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Steatotic liver disease (SLD) includes several conditions associated with steatosis (fat) in your liver.
Steatosis is a term used to describe the build-up of fat in your liver. A healthy liver contains only a small amount of fat. Fat build-up becomes a problem when it exceeds 5-10% of your liver’s weight.
There are two main types of SLD: metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-related liver disease (ALD).
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD) refers to the buildup of fat in liver cells in people who do not use alcohol regularly.
It can affect 25% of the population, and individuals with this condition typically do not experience symptoms. Some individuals with MASLD will develop inflammation (swelling) and cell damage within the liver, a condition known as metabolic dysfunction-associated steatohepatitis (MASH), formerly non-alcoholic steatohepatitis (NASH). It is typically people with MASH who develop progressive scarring of the liver and complications of liver damage.
MASLD/MASH is associated with a group of related metabolic disorders including being overweight or obese , having high blood cholesterol levels, high blood pressure and diabetes. These factors can influence each other and change how your body processes nutrients and stores fats.
Certain genes may also make you more likely to develop MASLD, which may help explain why some people develop this condition without any of the other common risk factors.
There is no specific treatment for MASLD; although many new drugs are undergoing clinical trials; and treatment for associated conditions such as high blood pressure, diabetes or cholesterol is usually recommended.
Eating a healthy diet, limiting alcohol intake and exercising regularly can reduce your risk of MASLD, or progression to MASH
Alcohol-related liver disease (ALD) refers to liver damage caused by excessive alcohol intake. You do not have to be addicted to alcohol to develop the condition, regularly drinking over the recommended amount of alcohol can increase your risk. This disease does not typically cause any symptoms until your liver has been severely damaged. There are various stages of alcohol-related liver disease.
Alcohol-related Steatotic Liver Disease – this stage refers to a build-up of fat in the liver due to excessive alcohol consumption. You will probably not experience any symptoms related to this. It is a sign, however, you are drinking at a harmful level, but abstinence from alcohol for a period of time can allow your liver to recover and in the majority of cases return to normal.
Alcoholic hepatitis – This condition refers to liver inflammation, and abnormal liver enzyme results, caused directly by excessive consumption of alcohol. Alcoholic hepatitis is most often caused by alcohol misuse over many years. However, it can also occur, although less commonly, if you drink to excess over a relatively short period of time. If you are diagnosed with alcoholic hepatitis, you must stop drinking alcohol without delay, people who continue to drink alcohol in this clinical setting have a high risk of progressive and serious liver damage. A significant proportion of people with severe alcoholic hepatitis will develop liver failure, which is a serious and life-threatening complication.
Alcohol-related cirrhosis – This refers to the build-up of scarring (damage) within the liver, which is not considered reversible, but further damage can be prevented if you stop drinking.
Cirrhosis refers to the build-up of severe scarring (fibrosis) within your liver and is the result of long-term, continuous liver damage; it can result from many different causes. Irregular bumps (nodules) replace normal liver tissue and the liver becomes harder and “stiffer”. Although your liver can continue to function (work normally) when cirrhosis is established, especially in earlier stages, should the condition progress, it can result in your liver health deteriorating suddenly, which essentially leads to liver failure.
You may have no symptoms, or develop non-specific symptoms, such as feeling tired, weak, nausea and loss of appetite, muscle and weight loss. Skin changes and the development of “red patches” are often present.
Further complications in more advanced stages may include jaundice (yellowing of the skin and eyes), vomiting blood, itchy skin, swollen legs and stomach, loss of sex drive and bleeding or bruising easily.
Cirrhosis cannot usually be cured but the symptoms can be managed and it is important to avoid disease progression which could lead to liver failure. Managing the underlying cause of liver disease is critical to prevent further damage and decompensation (liver failure). Lifestyle changes such as avoiding alcohol are critical, quitting smoking, losing weight if you are overweight or obese, and regular exercise can help to reduce further deterioration in liver health.
The most common types of viral hepatitis are type A, B and C. These viruses can cause inflammation in the liver. They can cause both short-term (acute) and long term(chronic) infections.
Hepatitis A – This is caught through consuming food that is contaminated with faecal matter of an infected person. Hepatitis A virus usually passes within a few months, however, it can sometimes be severe and require hospital admission.
Hepatitis B – This is contracted by exposure to blood or body fluids of an infected individual. Most adults who are exposed to hepatitis B virus are able to fight off the infection and recover from it within a few months. Some adults, however, will develop chronic infection, requiring long-term follow-up, and in a proportion of cases treatment. The aim of treatment is to reduce the risk of developing cirrhosis, the complications of chronic liver disease and liver cancer.
Hepatitis C – This is usually contracted through blood-to-blood contact with an infected person. It causes no noticeable complications aside from flu-like symptoms, therefore many people are unaware they are infected. A small proportion of people will manage to fight off the infection, the majority, however, will develop chronic hepatitis C, that can lead to cirrhosis and liver failure, if left untreated. Treatment is now widely available for hepatitis C virus, and can cure the infection in the majority of treated individuals
Haemochromatosis is a medical condition when your body stores excess iron. The extra iron accumulates around the body over time, damaging many organs, including the liver. Haemochromatosis may be caused by the inheritance of a faulty or abnormal gene which is responsible for the excess iron. Common symptoms include fatigue, weight loss, joint pain, erectile dysfunction, irregular periods, mood swings, depression and anxiety. People with genetic haemochromatosis can develop advanced liver disease, heart disease and diabetes.
