Fatty Liver Symptoms, and When to Get Screened

Fatty liver is one of the commonest conditions doctors find, affecting roughly a quarter of adults worldwide. Most people who have it feel nothing at all. That is the main thing to know about its symptoms: by the time it causes them, it has usually been there for years.

The symptoms, when there are any

• Tiredness that does not have another explanation
• A dull ache or a feeling of fullness under the right ribs

Neither is specific. Plenty of people with fatty liver have neither, and plenty of people with both turn out to have something else. This is why it is found on a blood test or a scan, not by how you feel.

Signs that it has gone further

When fat in the liver leads to inflammation and then scarring, the liver can eventually stop coping. These signs mean being seen promptly:

• Yellowing of the skin or the whites of the eyes
• Swelling of the legs or the abdomen
• Bruising easily
• Confusion or unusual drowsiness
• Vomiting blood or passing black stools, which needs emergency care

Who should get screened

Because symptoms come late, the useful question is whether you are at risk. Screening is worth it if any of these apply:

• Type 2 diabetes or prediabetes
• Overweight, especially around the waist: 90cm or more for men, 80cm or more for women
• High cholesterol, high triglycerides or high blood pressure
• Drinking alcohol regularly
• A liver enzyme result that was even slightly raised on a previous blood test

How it is checked

Blood tests. Liver enzymes such as ALT, along with blood sugar, HbA1c and cholesterol. Liver enzymes can be normal even when fatty liver is present, so a normal result does not rule it out if you are at risk.

Ultrasound. The usual way fat in the liver is seen. It is painless and takes a few minutes.

Scarring risk. Scores worked out from routine bloods, such as FIB-4, estimate the chance of scarring. Where that risk is not low, a FibroScan, a type of scan that measures liver stiffness, is the next step.

Ruling out other causes. Hepatitis B and C, alcohol and some medicines can all affect the liver, and they are worth excluding before putting it down to fat.

What happens if you have it

At the fatty stage, before scarring, it is one of the more reversible long-term conditions. Losing 7 to 10% of body weight is the most effective treatment, along with cutting alcohol and treating diabetes, cholesterol and blood pressure. The bloods are then repeated to see whether it is working.

You may see drips advertised as a fatty liver treatment. A glutathione drip can be taken alongside these changes, but no infusion reverses fatty liver on its own. More on what helps and what does not is on the fatty liver page.

Getting checked at Chye Clinic

Liver enzymes, blood sugar and cholesterol are part of the clinic's health screening, and abdominal ultrasound is included in the larger packages. If weight is part of the picture, medical weight management starts from the same bloods.

This article is general information and does not replace an assessment by a doctor who knows your history.