Symptoms of Hepatic Steatosis
The majority of patients with hepatic steatosis are completely asymptomatic, with 60-80% experiencing no symptoms whatsoever. 1
Clinical Presentation
Asymptomatic Disease (Most Common)
- Most patients with hepatic steatosis have no symptoms and are diagnosed incidentally through abnormal liver enzymes or imaging performed for other reasons 2
- Physical examination may be entirely normal or reveal only hepatomegaly in the absence of advanced disease 2
- Up to 50% of patients with nonalcoholic steatohepatitis (NASH) may have normal liver chemistries, making the condition even more difficult to detect clinically 2
Symptomatic Presentations (When They Occur)
When symptoms are present, they are typically nonspecific and vague 1, 3:
- Fatigue - the most commonly reported symptom 2, 3
- Right upper quadrant discomfort or pain - described as dull, non-specific abdominal discomfort 2, 1, 3
- Epigastric fullness 2
- Nausea 1
- Muscle pain 1
Important Clinical Distinction
Simple hepatic steatosis (70-75% of cases) occurs without cellular injury or inflammation, which explains why pain is typically absent - the liver capsule lacks pain receptors for stretch or fat accumulation alone 1. Pain typically requires inflammation, rapid enlargement, or capsular distension from other causes 1.
In contrast, steatohepatitis (NASH) with inflammation and hepatocyte injury (25-30% of cases) may produce more symptoms than simple steatosis 1.
Advanced Disease Manifestations
When hepatic steatosis progresses to cirrhosis and portal hypertension, patients may develop 2:
- Splenomegaly
- Spider angiomata
- Palmar erythema
- Ascites
- Variceal hemorrhage (rare at initial diagnosis)
Physical Examination Findings
- Hepatomegaly may be the only physical finding in early disease 2, 3
- Physical findings depend on disease stage, ranging from completely normal to signs of chronic liver disease and portal hypertension 2
Common Pitfalls
Do not exclude hepatic steatosis based on absence of symptoms - the disease is predominantly asymptomatic, and lack of symptoms does not indicate lack of disease or risk of progression 2, 1. The presence and progression of liver fibrosis, not symptoms, is the main predictor of liver-related outcomes 4.