Liver Specialist in Delhi: Dr. Hitendra K Garg, Hepatologist at Indraprastha Apollo

Fatty liver disease occurs when excess fat builds up inside liver cells. A small amount of fat in the liver is normal, but too much causes inflammation and injury, and over time permanent damage. It has become far more common because of sedentary work, diet, obesity and diabetes.

There are two main types. Non-alcoholic fatty liver disease (NAFLD) develops in people who drink little or no alcohol and is strongly linked to obesity, type 2 diabetes, high cholesterol, metabolic syndrome and inactivity. Alcoholic fatty liver disease develops from heavy drinking and worsens while drinking continues.

Many people have no symptoms at all in the early stages, and the condition is often picked up by chance during a routine health check. When symptoms do appear they include:

• Persistent tiredness
• General weakness
• Discomfort in the abdomen
• A feeling of fullness
• Mild pain in the upper right abdomen
• Raised liver enzymes on a blood test
• Difficulty losing weight

• Obesity
• Diabetes and insulin resistance
• High cholesterol or high triglycerides
• High blood pressure
• A sedentary routine
• A diet high in sugar and processed food
• Heavy alcohol use

Diagnosis combines an examination with tests: liver function tests, an abdominal ultrasound, blood tests and a metabolic assessment, and often a FibroScan. FibroScan is particularly useful because it measures liver stiffness and shows how much fibrosis has developed without a biopsy.

Treatment depends on the stage. Early fatty liver can often be reversed, which is why acting on it matters:

• Weight management. Even modest weight loss measurably improves liver health.
• Diet. Less sugar, fewer processed foods, less unhealthy fat, more fruit and vegetables.
• Physical activity. Regular exercise reduces liver fat and improves metabolism.
• Diabetes and cholesterol control. Treating the underlying metabolic problem is essential.
• Regular monitoring. Periodic review tracks whether the liver is improving.

Hepatitis means inflammation of the liver. It can follow a viral infection, heavy alcohol use, an autoimmune disease, certain medicines or a metabolic disorder. Hepatitis B and C matter most because untreated they can lead to chronic liver disease, cirrhosis, liver failure and liver cancer.

Many people live with chronic hepatitis without knowing, because there are often no symptoms early on. That is why screening matters for anyone at higher risk.

Hepatitis B is caused by the hepatitis B virus and spreads through infected blood and body fluids:

• From mother to child during childbirth
• Unprotected sexual contact
• Sharing contaminated needles
• Blood transfusion, now rare because blood is screened
• Exposure during healthcare work

Hepatitis C is caused by the hepatitis C virus and spreads mainly through blood-to-blood contact: contaminated needles, unscreened transfusions in the past, unsafe medical procedures and needle-stick injuries.

Both can stay silent for years. When symptoms appear they may include tiredness, fever, loss of appetite, nausea, vomiting, joint pain, dark urine, jaundice, abdominal discomfort and easy bruising.

• Liver function tests (LFT)
• HBsAg testing and HBV DNA quantification for hepatitis B
• Anti-HCV testing and HCV RNA testing for hepatitis C
• Ultrasound
• FibroScan and fibrosis assessment

Treatment for hepatitis B aims to suppress the virus, prevent liver damage and monitor the liver long term. For hepatitis C, current antiviral tablets cure most people, which clears the virus, reduces inflammation and lowers the risk of cirrhosis.

In cirrhosis, healthy liver tissue is gradually replaced by scar tissue. The scarring stops the liver working normally and can eventually cause liver failure. It develops slowly, over years, as a result of ongoing liver injury from chronic hepatitis B or C, fatty liver disease, alcohol, autoimmune liver disease or an inherited liver condition.

Early cirrhosis may cause few or no symptoms. As it progresses:

• Persistent tiredness and weakness
• Weight loss and loss of appetite
• Jaundice
• Swelling of the abdomen or the legs
• Itching and easy bruising
• Confusion or difficulty concentrating

• Portal hypertension. Raised pressure in the portal vein system.
• Ascites. Fluid collecting in the abdomen.
• Variceal bleeding. Bleeding from enlarged veins, which can be life-threatening.
• Hepatic encephalopathy. Brain function affected by liver failure.
• Liver cancer. The risk is higher once cirrhosis is present, so screening matters.

