Symptoms of Fatty Liver

In fatty liver disease (hepatic steatosis), fat builds up in your liver and can eventually cause problems with liver function. Over time, the disease can progress to life-threatening conditions such as cirrhosis and liver cancer.

Fatty liver disease comes in two forms. They are nonalcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease (AFLD), also called alcoholic steatohepatitis. These two types have different causes but similar results.

This article looks at early symptoms of fatty liver disease, how they progress to advanced symptoms, what complications may result, and when you should see a healthcare provider.

Early Symptoms

NAFLD and AFLD are often called silent diseases because they have no or very few symptoms. Fatigue and liver discomfort (upper abdominal pain) are the earliest possible symptoms.

Usually, healthcare providers discover fatty liver disease due to abnormal liver enzyme tests done for unrelated reasons.

Most people who have NAFLD never go on to develop liver damage. However, if the fatty liver develops signs of inflammation and cellular damage, the condition is called nonalcoholic steatohepatitis (NASH). At this stage, symptoms may include:

• Worsening fatigue
• Weakness
• Weight loss
• Jaundice (yellow skin or eyes)
• Visible spiderlike blood vessels in the skin
• Persistent itchiness

With the proper treatment and lifestyle changes, AFLD and NASH may be reversible. Recognizing these symptoms is important so your condition can be diagnosed and treated before you develop advanced symptoms.

Advanced Symptoms

Both NASH and AFLD can progress to cirrhosis of the liver. The liver is badly scarred at this stage, and damage may no longer be reversible. However, you can take steps to prevent further damage.

Not everyone has noticeable symptoms, even at this stage. When there are symptoms, they may include:

• Fatigue and weakness
• Poor appetite
• Unintended weight loss
• Nausea and vomiting
• Mild liver pain
• Easy bruising and bleeding
• Personality changes
• Sleep disorders
• Swelling (edema) in the feet and lower legs
• Severely itchy skin
• Dark urine

You'll notice more yellowing of the skin and whites of the eyes as jaundice becomes more likely.

Complications

As liver damage increases, you may develop complications of cirrhosis. These occur when your liver can no longer remove toxins from your blood. Possible complications are: 

• Hepatic encephalopathy: Inflammation of the brain that leads to confusion, trouble thinking, and memory loss
• Ascites: Bloating due to fluid build-up in the abdomen
• Liver cancer: Masses or tumors in the liver or biliary tract
• Portal hypertension: Increased pressure in the portal vein, which carries blood from the digestive system to the liver
• Internal bleeding: Portal hypertension leads to ruptured veins
• Hepatopulmonary syndrome: A rare condition of improper liver function that leads to dilated (widened) blood vessels in the lungs, which impairs lung function
• Hepatorenal syndrome: Poor blood flow to the kidneys, which impairs their function

Some of these complications—such as cancer and hepatorenal syndrome—can be life-threatening. 

When to Get Medical Help

If you have any symptoms that could point to fatty liver disease, NASH, or cirrhosis, take them seriously. This is especially important if you:

• Drink regularly
• Have obesity
• Have been diagnosed with a fatty liver

If you notice any symptoms, make an appointment with a healthcare provider.

Summary

Fatty liver disease generally has no obvious symptoms. Sometimes, it advances to nonalcoholic steatohepatitis and cirrhosis. You may have fatigue, weakness, and liver pain.

Cirrhosis can lead to nausea and vomiting, easy bruising and bleeding, and jaundice. Complications can be life-threatening. They include liver cancer, cognitive problems, and dysfunction of the lungs or kidneys.

Let your healthcare provider know about any of these symptoms that develop, especially if you're at risk for fatty liver disease, NASH, or cirrhosis.