholic Fatty Liver Disease (Alcoholic Hepatosteatosis)

Alcoholic hepatic steatosis, also called alcoholic fatty liver disease, occurs as a result of chronic, heavy alcohol consumption. As fat builds up inside the liver cells, liver function becomes difficult.

Many people with alcoholic hepatic steatosis do not experience any symptoms. However, pain and discomfort in the right upper abdomen are common side effects in advenced cases where the liver becomes enlarged. Once diagnosed, those with alcoholic hepatic steatosis usually see improvement after they stop drinking alcohol. In the case that a patient continues to drink, they run the risk of developing alcoholic hepatitis and alcoholic cirrhosis. Cirrhosis can then develop into liver cancer.

Non-Alcoholic Fatty Liver Disease (Non-Alcoholic Hepatosteatosis)

Non-alcoholic hepatic steatosis, also called nonalcoholic fatty liver disease, is the most common chronic liver disease in the Western world. As the name suggests, nonalcoholic liver disease refers to fat accumulation in the liver (hepatic steatosis) that was not brought on by the use of alcohol.

According to Johns Hopkins, about 10% to 20% of Americans have NAFLD. About 2% to 5% have NASH. It is the most common form of liver disease.

Most often, nonalcoholic hepatosteatosis is a result of obesity or metabolic syndrome – a condition typically characterized by high blood pressure, poor ability to use the hormone insulin, high blood sugar, high cholesterol, and excess body fat around the waist. While it can occur in all ages, hepatosteatosis is typically found in people aged 40 to 50 years old.

It is heavily influenced by lifestyle (poor diet high in sugar and carbohydrates, chronic excessive calorie intake, sedentary activity) and is distinct from fatty liver diseases caused by alcohol.

There are two types of nonalcoholic hepatic steatosis: simple fatty liver and nonalcoholic steatohepatitis (NASH).

Simple fatty liver

Most people with nonalcoholic hepatic steatosis have simple fatty liver. Generally non-threatening, simple fatty liver is a condition of fat in the liver – but without inflammation in the liver or damage to the liver cells. It is typically asymptomatic and does not cause any liver function problems. However, if fat is present in the liver for an extensive period of time, the liver cells can become inflamed and simple fatty liver can develop into nonalcoholic steatohepatitis.

Non-alcoholic steatohepatitis (NASH)

Nonalcoholic steatohepatitis is the most severe form of nonalcoholic hepatic steatosis. It accounts for about 20% of nonalcoholic steatohepatitis cases. While also a condition of fat in the liver, those with nonalcoholic steatohepatitis have liver inflammation and, usually, liver cell damage as well.

Those with NASH are at high risk of developing fibrosis and cirrhosis, which can ultimately lead to liver cancer. It’s often nicknamed a ‘silent killer’ because patients can live it with it for years without experiencing any symptoms.

Risk Factors

Heavy alcohol consumption is the main cause of alcoholic hepatic steatosis. Obesity and metabolic syndrome are some of the main risk factors for developing nonalcoholic hepatic steatosis. While alcohol consumption is not the direct cause of nonalcoholic fatty liver, it can complicate the situation.

Other possible contributing risk factors for non-alcoholic hepatic steatosis include:

  • Insulin resistance
  • High blood sugar
  • Type 2 diabetes
  • High levels of unhealthy fats, especially triglycerides
  • Thyroid or pituitary gland issues

Nicknamed the ‘silent killer’, nonalcoholic fatty liver disease is predicted to surpass hepatitis B & C as the leading cause of cirrhosis and main reason for liver transplants by 2020.

A healthy diet and regular exercise can help prevent non-alcoholic hepatosteatosis.

Screening for cirrhosis, particularly in patients with other risk factors such as viral hepatitis, obesity, or alcohol use is highly recommended.

Get a Subspecialty Second Opinion Today

The DocPanel platform enables people all over the world to get an expert second opinion in as little as 24 – 72 hours.

An easy 3-step process – instantly upload your scans, select an expert subspecialty radiologist (or have DocPanel assign your case to the appropriate subspecialist), and submit your request. Upon uploading your scans, you’ll also have the opportunity to ask any questions you might have about your case.
Not sure what a subspecialist is? Learn more with our in-depth article on the importance of getting a second opinion from a subspecialty radiologist.

Get your scans interpreted by one of the nation’s leading abdominal subspecialists, Dr. Semelka, or explore DocPanel’s complete team of subspecialty radiologists. Request a second opinion today.

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