What is a decrease in parenchymal echo texture in the liver

Fatty liver (steatosis hepatis)

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Written by Lydia Kloeckner • Medical editor
Checked by Prof. Dr. Dr. Andreas Teufel • hepatologist

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Fatty liver is when the liver stores too much fat. The cause is usually an unhealthy lifestyle. The good news: if recognized in time, the disease can often be cured. Here you will find out which symptoms can indicate a fatty liver and which diet can help.

The most common causes of fatty liver are

A fatty liver occurs when the liver stores too much fat: If there is too much fat in more than five percent of the liver cells, doctors speak of fatty liver or steatosis hepatis (steatosis = obesity, Greek hepar = liver).

Alcoholic and non-alcoholic fatty liver disease can often not be clearly distinguished from one another. Fatty liver is often the result of a combination of factors, including alcohol and obesity.

Cause unhealthy diet

An unbalanced diet and lack of exercise can lead to so-called non-alcoholic fatty liver, or NAFLD for short. nonalcoholic fatty liver disease. Because: If you take in more energy than you need through nutrition, the body stores the excess energy as fat - and not only in the form of fat deposits under the skin, but also in the liver.

This harms the liver itself on the one hand, and the entire body on the other. Because fat deposits in the liver and muscles are among the main causes of metabolic syndrome and type 2 diabetes.

In addition, certain drugs can promote non-alcoholic fatty liver disease, for example amiodarone, glucocorticoids, tamoxifen, diltiazem and some anti-retroviral drugs.

Cause alcohol

Too much alcohol can also lead to fatty liver disease. The liver has certain proteins that can break down alcohol. However, if you give the liver too much alcohol, it will be damaged. The liver can then no longer break down fatty acids as usual, so that more and more fat collects in it.

There is a risk of alcoholic fatty liver for ...

  • ... men who drink so much alcohol that their daily dose exceeds 20 g of pure alcohol. That corresponds to about half a liter of beer or two glasses of wine (approx. 300 ml).
  • ... women who drink so much alcohol that their daily dose exceeds 10 g of pure alcohol. This corresponds, for example, to a small glass (300 ml) of beer or a glass of wine (approx. 150 ml).

However, drinking alcohol every day is always risky. The liver needs regular breaks in order to be able to recover.

Video: Safe Use of Alcohol


Fatty liver: symptoms

Often times, fatty liver does not cause symptoms at first. Sometimes a slight feeling of pressure or fullness in the right upper abdomen is the first symptom.

More severe symptoms can occur if the obesity leads to inflammation of the liver (hepatitis). Typical symptoms of inflammation caused by fatty liver are:

  • Pressure and / or pain and swelling in the upper right abdomen
  • Yellowing of the whites of the eyes
  • yellow skin (jaundice)
  • Enlargement of the spleen

Fatty liver: treatment

Fatty liver can be cured in many cases. When sufferers change their diet, exercise more and do without alcohol, they break down excess fat deposits - including those in the liver.

That means: Anyone who is overweight should lose weight - ideally through a healthier diet and sufficient exercise. "Losing weight is the most important thing. In patients who manage to achieve a healthy body weight, the fatty liver can even regress completely," says Prof. Andreas Teufel.

Alcoholic fatty liver disease only regresses if the person concerned refrains from alcohol. It is also important to achieve and maintain a healthy weight with this form of the disease. Because being overweight puts additional strain on the damaged liver.

In those affected who do not change their lifestyle, the condition of the liver worsens further: First of all, the liver becomes inflamed. Then one speaks of fatty liver hepatitis. In the worst case, this results in cirrhosis of the liver.

Fatty liver: nutrition

In general, fatty liver patients should eat in such a way that they achieve a healthy weight. If you are overweight, it is optimal if you lose about half a kilogram to a whole kilogram per week. Every gram of excess weight lost also relieves the liver.

In order to lose one kilogram of body fat, you have to consume around 7,000 kilocalories fewer calories from food than the body burns during the day. If you want to lose the aforementioned amount of body fat per week, you have to save 500 to 1,000 kilocalories a day - or burn it through exercise.

But it's not just about sticking to a low-calorie diet. The composition of the diet also has an impact on the health of the liver (and all other organs). It is important, for example, that as much fiber as possible is on the menu, not too much fat and sugar and no alcohol.