Established scarring cannot usually be reversed, but treatment slows progression and improves day-to-day life: treating the underlying cause, controlled sodium intake with adequate protein, medicines for specific complications, and regular review so complications are caught early.

Fibrosis is scar tissue building up in the liver after long-standing inflammation or injury. It is an earlier stage than cirrhosis, and this is the encouraging part: treating the cause early can halt fibrosis and sometimes reverse it. The usual causes are fatty liver disease, hepatitis B or C, alcohol, and chronic or autoimmune liver inflammation.

Most people have no symptoms early on. Tiredness, weakness, mild abdominal discomfort and raised liver enzymes are the usual findings, which is why screening matters for anyone at higher risk.

FibroScan is non-invasive, painless, quick, needs no hospital stay, and gives an accurate reading of fibrosis. It is used both to assess the liver and to check whether treatment is working.

Treatment removes the cause and reduces inflammation, usually through weight loss, avoiding alcohol, controlling diabetes and cholesterol, and other lifestyle changes. Early-stage fibrosis responds well when it is acted on in time.

Alcoholic liver disease follows long-term heavy drinking and ranges from simple fatty liver to advanced cirrhosis. The liver processes alcohol, but repeated heavy exposure inflames and progressively injures it.

• Alcoholic fatty liver. The earliest stage, and often reversible if drinking stops.
• Alcoholic hepatitis. Inflammation of the liver, which can be mild or severe.
• Alcoholic cirrhosis. Advanced scarring, which may be irreversible.

Tiredness, loss of appetite, weight loss, abdominal discomfort, jaundice, swelling and weakness.

The single most important step is stopping alcohol completely. Alongside that: nutritional support, monitoring of liver function, treatment of any complications, and counselling. Acting early makes a substantial difference to the outcome.

Jaundice is not a disease in itself. It is a sign that something is affecting the liver, the bile ducts or the red blood cells, and it appears when bilirubin builds up in the blood.

Yellowing of the skin and the whites of the eyes, dark urine, pale stools, tiredness and weakness.

• Hepatitis
• Liver cirrhosis
• Gallstones
• Blockage of the bile duct
• Liver failure

Jaundice can be the first visible sign of serious liver disease. Finding the cause early often prevents it from progressing. Anyone with yellow eyes, ongoing tiredness or abnormal liver tests should be assessed promptly.

Liver failure occurs when enough of the liver is damaged that it can no longer do its work: clearing toxins, making proteins, helping digestion, and regulating blood clotting and metabolism. It needs prompt assessment.

Acute liver failure develops suddenly, within days or weeks, after a severe infection, drug toxicity or poisoning. Chronic liver failure develops over months or years, usually on a background of cirrhosis, chronic hepatitis B or C, alcohol-related liver disease or advanced fatty liver.

• Severe tiredness
• Yellowing of the eyes and skin
• Swelling of the abdomen or legs
• Confusion or difficulty concentrating
• Easy bruising
• Loss of appetite, nausea and weight loss

Assessment uses liver function tests, ultrasound, FibroScan, CT or MRI, endoscopy and blood investigations. Treatment depends on the cause and the severity. Diagnosing it early improves the outcome and helps avoid life-threatening complications.

Portal hypertension is raised pressure in the portal venous system, which carries blood from the digestive organs to the liver. It usually develops because cirrhosis or chronic liver disease obstructs normal blood flow through the liver, so pressure builds up behind it.

Often none in the early stages. Later: swelling of the abdomen, an enlarged spleen, bleeding from the gut, tiredness, weakness and fluid retention.

• Ascites
• Oesophageal varices
• Gastric varices
• Internal bleeding
• Liver failure

Treatment depends on severity and on the underlying liver disease, and may combine medicines, endoscopic procedures such as variceal banding, regular monitoring, lifestyle changes and treatment of the cirrhosis itself.