Treatment of haemochromatosis is aimed at removing the excess iron from your body. This can be achieved by regular bleeding known as venesection or phlebotomy. During venesection a unit of blood, usually 450 millitres (mls), is removed. Initially, you may need to undergo regular venesection, until your iron levels are restored to normal. Once this is achieved, it is important your iron levels are maintained within the normal range, and you may need to have this procedure repeated at intervals.
Gallstones are small hard stones found in the gallbladder, they are often present and may cause no symptoms. However, if they become ‘trapped’ they can trigger intense pain in the upper abdomen. Some people with gallstones can also develop complications like inflammation of the gallbladder (cholecystitis) which can cause persistent pain; and when the bile ducts are obstructed (blocked), jaundice develops. The presence of jaundice and a high temperature requires urgent medical attention. This is broadly referred to as biliary disease, which is an umbrella term for all diseases which are related to any complications created by these blockages.
Treatment for gallstones depends on the severity of the symptoms. If the pain is mild, you may be prescribed pain medication but if your symptoms are more severe and frequent, surgery to remove your gallbladder is recommended.
An ERCP may also be advised. This is an interventional endoscopic procedure used to remove gallstones from the bile ducts, when the bile ducts are blocked (obstructed).
Liver lesions is a broad term referring to abnormal cells or damaged areas of the liver which can either be benign (non – cancerous) or malignant (cancerous). They can vary in size, cause and significance.
Benign liver lesions are common and do not spread to other areas of your body or cause health issues.
Liver lesions often have no symptoms, and in many cases they are found when people undergo scans for other health issues. However, some liver lesions can be associated with symptoms, including bloating, abdominal discomfort or pain, nausea and vomiting, weight loss, fatigue, jaundice and fever.
Treatment for malignant liver lesions can include surgery to remove the lesion(s), liver transplantation, and procedures that involve blocking the blood supply to the liver lesion (embolization).
Hepatocellular carcinoma (HCC) is a cancer of the liver cells and is also sometimes referred to as hepatoma. This is the most common type of primary liver cancer (cancer that starts within the liver).
Early HCC may not cause any symptoms, but more advanced stages of HCC can cause symptoms such as feeling generally unwell, loss of appetite, loss of weight, abdominal pain or swelling, lack of energy, shoulder pain and jaundice.
You are at higher risk of developing HCC if you have underlying advanced liver scarring or cirrhosis, viral hepatitis, alcohol use disorder, haemochromatosis, metabolic risk factors (diabetes, insulin-resistance, obesity) or a family history of HCC.
Diagnosing liver cancer requires a combination of blood tests, ultrasound scan, CT or MRI scan, and in some cases biopsy (sampling of the cancer).
Treatment differs depending on size, number and position of tumours. Other factors considered in selecting the most suitable treatment include how well the liver is working, other medical conditions a patient has, and the general health of the individual.
Gallbladder cancer is an abnormal growth of cells that begins in the gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder stores bile, a digestive fluid produced by your liver. Gallbladder cancer is a rare form of cancer and can present with abdominal pain or discomfort. However, it can be discovered incidentally (found having routine scans of the abdomen).
Although patients may experience no symptoms, some individuals will present with jaundice, itchy skin, change in the colour of stool and urine, loss of appetite, high temperature, “feeling a lump in the abdomen”, or more general symptoms such as nausea, vomiting or right sided abdominal pain.
The bile ducts connect your liver with your gallbladder and your digestive system (small bowel) and they carry the digestive fluid bile to the small bowel. Cholangiocarcinoma (bile duct cancer) is a specific type of cancer that forms in the bile ducts.
Symptoms of bile duct cancer are similar to those listed above and include, jaundice, itchy skin, change in the colour of stool and urine, a loss of appetite, fatigue, a high temperature, abdominal pain and nausea.
The severity of gallbladder or bile duct cancers depends on the location, size and spread of the tumour. In addition, your general health needs to be taken into consideration. Treatment for removable (operable) bile duct cancer depends on the location of the cancer but usually involves surgery and chemotherapy.
For bile duct cancer that cannot be removed, treatment may involve chemotherapy, radiotherapy and surgery (or other procedures) may be performed to bypass blocked bile ducts and relieve jaundice.
Pancreatic cancer is a type of cancer that begins as a growth of cells in the pancreas. The pancreas lies behind the lower part of the stomach. Its function is to make enzymes that help digest food and hormones that help manage blood sugar.
Symptoms of pancreatic cancer usually do not develop until the late stages of the disease. Typical symptoms include jaundice, a high temperature, fatigue, feeling hot or shivery, a loss of appetite, change in the colour of stool and urine, stomach pain, nausea, indigestion, diarrhoea or constipation. Treatment will depend on the location and size of the tumour, if it has spread to other organs (or sites) and your general health.
Pancreatic cysts are pockets of fluid within the pancreas. These cysts are often found by chance (incidentally) on scans, as people may not have any symptoms. Most cysts are not cancerous, though some can become cancerous over time. Some of these cysts may require monitoring over time.
