There are many disease causes of fatty liver, including common ones such as alcoholism, overnutrition or deficiency, endocrine disorders, drugs or hepatic toxins, and acute fatty liver encephalopathy which can be caused by pregnancy.

bubble_chart Diagnosis

Medical history and symptoms

Some patients experience discomfort in the liver area, lack of strength, and decreased appetite, but most show no clinical symptoms. Therefore, it is essential to inquire in detail about long-term alcohol consumption, nutritional imbalances, exposure to chemical reagents or history of hepatotoxic drug use, and the presence of diabetes. For pregnant women in their first pregnancy at 34–40 weeks who present with severe and persistent nausea and vomiting, followed by abdominal pain and jaundice, along with mental fatigue, drowsiness, and rapid progression to coma, acute fatty liver of pregnancy should be considered.

Physical examination findings

Most patients exhibit mild to grade II hepatomegaly, with about 4% showing splenomegaly. A few severe cases may present with jaundice, spider angiomas, and symptoms of portal hypertension. However, spider angiomas may disappear after treatment, and portal hypertension can return to normal.

Auxiliary examinations

Blood lipids, particularly triglycerides, are elevated. ALT and GGT levels are increased, and the glucose tolerance curve may show abnormalities, with delayed peak rise and decline. Prothrombin time may be prolonged by up to 40%, but this can be corrected with vitamin K.

Imaging studies primarily include B-mode ultrasound and CT. Ultrasound reveals liver enlargement, with dense and enhanced fine echoes in the anterior part of the liver and posterior attenuation. CT shows reduced liver density, with enhanced echoes in the portal vein compared to the liver parenchyma.

Fatty liver is a reversible change. Early diagnosis and timely treatment can generally restore normal liver function. Treatment includes eliminating the cause of the disease, such as discontinuing hepatotoxic drugs, abstaining from alcohol, and managing underlying conditions like diabetes. Dietary adjustments and lipid-lowering medications are also recommended, such as inositol 0.5–1.0g, three times daily; lecithin 2–3 tablets, three times daily; and Dongbao Gantai 1.5g, three times daily. For severe cases, coenzyme A 50–100 units may be administered intramuscularly once daily, along with adenosine triphosphate 20–40mg once daily or intravenous infusion of an energy mixture.