Brisbane Liver Specialist Complaints

WHAT IS FATTY LIVER DISEASE?

Fatty liver disease - more than 5% fat in your Liver

Fatty liver disease or hepatic steatosis, or diffuse hepatic steatosis, is a common condition associated with the occupancy of excess fat in the liver cells. The liver is the most frequent location for fat build-up since it plays a crucial role in the metabolism of fats. Usually, the liver contains some amount of fat, but when the deposition reaches or exceeds 5% of the liver cells (hepatocytes), it is treated as unhealthy.

Does your Brisbane Liver Specialist explain how to reverss Fatty :Liver ? Read information below.

Non - Alcoholic Fatty Liver Disease

Non-alcoholic Fatty Liver Disease (NAFLD)

It is an increasingly recognised fatty liver disease where fat builds up in the liver without excessive alcohol intake. It can lead to significant damage over the years. This condition is further divided into four stages.

The non-alcoholic fatty liver disease stages are as follows:

Non-alcoholic Fatty Liver (NAFL)
Non-alcoholic Steatohepatitis (NASH)
Fibrosis
Cirrhosis

Non-alcoholic Fatty Liver (NAFL): It is also known as a simple fatty liver condition characterised by fat deposition in the liver without significant inflammation or harm to the liver cells. This may result in abdominal discomfort or pain due to hepatomegaly (enlarged liver).

Non-alcoholic Steatohepatitis (NASH): This is a severe form of NAFLD condition characterised by fat accumulation, inflammation, and damage in the liver. NASH has the potential to advance to liver fibrosis, cirrhosis and liver cancer; it is important to note that NASH can be a coexisting condition with other liver diseases such as chronic hepatitis C.

NASH is categorised into two types:

Primary, which is linked to obesity and diabetes without excessive alcohol consumption.
Secondary, which is induced by drugs or toxins.

Fibrosis: Fatty liver fibrosis is a condition characterised by the formation of scar tissue (fibrosis) in the liver and adjacent hepatic blood vessels due to prolonged inflammation in the liver.

Cirrhosis: Fatty liver cirrhosis is the most advanced stage and emerges after prolonged inflammation, causing the liver to contract, develop permanent scarring, and become nodular in appearance. This damage is irreversible and can result in liver failure and risk of liver cancer.

Most individuals with non-alcoholic fatty liver disease typically exhibit the initial phase of the condition, known as simple fatty liver or steatosis, while only little progress to the more severe stages. The development of fibrosis or cirrhosis may take several years to occur.

Non-alcoholic fatty liver disease (NAFLD) is associated frequently with metabolic syndrome, characterised by obesity, diabetes, and hyperlipidaemia. As per a research study report, around 80% of individuals diagnosed with metabolic syndrome also present with NAFLD.

The best possible strategy to reverse fatty liver is to follow a stratgey devised by yourself as it is unlikely your Liver specialist will have any plan.

Alcoholic Fatty Liver Disease

Alcoholic fatty liver disease, also called alcoholic steatohepatitis, is one of the Alcoholic Liver Disease (Alcoholic Related Liver Disease - ARLD) conditions caused by excessive consumption of alcohol (≥ 40g in males, ≥ 20g in females) and is often a result of the metabolic effects caused by consuming moderate to high quantities of ethanol (alcohol). Ingesting such amounts of alcohol can lead to the development of fatty liver due to its impact on the body's metabolism.

In the consumption of alcohol, the liver metabolises most of it to eliminate it from the system. However, this breakdown process generates toxic compounds that can harm liver cells, trigger inflammation, and compromise the body's inherent defences.

Alcoholic fatty Liver Disease typically improves upon cessation (stoppage) of alcohol intake. However, if alcohol consumption continues, it can lead to severe liver problems.

The alcoholic fatty liver disease stages are as follows:

Alcoholic Fatty Liver or Steatosis

Alcoholic hepatitis

Alcoholic cirrhosis

Alcoholic Fatty Liver or Steatosis: It is a common condition caused by alcohol-induced fatty liver. In this condition, the liver enlarges, which may or may not cause noticeable symptoms. Discomfort or pain can arise in the upper right area of the abdomen.

Alcoholic hepatitis: It is a condition characterised by inflammation of the liver, resulting in symptoms such as fever, nausea, vomiting, abdominal pain, and jaundice.

Alcoholic cirrhosis: This is the advanced stage where the liver cells develop fibrous scar tissue.

