Today, fatty liver is a “trendy” disease that many people have.
But do you know how it is diagnosed?
The earliest diagnosis of fatty liver is often made by the patient during a physical examination or other reasons for the examination of abdominal ultrasound, if the abdominal ultrasound suggests that the liver shows anterior enhancement and posterior weakening, that is, “bright liver”, ultrasonographers will give the diagnosis of fatty liver.

However, imaging is only one of the clinical manifestations of fatty liver, and the causes, risk factors, severity of the disease, and presence of complications must be comprehensively analyzed and evaluated by specialists.
In terms of etiology and risk factors, excess energy metabolism is the most common cause of intrahepatic steatosis, but alcohol, drugs (glucocorticoids, oral estrogens, methotrexate, amiodarone, valproic acid, aspirin, iliconazole, thiazide diuretics, cyclophosphamide, tamoxifen, etc.), abnormalities of copper metabolism, and abnormalities of glucose metabolism also lead to fatty deposits in the liver.

In addition, in patients with elevated aminotransferases, young patients should exclude hereditary metabolic diseases such as hepatomegaly, hemochromatosis, etc.; if accompanied by elevated transpeptidase, it is necessary to distinguish it from alcohol, drugs, primary biliary cholangitis, etc.; if accompanied by elevated globulin or immunoglobulin, it is necessary to distinguish it from autoimmune hepatitis. When accompanied by elevated globulin or immunoglobulin, it is necessary to distinguish it from autoimmune hepatitis; when there is an inhomogeneous fatty liver on abdominal ultrasound, it is necessary to differentiate it from other liver-occupying diseases; and when the clinical diagnosis of cirrhosis is made, it is necessary to improve the hardness of the liver, gastroscopy, and abdominal enhancement CT or MRI to assess the cirrhosis and related complications.

Most patients can be diagnosed based on history, laboratory tests, and imaging studies. Liver biopsy may be considered if the cause is still uncertain or if the extent of the condition is not clearly determined.
Thus, fatty liver is common but not straightforward. Once fatty liver is diagnosed, it is recommended to visit a hospital to complete an assessment of the condition and develop a subsequent long-term management program.

Long-term management program

This long-term management program focuses on the patient’s lifestyle modification, maintenance and, if necessary, medication, and long-term monitoring and management modalities.
Fatty liver itself is a long-term chronic disease that can progress or reverse in both directions in the early stages of the disease as influenced by lifestyle.

Therefore, lifestyle modification and long-term maintenance to achieve and maintain weight loss in patients remains a top priority. Weight loss in patients leads to biochemical and histological improvements, as well as improved quality of life. It is recommended that patients lose 0.5-1 kg per week through dietary modification and exercise.
It has been shown that patients who lose 5% of their body weight can achieve a reduction in hepatic lipoatrophy; 7%-10% of their body weight can improve inflammation and hepatic fibrosis.

In addition, doctors may prescribe liver-protective drugs to improve liver function in some patients with fatty liver disease, but even if liver function returns to normal, it does not mean that fatty liver disease is completely cured. Resolution of fatty liver disease requires histologic evidence of the extent of lipoatrophy and resolution of intrahepatic inflammation and fibrosis.

New drugs are being developed to treat the inflammation and fibrosis of fatty liver, and patients can talk to their doctors about trying to enroll in a clinical trial of a suitable new drug. Even if histologic evidence of fatty liver disappearance is achieved with treatment, fatty liver may recur if the patient regains weight or is exposed to risk factors. Therefore, an individualized long-term management plan must be developed according to the patient’s situation.
Therefore, the treatment of fatty liver does not happen overnight, but requires a long-term battle and the development of a personalized long-term management plan with the patient’s participation.

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