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For the week of: 3/15/99 misra.jpg (7043 bytes)

Gastroenterologist with the "Borland Groover Clinic"
www.borland-groover.com

 

Question: "What do you do if you have been diagnosed to have a "fatty liver?" I am not an alcoholic and have never abused alcohol. I have increased levels of serum ferrritin in the blood and serum folate as well. I have had attacks of gout in the past which I ascribe to large intake of red meat and offals."

 

Answer: Fatty Liver is a general term used to describe deposition on excess fat in the liver. With better imaging tests and frequent blood tests, this condition is being diagnosed more ferquently.

The liver is a central organ in the production, transport and modification of body fat. It is the "fat factory" and the "fat airport" in the body. A large number of diseases can disrupt this process and cause excess fat deposition in the liver.

Fat in the liver is of two types:

a. large droplets of fat and

b.small droplets of fat.

The large droplets variety is much more common, and is probably the type of fatty liver you have.

The various causes of fatty liver are:

1. Obesity.

2. Alcohol.

3. Diabetes.

4. Medications like hormones, steroids, heart medications etc.

5. Several uncommon diseases of fat and carbohydrate metabolism.

6. Several diseases of the pancreas and intestines, all uncommon.

7. Malnutrition.

8. Other diseases.

By talking to you and examining you, your doctor should be able to come to a reasonable diagnosis. In my practice the first 4 causes are the most common.

Your doctor may order additional blood tests to confirm that the abnormal liver tests are from fatty liver and not any other disease. Additional tests may include an ultrasound or a CT scan of the liver. Rarely a liver biopsy may be done to confirm the diagnosis. In this test a fine needle is used to remove a piece of the liver and examine it under the microscope. Even though this test is the 'gold standard', it is done only when non invasive tests fail to give a diagnosis.

The treatment of fatty liver is the treatment of the underlying cause, eg. weight loss, stopping alcohol or the offending medication, better control of diabetes etc. This improves the liver tests.

The second part of your question is about an elevated ferritin. Ferritin is an iron containing protein in the blood. Several acute illnesses can increase it's level in the blood. In the absence of an acute illness, a high level usually indicates excess iron in the blood. A genetic disease of iron overload called Hemochromatosis is now being recognised more frequently as a cause of liver disease and cirrhosis of the liver.

Eating more meat does not cause a high ferritin. You may need to talk to your doctor about this.

If you have any additional questions or need clarifications, please contact your doctor.

Bharat K. Misra, MD
Gastroenterologist with the "Borland Groover Clinic"
www.borland-groover.com

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