The liver is the largest organ in the human body. It is essential for food digestion, removing toxins and poisons from the body, and storing energy. When the liver becomes diseased, it can start to fail, leading to severe complications and death. Fatty liver disease is a common disorder affecting nearly a quarter of the world’s population. There are two types of fatty liver disease which are nonalcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease.
Alcoholic fatty liver disease occurs in people who chronically and excessively drink alcohol. The liver breaks down alcohol in the body, but a side effect of this breakdown is liver damage. Alcoholic fatty liver disease is the earliest sign of liver damage from alcohol. If alcohol consumption is not drastically reduced, it will lead to alcoholic hepatitis and cirrhosis.
NAFLD unrelated to alcohol consumption. It is classified into two subtypes: simple fatty liver and nonalcoholic steatohepatitis (NASH). A simple fatty liver does not result in damage or complications, while NASH causes cell damage and inflammation to the liver. This can lead to permanent scarring, cirrhosis, and liver cancer.
1. Fatigue
When the liver becomes damaged, the body will send more blood to the organ than usual in order to attempt to protect against further damage. This excess blood flow can result in excessive fatigue since blood and oxygen are being diverted to the liver from other places. In advanced liver disease, there are changes that researchers think occur in the brain. Hormone changes are also thought to occur which can lead to loss of energy and fatigue.
The brain seems to lower production of the neurotransmitter, serotonin. Serotonin is responsible for changes in mood, like depression. Depression is known to affect energy levels and can contribute to heightened feelings of fatigue.
Fatigue is a general symptom with many possible causes. For this reason, physicians may not attribute fatigue to a liver problem initially.
2. Weight Loss
Weight loss that occurs with fatty liver disease can be due to a few different factors. Nausea and vomiting that occur can inhibit the appetite, causing rapid weight loss.
Muscle wasting occurs with severe liver disease. This muscle wasting is typically seen first in the arms and legs. It can give the appearance of fat loss, but is really the muscle tissue breaking down. Unexplained weight loss due to muscle wasting is one of the signs of advanced liver disease.
3. Abdominal Pain
During advanced stages of fatty liver disease, abdominal pain can be present. This pain is typically located in the center or upper right part of the abdomen. Pain can indicate internal bleeding due to rupture of blood vessels in the gastrointestinal tract. Vomiting of blood can occur in addition to abdominal pain because of this bleeding. Blood in the stool may also be noted. Abdominal pain is often accompanied by swelling in the abdomen. This swelling is caused by excess fluid, called ascites.
4. Abdominal Swelling
Abdominal swelling can occur with severe liver disease. The area around the belly button will get pushed out and the skin around the abdomen will become tight due to swelling. It can cause breathing problems due to pressure on the organs and muscles, including the diaphragm.
Ascites caused by fatty liver disease can be treated with medications to reduce fluid retention, like diuretics. For more severe cases, a more invasive approach may be necessary, where the fluid is manually drained from the abdomen.
5. Jaundice
When the skin or whites of the eyes become tinged with a yellow color, this is known as jaundice. The yellow color is caused by excess amounts of bilirubin in the blood. The bilirubin is usually excreted from the body, but when the liver is damaged, it can not process it and a buildup occurs. Typically, the bile duct of the liver becomes blocked due to scarring which causes jaundice. Jaundice is one of the ominous signs of fatty liver disease and indicates scarring and cirrhosis along with possible impending liver failure.
6. Enlarged Spleen
An enlarged spleen can be caused by cirrhosis of the liver. It can produce vague abdominal pain and some bloating in the splenic area. If the spleen is very enlarged, it can cause loss of appetite and heartburn-like symptoms. This is because the spleen can put pressure on the stomach and cause the contents to back up into the esophagus. The increased pressure can also produce a false feeling of fullness, and limit the volume of food the stomach can contain.
7. Enlarged Blood Vessels
Severe liver disease can cause enlarged blood vessels in the esophagus, called esophageal varices. When the liver becomes severely diseased, it can result in high blood pressure in the portal vein. This vein supplies the liver with its blood. The pressure causes surrounding blood vessels to grow larger over time. The dilation, or enlargement, in these adjacent blood vessels eventually spread to the lower area of the esophagus and stomach. Because the vessels have been stretched for a long period of time, they are prone to rupture. This can result in significant blood loss during episodes of vomiting or from the lower end of the gastrointestinal tract. The blood in the GI tract that is excreted is usually painless. Stools may appear dark and tarry from the blood. Blood loss during rupture can cause paleness, lightheadedness, and anemia.
