Often the main problem is variable bowel habit - there is sometimes diarrhoea and other days constipation. This is the main symptoms of irritable bowel syndrome (IBS)...

Fatty Liver

Yellow appearance of a liver with excess fat
The liver is within the abdominal cavity but actually is placed mostly behind the ribs on the lower right rib cage. Sometimes the liver is enlarged with fatty liver but usually only mild enlargement
Most of the time the liver can cope with the extra fat - but sometimes it is just NOT HAPPY

What is fatty liver?


  • Answer : simply what the name suggests - too much fat in the liver!
  • Some important facts:
    • Fatty liver is the accumulation of fat (mainly as triglycerides) within liver cells.
    • This happens when the fat coming into the liver is more than the fat going out (the liver makes and secretes fat).
    • This condition is becoming more common.
    • It is the commonest cause of abnormal liver enzyme tests (blood tests for the liver). This is because fat in the liver may cause some inflammation.

What causes fatty liver?

  • Excess alcohol intake may be the main underlying cause.
    • How much is too much?

    • Refer also to section on alcohol and liver.

    • The risk of moderate alcohol intake (2 standard drinks per day; less than 20g) causing significvant fatty liver is 5-fold for non-obese men, 15-fold for overweight men and 35-fold for obese men.

    • Obesity and even moderate alcohol intake not good for the liver!!!
    • Safe limit may only be 3 standard drinks per week  - better to be nil

  • There are an increasing number of people with fatty liver that is NOT caused by alcohol.
    • This condition has an association with being overweight, having diabetes (or pre-diabetes - also called impaired glucose tolerance -  and having raised cholesterol or raised triglyceride levels in the blood.
  • The underlying problem is considered to be "insulin resistance".
    • This means that the body is not responding normally to the insulin hormone.
    • This problem directly relates to the amount of fat tissue in the body.
    • Fatty tissue is not inert. It secretes a range of hormones that control the body's metabolism.
    • Insulin resistance promotes increased rate of delivery of fat to the liver from the tissues.
    • Insulin resistance (and therefore fatty liver) is primarily determined by body weight and also the level of physical activity.
    • Fatty liver is a marker for significant insulin resistance and is associated with a 2- to 5-fold risk of developing type 2 diabetes

    • The main risk to health with fatty liver is not severe liver disease but diabetes, heart disease and stroke - all long term consequences of insulin resistance / metabolic syndrome

  • Fatty liver is more common some ethnic groups.
    • That is, for a given weight there is more fatty liver in some groups.
    • It is more common with Indian and Chinese compared with European groups.
    • It is also more common in Pacific Islanders.
  • About 10% of people with excess fat in the liver will develop inflammation in the liver.
    • The medical term is called steatohepatitis.
    • This sometimes abbreviated as NASH - non-alcohol steatohepatitis.
    • Another abbreviation is NAFLD (non-alcoholic fatty liver disease).
  • This inflammatory process, if sustained over a long period of time, can lead to significant liver fibrosis and eventually to cirrhosis (severe liver damage).
    • The risk is low (compared to other causes of liver disease).
    • Overall only 2% will progress to cirrhosis.  This is a much smaller risk than for fatty liver caused by alcohol alone
    • The risk is higher with type 2 diabetes
    • The risk is higher with obesity AND moderate alcohol (or greater) alcohol intake


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