Symptoms of Fatty Liver Disease
Clinical Presentation
Most patients with nonalcoholic fatty liver disease (NAFLD) are completely asymptomatic, and the condition is typically discovered incidentally through abnormal liver enzyme tests or imaging studies. 1, 2
When Symptoms Do Occur
When present, symptoms are characteristically non-specific and mild, including: 1, 3
- Fatigue - the most commonly reported symptom 1, 4
- Right upper quadrant discomfort or dull aching 1, 5
- Epigastric fullness 1
- Dyspepsia 5
- Abdominal discomfort 4
Physical Examination Findings
In the absence of advanced liver disease, hepatomegaly may be the only physical finding on examination. 1
Once cirrhosis develops, additional signs may appear: 1
- Splenomegaly
- Spider angiomata
- Palmar erythema
- Ascites
Important Clinical Caveats
Severe symptoms such as significant nausea, vomiting, or severe pain are NOT typical of uncomplicated fatty liver disease and should prompt immediate investigation for alternative diagnoses including: 2, 3
- Acute fatty liver of pregnancy (in pregnant patients)
- HELLP syndrome
- Drug-induced liver injury
- Gallstone disease
- Autoimmune hepatitis
- Other acute hepatic conditions
Pain accompanied by fever, jaundice, or significant weight loss requires urgent evaluation as these are not features of simple NAFLD. 2
Laboratory Findings at Presentation
Most commonly, patients present with: 1
- Mildly elevated AST and/or ALT with AST:ALT ratio typically <1
- Normal or near-normal ALT does not exclude NASH
- Alkaline phosphatase and/or gamma-glutamyltransferase may be mildly elevated
- Bilirubin typically remains normal unless advanced disease is present
In advanced disease, laboratory abnormalities may include: 1
- Elevated INR
- Hypoalbuminemia
- Thrombocytopenia (indicating cirrhosis or portal hypertension)