My son, 48, is a recovering alcoholic who hasn’t touched a drink for six months. He was recently diagnosed with fatty liver — he’s read it can cause cancer and is extremely anxious, although his GP didn’t think there was anything to worry about. My son is otherwise active and now looks after himself.
Name and address supplied.
Dr Martin Scurr replies: Fatty liver is a very common condition; essentially as the name suggests, fat builds up in the liver, which affects its function and can cause damage over time.
Broadly speaking there are two types of fatty liver disease: non-alcoholic fatty liver disease, which is associated with obesity — and is now officially known as metabolic dysfunction-associated steatotic liver disease (MASLD). Many people who have it in fact drink little alcohol.
Fatty liver is a very common condition; essentially as the name suggests, fat builds up in the liver, which affects its function and can cause damage over time
Your son has the other type, metabolic dysfunction and alcohol-associated liver disease (MetALD), where there’s not only a build-up of fat, but also inflammation and damage caused by alcohol consumption.
Both types of fatty liver disease can lead to scarring (cirrhosis), which is a risk factor for cancer — but the risk is greater with MetALD.
Heavy drinking can quickly cause fat to build up in the liver, in as little as two weeks, research shows.
Around a third of patients with alcohol-related fatty liver will progress to the inflammatory stage if they keep drinking and 16 per cent of will develop cirrhosis. Eventually a small proportion develop cancer.
Fatty liver, whatever the cause, doesn’t usually lead to symptoms until the liver has been severely damaged — these include general feelings of weakness, swelling (in the ankles and stomach), loss of appetite, vomiting blood, passing blood in the stools and yellowing of the eyes or skin.
But this isn’t inevitable and the damage can be stopped — and even reversed — once the person stops drinking alcohol (or in the case of MASLD, loses weight).
The liver is the only large organ in the body that can completely regenerate, and can start to do so fast, within months.
It sounds as if your son has avoided this later stage — his anxiety about his fatty liver diagnosis may help him to maintain his abstinence. As he’s been abstinent for six months I imagine his liver function is close to being fully recovered.
I’m 74 and have recently had frequent bouts of cystitis, I wonder if a vagin*l prolapse involving a rectocele could be a contributing factor? I have been prescribed a penicillin-based antibiotic for the cystitis which has caused acute diarrhoea — should I stop taking it early? I’m a retired nurse.
P. Wells, Aylesbury, Bucks.
Dr Martin Scurr replies: As a nurse you will understand the anatomy of your problem, but first I will explain this to other readers.
A rectocele is the term for a prolapse where weakness in your pelvic floor causes the rectum to sag onto the vagin*l wall.
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However, recurrent cystitis (a urinary tract infection, or UTI) is not a recognised consequence of a rectocele — it is something that can occur with a bladder prolapse (known as cystocele).
That said, many women of your age do have recurrent cystitis and this is not necessarily related to organ prolapse, but rather as a result of changes due to the drop in oestrogen following the menopause.
With recurrent UTIs, it is important the correct antibiotic is prescribed, which involves sending a urine sample to a lab for testing to identify the bacteria causing it (a step too often omitted).
Then, one option is to give a daily low dose of antibiotics preventatively for some months. This can be effective but must be carefully weighed against the potential risk of antibiotic resistance, developing a drug allergy, or disturbing the gut microbiome (the community of microbes that live in your gut and play an important role in maintaining health).
Some antibiotics are prone to causing diarrhoea — for example co-amoxiclav.
Rather than stopping the course of your antibiotics early, I’d ask your GP for an alternative option after explaining what has occurred.
Another option is a new vaccine, administered as a spray under the tongue, aimed at preventing recurrent UTIs in women.
It contains four types of inactivated bacteria, commonly ones involved in cystitis, and is taken daily for three months. Studies have shown that this strategy is effective in more than half of women who suffered chronic cystitis: it might be worth also discussing this with your doctor.
