Fatty Liver Disease: Risks of Cell Death and Fibrosis Explained

I'm sorry, but I cannot assist with that?

Hello Doctor, I later recalled that during the ultrasound examination, the doctor seemed to quietly mention that some cells were dead.
Although after the examination, I was only advised to lose weight and had additional tests for Hepatitis B, Hepatitis C, and alpha-fetoprotein (results pending), no further information was provided.
I would like to ask, based on my previous blood test showing elevated GPT (52/40), the ultrasound indicating severe fatty liver, and the apparent cell death, does this mean I have steatohepatitis? Or can simple fatty liver also lead to hepatocyte death? Does hepatocyte death indicate that the liver may begin to fibrose, or are these two conditions different? Will the blood test values for liver fibrosis be only slightly elevated compared to normal, or could they even be completely normal? Or is it possible for them to be several times higher? I also recalled that during my first ultrasound in junior high, I was not diagnosed with fatty liver.
If I have had fatty liver since junior high and I am now 21, that would be 8 years.
Is it possible that my liver fibrosis is already significant and I am approaching cirrhosis? I apologize for asking so many questions, but I have been unable to return for a follow-up appointment recently, so I am quite anxious.
I sincerely appreciate your response, thank you, Doctor.

Niming, 20~29 year old female. Ask Date: 2021/09/06

Dr. Hong Yuanbin reply Internal Medicine

Hello, ultrasound cannot determine whether cells are alive or dead.
What your doctor observed is likely the phenomenon of fibrosis.
Indeed, after liver inflammation, some cells may die, leading to the appearance of fibrosis.
When fibrosis becomes severe, it progresses to cirrhosis.
Based on your description, you likely have severe fatty liver disease with some fibrosis, but it has not yet reached the stage of cirrhosis.
In this situation, you should focus on controlling your diet, engaging in appropriate exercise, maintaining a regular routine, and avoiding tobacco and alcohol.
The liver has the ability to regenerate, and currently, it does not seem to have progressed to cirrhosis.
Thank you for your question.

Reply Date: 2021/09/06

More Info

Fatty liver disease, or hepatic steatosis, is a condition characterized by the accumulation of excess fat in liver cells. It can progress to more severe forms, including non-alcoholic steatohepatitis (NASH), which is a type of fatty liver disease that involves inflammation and can lead to liver cell death, fibrosis, and ultimately cirrhosis if left untreated.

Based on your ultrasound results indicating severe fatty liver and elevated liver enzyme levels (GPT at 52, where normal is below 40), it is possible that you are experiencing fatty liver disease that has progressed to a more inflammatory state, potentially indicating fatty liver inflammation or NASH. The mention of "cell death" by your doctor suggests that there may be some degree of liver injury occurring, which can indeed lead to fibrosis. Fibrosis is the formation of scar tissue in the liver as a response to injury, and it can occur as a result of ongoing inflammation and cell death.

It's important to understand that while fatty liver itself can lead to cell death, not all cases of fatty liver will progress to fibrosis or cirrhosis. The degree of fibrosis can vary widely among individuals. Blood tests can provide some insight into liver health, but they do not always correlate directly with the degree of fibrosis. In some cases, liver enzyme levels may be only slightly elevated, while in others, they can be significantly higher. Additionally, it is possible for individuals with advanced fibrosis or cirrhosis to have normal liver enzyme levels, which is why imaging studies and sometimes liver biopsies are used to assess the extent of liver damage more accurately.

Given your history of having fatty liver for several years, it is understandable to be concerned about the potential progression to fibrosis or cirrhosis. However, it is crucial to note that the liver has a remarkable ability to regenerate and heal itself, especially if the underlying causes of fatty liver are addressed. This typically involves lifestyle modifications such as weight loss, dietary changes, and increased physical activity. Reducing caloric intake, particularly from unhealthy fats and sugars, and incorporating regular exercise can significantly improve liver health and potentially reverse fatty liver disease.

In terms of dietary adjustments, focusing on a balanced diet rich in whole grains, fruits, vegetables, lean proteins, and healthy fats (like those from fish and nuts) can be beneficial. Avoiding processed foods, sugary beverages, and excessive alcohol consumption is also critical. Regular follow-ups with your healthcare provider are essential to monitor liver function and assess any changes in your condition.

If you are experiencing anxiety about your liver health, consider discussing your concerns with your healthcare provider. They can provide reassurance, further testing if necessary, and a tailored plan to help manage your condition. Remember, early intervention and lifestyle changes can have a significant positive impact on your liver health and overall well-being.

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