Ask a doctor on the topic of Internal medicine

Evaluation of findings on CT scan - Inhomogeneous hepatic steatosis

November 22, 2015 | 40,00 EUR | answered by Dr. med. Frauke Gehring

Dear Sir or Madam,

Due to suspicion of kidney stones, a native CT scan was performed on me to search for stones. As additional diagnoses, "sigmoid diverticulitis" and "evidence of inhomogeneous hepatic steatosis" were made.
The findings regarding the liver are as follows: "The liver is inhomogeneous and partially significantly reduced in density as in hepatic steatosis with areas of focal increased fat content."
When I returned to the treating physician for discussion of the findings, he only briefly mentioned the "fatty liver" and advised me to change my lifestyle and exercise more. However, he emphasized that the diverticulitis is more critical.
Regarding myself: I am 1.88 meters tall and weigh 78 kg - I am not overweight. However, I must admit that due to the fact that I bought some gastronomic establishments in Spain in 2012, I did not have a healthy lifestyle (whether it was alcohol or food - neither was normal, not to mention the lack of exercise). Since the beginning of 2015, I have been living in Germany again and only drink, if at all, once a month.
What surprises me a little is: Why is the liver being "put on the back burner"? I have spent several hours googling unsuccessfully, and from what I read, "focal increased fat content" and a reduction in density are far from insignificant.
After this finding, despite the fact that the doctor downplayed everything, I have completely changed my eating habits. However, I would like someone to explain to me why such a finding is considered insignificant. Perhaps Google is just causing a bit of panic (cue liver cirrhosis), but I would like to understand why the liver finding is not given any real attention.

Thank you!

Dr. med. Frauke Gehring

Good day,

I also consider the findings to be important, but the fact is that internists see so many fatty livers (many people simply have them due to being overweight) that they may not take them seriously enough. However, there is indeed a difference: an alcohol-related fatty liver (which I assume you have, since you are not overweight) can progress to cirrhosis with continued alcohol consumption. This almost never happens with nutrition-related obesity. Perhaps your doctor has underestimated this. The liver values are important, as they indicate whether there is already fatty liver hepatitis present. If values are elevated, I would recommend giving the liver a complete break from alcohol until it calms down. I would suggest monitoring the values every 3 months if they are elevated.

In summary, Google exaggerates in that a nutrition-related fatty liver is not a major problem, and that an alcohol-related fatty liver will not progress to cirrhosis if it is relieved. So you have it all under control.

All the best!

Sincerely, Dr. Höllering