The extent of liver damage increases proportionally with the amount of alcohol consumed. Alcoholic fatty liver disease represents the initial phase of liver damage resulting from alcohol consumption, followed by alcoholic hepatitis and cirrhosis as progressive stages of alcohol-related liver disease.

Does your Brisbane Liver Specialist explain what Alcoholic Liver Disease is ?

SUMMARY OF ways to grade FATTY LIVER

Basically there are two ways to evaluate Fatty Liver - by visually or quantitative (numbers)

ULTRASOUND

Visual – B Mode Ultrasound

Grade 1 Mild

Images - Increased Echogenicity. Periportal fat and diapragm still visible.

Grade 2 Moderate

Images - Loss of Periportal Fat around Portal Vein and Hepatic veins

Grade 3 Severe

Images - Loss of visualisation of Diaphram and Liver veins.

Quantitative – Ultrasound Elastography – 2d Shearwave – CAP

Under this method, the Scan company will do a combined Upper Abdomen Ulstrasound plus 2d Shearwave analysis, all the one appointment.

1. Controlled Attennuation Parameter (CAP) for assessing Steatosis

s0: Normal (below 184 dB/m)

s1: Mild (184-248 dB/m)

s2: Moderate (249-280 dBm)

s3: Severe ( abover 280 dB/m)

You need to get the Scan company to provide this information on the scan images and report.

2. Visually - the signs for the thre stages are as above. The Radiologist should state what stage your Fatty Liver is , plus whether there are signs of Cirrhosis such as intilally an enlarged liver, and later a nodular shrunken liver. Your Liver specialist should be able to signe the scans and reports and advise if they agree with the Radiologist or not.

Estimate of Fibrosis - The 2d Shearwave will also provide a minimum of ten passes to establish median score. This score is supposed to compare to Fibroscan, ie, F0 to F4.

FATTY Liver grading - ULTRASOUND visual B-mode OR quantitative - transient ELASTOGRAPHY

Grade 1. Increased Echogenicity, but can still see vessels and diaphragm.

Grade 2. Increased Echogenicity obscuring periportal fat around vessel walls.

Grade 3 Increased Echogenicity but vessels and diapragm are obscured.

CAP - Controlled Attenuation Parameter.

measuring liver stiffness with Ultrasoound machines such as 2D Shearwave.

Note that Echogenicity does not prove or disprove Cirrhosis. Visuals

Ultrasound symptoms of Fatty Liver and grading

To reverse Fatty Liver you nee to look at Ultrasound symptoms

Increased Echogenicity - Brighter on Ultrasound

Attenuation of Liver is brighter than the right kidney

Mild - Increased Echogenicity. Brighter than normal. Brighter than right kidney. Well visualised vessels and diaphragm and Periportal fat.

Moderate - Increased Echogenicity. Impaired visualised vessels and diaphragm.

Loss of Periportal fat around Portal vein and other liver veins,

Severe - Non - visualised vessels and non-visualised diaphragm (Can't see them)

(Layman - as the grading of Fatty liver is worse, the harder it is to see the vessel walls and white outline (Periportal fat) such as the portal vein and the white outline of the liver, (the diaphragm)

MORE EXAMPLES OF GRADING OF FATTY LIVER

Sonographic Tendencies - another good

example of Ultrasound images.

" When there is fatty infiltration of the Liver the parenchyma (Liver) becomes more echogenic (hyperechoic). Fatty liver can be described by ultrasound as mild, moderate and severe, though this is more a qualitative assessment, with mild fatty liver you’ll see increased echogenicity, and loss of the interface with the hepatic vein w

BJR Fatty Liver comparisons - Ultrasound, CT and MRI.

" Ultrasound, CT and MR at steatosis—examples. B-mode ultrasound transverse images of the liver (first row), axial unenhanced CT images of the liver at the level of the spleen (second row), and axial MRI PDFF images of the liver (third row) are shown for four patients. Steatosis grade was determined at liver biopsy with direct histological visua

IS YOUR BRISBANE LIVER SPECIALIST SHOWING YOU ON A COMPUTER

Diagnosis of Fatty Liver stage is the missing Link in all this process.

AtWhen you weigh yourself on a set of scales, you know exactly how much you weighed last week. You know exactly how much you weigh now. Unfortunately, in the Liver diagnosis business, it seems that Brisbane Liver Specialists have a problem in diagnosing if you are going forwards or backwards. You have no starting point and no end point. More on this later. I am fairly certain that heart specialists have bo problem telling you exactly what is the problem with your heart. But for some reason, Radiologists , Hepatologists and Gastroenterologists have a major problem in determining what stage Fatty Liver you are. More conming on this later.