Fatty Liver Disease

Fatty liver disease can be easy to overlook and misdiagnose because it doesn’t have symptoms — like fatigue (being really tired), belly pain, swelling in your abdomen or legs, nausea and weight loss — until it’s progressed pretty far. But when caught early, this disease is manageable — and even reversible — with the right care.

Your primary care provider may suspect you have fatty liver disease if you have abnormal blood tests or imaging tests during a routine physical. They’ll check your weight and talk with you about your symptoms, if you even have any. They’ll also press on your belly to see if you have an enlarged liver. During this exam, your provider will ask about your diet, exercise habits and alcohol use. They’ll check for fatty liver risk factors, like being overweight or having high blood pressure, high cholesterol or diabetes. We also use various tests to confirm a fatty liver disease diagnosis.

Blood tests

We’ll take blood samples (also called liver function tests) to see if your liver is working right. Then, we’ll send the samples to our lab, where they’re examined under a microscope. Elevated liver enzymes or low protein levels in your blood may mean you have liver damage and inflammation (nonalcoholic steatohepatitis). 

Imaging tests

You also can expect to have imaging tests like an abdominal ultrasound or a CT scan. These tests give us detailed pictures of your liver to see if it’s healthy or enlarged, shrunken or full of fat.

Another test called elastography (FibroScan^®) uses painless, low-frequency vibrations that can tell us if your liver is stiff from scar tissue buildup (fibrosis). If you have a lot of this, you might have cirrhosis of the liver.

Liver biopsy

Your provider might also do a liver biopsy if they decide they want more information than blood or imaging tests can provide. They’ll use a needle to take a sample of cells from your liver. A pathologist will then check out your tissue samples under a microscope to find out how much liver damage you have.

When you come to Cleveland Clinic for NAFLD, you can feel good about having skilled healthcare providers guiding you every step of the way. This team could include:

• Gastroenterologists (digestive system specialists).
• Hepatologists (liver specialists).
• Pathologists (tissue specialists).
• Dietitians.
• Exercise physiologists.

Your gastroenterology and hepatology team will work together to rule out other liver diseases or liver failure, confirm a fatty liver diagnosis and find out how severe it is — in case it’s progressed.

All of the information we get during diagnosis helps us design your personalized treatment plan. We’ll consider many things — like your age, lifestyle, body weight and how severe your fatty liver disease is — when recommending treatment.

Lifestyle changes

Your liver is an amazing body part. It’s often able to repair itself, so sometimes making important changes in how you live might be all of the treatment you need. Not only can lifestyle changes help with fatty liver disease, but they can also lower your blood pressure and cholesterol and improve your blood sugar.

Your provider might talk to you about reducing stress. Stress can take a toll on your body in many ways. It can sometimes make you want to eat, which can cause you to gain weight. Losing weight through a better diet and more exercise can reduce the fat in your liver and help it get better. You and your provider can talk about the best nutrition and exercise plan for you and your lifestyle.

If you have a body mass index (BMI) greater than 40 or greater than 35 with other health conditions, you might be a candidate for weight loss surgery. Talk with your provider to see if this option is right for you.

Medication

There’s no medicine yet that can reverse fatty liver disease. But you can often improve your fatty liver by tackling other contributing health problems. If lifestyle changes like eating better, losing weight and exercising more haven’t helped you manage your high blood pressure, high cholesterol or diabetes, you can take medications to do this. Your provider can talk with you about the right ones for you.

Liver transplant

If your fatty liver disease has progressed to liver failure or severe cirrhosis, your provider might recommend a liver transplant. This surgery will replace your failing liver with a healthy liver from a donor. You go on a waiting list to be matched with a deceased donor, or you may have a living donor transplant (usually from a family member or friend).

Taking the Next Step

It’s probably scary to hear something’s wrong with your liver. But catching fatty liver disease early means you — and your liver — have the chance to get healthy again. It’s important not to wait. From easing your fears to helping you make lifestyle changes, Cleveland Clinic’s experienced and compassionate providers are here for you.

We can find the right treatment to slow or stop the disease from progressing and prevent serious health complications like liver damage or failure. And we’ll help you stay healthy once you recover. We’re by your side every step of the way.