NAFLD: symptoms & diagnosis
What are the symptoms of NAFLD?
Most people with mild NAFLD are unlikely to notice any symptoms. Some may experience discomfort n the liver area and tiredness.
For those who go on to develop NASH, Fibrosis and Cirrhosis it may be many years before symptoms develop. The following symptoms may indicate a serious development in your liver condition. Patients with a liver condition who develop any of the following symptoms should see urgent medical attention:
- yellowness of the eyes and skin (jaundice)
- bruising easily
- dark urine
- swelling of the lower tummy area (ascites)
- vomiting blood (haematemesis)
- dark black tarry faeces (melena)
- periods of confusion or poor memory (encephalopathy)
- itching skin (pruritus)
If your skin and the whites of your eyes turn yellow you may have jaundice.
Two things can cause jaundice:
- a blockage (obstruction) in the bile duct
- damage to your liver or some defect affecting the liver so that it cannot deal with bilirubin, a by-product of the breakdown of old red blood cells.
If either of these occurs, bilirubin – which is yellow – flows back into the blood and shows up in the skin and the eyes.
Swelling in your abdomen is known as ascites. The swelling is caused by fluid building up in the lining around your abdomen. This can happen slowly over weeks or months and can be painful, especially if the fluid becomes infected and requires urgent attention.
You may also get swelling in your legs, ankles or feet, known as peripheral oedema.
People with cirrhosis are prone to infections, which can make their liver condition worse. As a result, they should seek medical attention if they develop a temperature..
Internal bleeding due to liver damage is often first noticed in very dark or black tarry faeces (maelena) and the vomiting of blood (haematemesis). Having either of these symptoms will need urgent medical attention.
If your liver is badly scarred from extensive fibrosis or cirrhosis, blood will be unable to flow through it easily. As a result, pressure builds up in the vein that carries blood to the liver from the gut – the portal vein.
Having high blood pressure in the portal vein is known as portal hypertension. As the pressure mounts, blood begins to back up. It finds another way of reaching the heart by using extra veins
lining your oesophagus and stomach known as varices. Varices have fragile walls, which cannot easily handle the increased blood flow and often burst, leading to internal bleeding.
This blood loss may just be a gentle ooze, resulting in symptoms of anaemia that include tiredness and shortness of breath, but sometimes there can be major bleeding, with a haemorrhage and vomiting of blood. Haemorrhaging varices are a serious and life-threatening complication of cirrhosis and need emergency medical treatment.
How is NAFLD diagnosed?
In most cases people only find out they have a fatty liver when a routine blood sample (usually liver function tests) shows there may be a problem. If this happens you may be asked a lot of questions about your lifestyle, such as, any drugs you are taking (including over-the-counter medication and nutritional supplements), your diet, the amount of exercise you do and the amount of alcohol you drink.
Further tests may be needed to confirm the diagnosis such as an Ultrasound, FibroScan, CT or CAT Scan or MRI scan. In some cases a liver biopsy may be needed.
Treatment for NAFLD
There is no specific treatment for NAFLD that all doctors agree on.
However, if your NAFLD is linked to being overweight then you will be advised to make various lifestyle changes including losing weight gradually and taking sensible exercise. There is good evidence that gradual weight loss coupled with increased exercise can reduce the amount of fat in your liver.
In mild cases of NAFLD doctors may concentrate on treating associated conditions, such as obesity and diabetes, which can cause fat to build up. They will also treat disorders such as high blood pressure and high cholesterol as these are often associated with NAFLD.
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Maintaining a healthy weight through eating a well-balanced diet and taking regular exercise is the best way to prevent NAFLD. The health risks from being overweight or obese can impact on your physical, social and emotional well being. People with NAFLD who go on to develop Cirrhosis are at a higher risk of liver failure.
Although it is not always possible to avoid NAFLD, as some factors such as genetics cannot be prevented, you can significantly reduce your risk by exercising as much as you are able to, and eating healthily to control your weight (see our diet and liver disease information).
Better control of existing medical conditions, such as glucose levels in diabetes, can also help prevent the development of NAFLD and NASH.
NICE have published a new quality standard Obesity in adults: prevention and lifestyle weight management programmes. Click here to view.
NICE have also issued a new guideline on how to identify the adults, young people and children with non-alcohol related fatty liver disease (NAFLD) who have advanced liver fibrosis and are most at risk of further complications. It outlines the lifestyle changes and treatments that can manage NAFLD and advanced liver fibrosis.
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