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Oftentimes, non alcoholic fatty liver disease occurs with no signs or symptoms. This is otherwise known as a silent disease or an asymptomatic condition. When symptoms do occur, however, they may include feelings of weakness and fatigue, weight loss and decreased appetite, abdominal discomfort and nausea, an enlarged liver or enlarged breasts (in men), yellowish skin and eyes, red palms and spider-like blood vessels, mental confusion, pain in the upper right abdomen, fluid buildup, and swelling of both the legs and the abdomen. Because simple fatty liver and non alcoholic steatohepatitis both exist with few to no symptoms, it’s not uncommon for complications to occur rather suddenly.

Cirrhosis is without a doubt the main complication of non alcoholic fatty liver disease. In simple terms, cirrhosis is defined as severe scarring of the liver, usually in response to some sort of liver injury. For example, when inflammation occurs, the liver produces areas of scarring in an attempt to halt the inflammation. If this process is not interrupted, cirrhosis can progress to a number of conditions such as ascites, esophageal varices, hepatic encephalopathy, liver cancer, and end-stage liver failure. Approximately 20 percent of people with non alcoholic steatohepatitis will progress to cirrhosis, and the rate of progression is worse in individuals with more than one liver disease, like alcoholic liver disease and chronic viral hepatitis.

Ascites is the abnormal buildup of fluid in the abdomen and may be accompanied by abdominal pain and bloating, shortness of breath, and liver failure. Esophageal varices refers to the swelling of the veins in the esophagus, the tube that connects the throat to the stomach, which can rupture and bleed as a result of the enlarged veins. Hepatic encephalopathy is a syndrome that alters the level of consciousness in people with liver failure and can lead to confusion, drowsiness, and slurred speech. Liver cancer can be either a primary or a secondary cancer, meaning that it can begin in the cells of the liver or spread from another organ, respectively. Lastly, end-stage liver failure means that the liver has stopped functioning completely.

In addition to the conditions that can result from cirrhosis, cardiovascular disease shares a bidirectional relationship with non alcoholic fatty liver disease. In practice, sufferers of NAFLD are more likely to develop cardiovascular diseases, and those with cardiovascular diseases are more likely to die from NAFLD. The most common cardiovascular diseases associated with NAFLD are coronary heart disease and stroke, although the exact relationship is not entirely understood. Doctors do suspect, however, that both simple fatty liver and non alcoholic steatohepatitis may contribute to the development and progression of cardiovascular diseases.

Given these potentially life-threatening and often irreversible complications, it is important to see a doctor if any signs of cirrhosis are present. Symptoms to watch out for include yellow skin, fatigue, periods of mental confusion or drowsiness, and easily bruising or bleeding. A blood test or an imaging scan, such as an ultrasound, will quickly be able to either confirm or rule out the occurrence of non alcoholic fatty liver disease and the presence of cirrhosis.