"Even patients for whom obesity was the main cause of fatty liver disease should refrain from alcohol," says Prof. Teufel. "On the one hand, alcohol is high in calories, and on the other hand, consumption increases the risk of hepatitis."

Fatty liver patients should also avoid ...

  • ... grape and fructose from juices and sweets. Complex carbohydrates from vegetables, fruits, whole grain products and legumes are recommended. They are better for the liver and fill you up more sustainably.
  • ... Saturated fatty acids: They promote the fatty degeneration of the liver. Animal foods such as butter, cream, sausage, cheese, fatty meat as well as coconut oil and coconut fat are rich in saturated fatty acids. Overall, saturated fat should make up less than a third of your daily calorie intake.

Vegetable oils such as olive oil, rapeseed oil or linseed oil as well as fatty vegetable foods such as olives, nuts and avocado are healthy - of course, only if you do not consume so much of them that your daily calorie balance is positive.

Would you like to eat more consciously?

We would be happy to help you with this. The Onmeda nutrition guide accompanies you week after week on your way to a healthier life. With tips, helpful information and delicious recipes.

Fatty liver: diagnosis

Since fatty liver does not initially cause symptoms, changes in blood values ​​are often the first indication of the disease. "Many people affected by chance find out during a routine examination that their liver values ​​are elevated," says Prof. Andreas Teufel. The most important liver values ​​include

  • the gamma-glutamyltransferase (Gamma-GT for short),
  • glutamate pyruvate transaminase (GPT), also called alanine aminotransferase (ALT, ALAT), and
  • glutamate oxaloacetate transaminase (GOT), also called aspartate aminotransferase (AST, ASAT).

Often only the level of gamma-glutamyltransferase has increased in fatty liver. If the values ​​of the so-called transaminases (GPT, GOT) are also high, this is often a sign of additional inflammation of the liver (fatty liver hepatitis).

"The blood values ​​alone are not enough to diagnose fatty liver," says hepatologist Prof. Teufel. "Other metabolic diseases such as iron storage disease as well as diseases of other organs and viral diseases can lead to changes in liver values."

In order to be able to diagnose fatty liver reliably, further examinations are necessary. Among other things, the doctor palpates the patient's abdomen. If the liver feels enlarged, this can be another indication of obesity.

The doctor can get a more accurate picture of the size and condition of the liver through an ultrasound scan. Fatty liver tissue appears lighter in the ultrasound because it is denser and therefore more “echogenic”. That is, it reflects the sound waves more strongly.

To find out how far the disease has progressed, the doctor can take a tissue sample from the liver (known as a liver biopsy). A liver puncture is necessary for this. This means that the doctor pierces the liver with a special needle under local anesthesia and takes a sample.

Online information from the Helmholtz Center Munich: www.diabetesinformationsdienst-muenchen.de (accessed: August 17, 2020)

Online information from the German Liver Foundation: www.deutsche-leberstiftung.de (accessed: August 17, 2020)

Alcohol-toxic liver damage. Online information from the medical reference work AMBOSS: www.amboss.com (as of June 10, 2020)

Alcoholic liver disease. Online information from Austria's public health portal: www.gesundheit.gv.at (as of January 28, 2019)

Online information from the Pschyrembel: www.pschyrembel.de (as of May 2017)

Siegmund-Schultze, N .: Non-alcoholic fatty liver disease: Extended fatty liver index improves predictive power. Deutsches Ärzteblatt, vol. 114, no. 8, p. A373 (February 2017)

Rassow, J., et al .: Dual Series Biochemistry. Thieme, Stuttgart 2016

Dietary recommendations for non-alcoholic fatty liver. Online information from the Clinic for Nutritional Medicine at Klinikum rechts der Isar, TU Munich: www.mri.tum.de (as of July 2016)

Bänkler, W .: Short textbook internal medicine. Thieme, Stuttgart 2015

Guidelines of the German Society for Digestive and Metabolic Diseases (DGVS): Non-alcoholic fatty liver diseases. AWMF guidelines register No. 021/025 (as of February 2015)

additional Information

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ICD-10 Diagnostic Key:

You can find the appropriate ICD-10 code for "fatty liver (steatosis hepatis)" here:

Last content check:17.08.2020
Last change: 22.09.2020