When too much fat is stored in your liver

Dear doctor,

I would like to know more about fatty liver disease. Can it occur in someone who does not take alcohol?

Regie

Dear Regie,

Fatty liver disease or hepatic steatosis is a condition where there is build-up of fat within the liver. The build-up of fat may occur as a result of excessive alcoholic consumption, in which case it is called alcoholic fatty liver disease. This type of fatty liver disease can lead to liver inflammation (alcoholic hepatitis), which can lead to scarring of the liver (fibrosis and cirrhosis) that may lead to liver failure. Liver cirrhosis is also a risk factor for developing liver cancer.

Most cases of fatty liver disease, however, are due to non-alcoholic fatty liver disease (NAFLD), which develops in people who take little or no alcohol. Non-alcoholic fatty liver disease may either be the simple type, where the condition does not progress beyond the accumulation of fat, and it does not cause any problems. Simple fatty liver is the most common type of fatty liver disease.

The other type of non-alcoholic fatty liver disease is the one where the liver becomes inflamed and there is cell damage (non-alcoholic steato-hepatitis or NASH). This inflammation of the liver can lead to scarring and cirrhosis, just like alcoholic fatty liver disease, and can complicate to liver failure or liver cancer.

Though there is no exact know cause of non-alcoholic fatty liver disease, the risk factors include:

- Obesity - Malnutrition - Diabetes - Underactive thyroid (hypothyroidism) - Underactive pituitary gland (hypopituitarism) - Polycystic ovarian syndrome - Chronic viral hepatitis, especially from Hepatitis C - Rapid weight loss - Exposure to some toxins and chemicals - Long term use of some medications - Having high levels of cholesterol due to excessive intake or production or due to problems with lipid storage - Obstructive sleep apnea - Genetic risk

Most people with early or simple fatty liver disease do not have any symptoms, while a few develop fatigue and pain in the upper abdomen.

If hepatitis develops, there is abdominal pain, fever, nausea and vomiting, and jaundice (yellow eyes, skin and mucus membranes). With cirrhosis, the hepatitis symptoms may continue, in addition to ascites (build-up of fluid in the abdomen), swelling of the hands and feet, enlarged spleen, bleeding tendencies and weight loss. Cirrhosis can lead to confusion due to accumulation of toxic substances like ammonia in the blood stream. Cirrhosis can also lead to liver failure, which is fatal. In addition, about 90 per cent of those who develop liver cancer have cirrhosis.

Diagnosis of fatty liver disease is made through scans, with additional tests to check for underlying conditions and complications. Management of fatty liver disease includes adopting a healthy diet rich in fruits, vegetables, whole grains and healthy fats; maintaining a healthy weight; regular exercise; avoiding alcohol and management of any underlying illnesses like diabetes, hypertension and high cholesterol levels. Vaccination against Hepatitis A and B can reduce the risk of developing chronic hepatitis from those specific viruses. Liver transplant surgery can be done once cirrhosis sets in to prevent further deterioration.

Dear Healthy Nation,

My brother was diagnosed with a kidney stone three days ago and even though he is no so much pain, he was told to wait for it to come out by itself at home. Is there no other treatment? What caused it?

Naomi

Dear Naomi,

Kidney stones form when the urine gets too concentrated with minerals and salts and they crystallise and bond together to form hard deposits. This may either be because there is too much of the minerals in the waste or because there’s too little fluid.

A kidney stone may be present without causing any symptoms until the day it moves to another part of the kidney or it moves down to the ureters. The kidney stone can cause severe sharp pain on the side and the back that spreads to the lower abdomen and the groin. The pain may come and go and may also be associated with pain while passing urine. The location and intensity of the pain may also change. The stone may also block urine flow leading to swelling of the kidneys and urinary tract infection with change in urine colour and smell, blood in urine, fever and chills, nausea, vomiting, frequent urination and abdominal pain. There are different kinds of kidney stones based on the contents of the stones such as calcium stones, struvite stones, uric acid stones and cysteine stones. The risk factors for developing a stone include:

- Having a personal or a family history of having a kidney stone - Dehydration - Recurrent urinary tract infection - Diets high in salt, oxalates, sugar, fructose and purine - Some metabolic disorders - Obesity - Diabetes - The genetic disorder called cystinuria

- Gastric bypass surgery - Inflammatory bowel disease and chronic diarrhoea - Some supplements and medications

After the initial evaluation, a kidney stone is diagnosed through a kidney-ureter-bladder (KUB) x-ray or CT scan or intravenous pyelogram. The scans help to determine the size and shape of the stone and the condition of the kidneys. Other tests will be done to examine for urine infection, examine the health of the kidneys and to determine the underlying cause of the stones. In case the stone is small and there are no complications, then it may be advisable to let it pass without intervention other than taking a lot of water, and using pain killers, and may be a urine alkaliniser. In case the stone is large or it is causing significant obstruction or there is infection present, then other means of removing the stone may be used such as

- Shockwave lithotripsy – soundwaves are used to break the stone into small pieces that are then passed out in urine

- Uterescopy – the stone is removed or broken down through an endoscope passed into the ureter

- Percutaneous nephrolithotomy/nephrolithotripsy – a scope is introduced through a small cut in the back and the stone is removed whole or is crushed first.

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