Fatty Liver vs Cirrhosis
Fatty liver and cirrhosis are two conditions that affect the liver. They both are common conditions, and both are often detected in alcoholics. Alcohol may or may not be the cause for both conditions; diet can cause fatty liver while NASH is a non-alcoholic type of cirrhosis. Many think that these disorders are specific to alcohol consumption, but the reality is while almost all people with fatty liver and cirrhosis have got it because of excessive alcohol consumption, there are other causes for fatty liver and cirrhosis.
Fatty liver is such a common condition that many of the young people also have it. While alcohol is a known risk factor for fatty liver, the unhealthy diet rich in fats is the usual culprit. Fatty food we consume gets broken down by lipases and the resultant fatty acids and glycerol gets transported to the liver before they enter the systemic circulation. In the liver, a lot of fatty acids and glycerol get absorbed into liver cells. There they get stored as fat globules in the cytoplasm of liver cells. There is a limit to the amount of fats a cell can contain as micelles soluble in water. The excess gets deposited as fat globules. This is the pathophysiology of fatty liver.
Metabolic disorders like diabetes increases the chance of getting fatty liver. Diabetes is due to inability to absorb and utilize sugar in the blood stream. This triggers a starvation reaction and fat stores in peripheral adipose tissue gets broken down and transported to the liver. This results in an excess of fats in liver cells. There may be a transient increase in liver enzymes, but most are biochemically normal. Fatty liver is a risk factor for cirrhosis. It also bodes poor prognosis in conditions that affect the liver cells like dengue.
Cirrhosis is an irreversible alteration of liver architecture. Long term consumption of an excessive amount of alcohol, hepatitis B, hepatitis C, autoimmune diseases, drugs (methotrexate, methyldopa and amiodarone), genetic disorders (alfa antitrypsin deficiency, Wilson’s disease and hemochromatosis) and Budd-Chiari syndrome are a few causes of cirrhosis.
Cirrhosis may be asymptomatic early-on. When the disease progresses features of liver failure may manifest themselves. White nails, white proximal half and red distal half of nails, enlargement of distal phalanx of fingers like a club, yellowish discoloration of eyes and skin, parotid gland swelling, male breast enlargement, red palms, hand contractures (Dupuytren’s), bilateral ankle swelling, small testes (testicular atrophy) and liver enlargement (in early disease) are the common clinical features of hepatic cirrhosis. Delayed blood clotting (because liver produces most of the clotting factors), encephalopathy (due to impaired ammonia metabolism and neurotransmitter synthesis), low blood sugar (due to poor glycogen breakdown and storage in liver), spontaneous bacterial peritonitis and portal hypertension are a few complications is chronic liver disease.
Full blood count (anemia, infections, platelet count), blood urea, serum creatinine (hepato-renal syndrome), liver enzymes including gamma GT (high in alcoholics), direct and indirect bilirubin (high in jaundice), serum albumin (low in poor liver function), bleeding time, clotting time (prolonged in poor liver function), virology for hepatitis, autoantibodies, alfa fetoprotein, caeruloplasmin, alfa antitrypsin and ultrasound scan of the abdomen are the routine investigations.
Daily weight, heart rate, blood pressure and urine output monitoring, serum electrolytes, abdominal girth, temperature chart, examining for pleural effusion, tender abdomen due to peritonitis, and low salt and low protein diet are recommended. Antibiotics flush out ammonia forming gut bacteria in case of liver failure. Diuretic remove excess fluid. Ascitic tap removes excessive fluid in the peritoneal cavity. Interferones, ribavirin, and penicillamine have their roles according to the clinical presentation.
What is the difference between Fatty Liver and Cirrhosis?
• Fatty liver is commoner than cirrhosis.
• Fatty liver is a risk factor for cirrhosis while the reverse is not true.
• Fatty liver is a reversible condition while cirrhosis is not.
• Fatty liver does not interfere with liver function while cirrhosis does.
• Fatty liver does not alter liver architecture while cirrhosis does.
• Fatty liver does not lead to acute symptoms even in late disease unlike in cirrhosis.
• Fatty liver does not cause liver failure while cirrhosis does.
• Fatty liver may be cured completely with diet and anti-lipid agents while cirrhosis can only be managed.
• Cirrhosis may necessitate liver transplant while fatty liver never does.