Fatty liver to cirrhosis: Why can't you see the silent damage?

A person in his late 30s came to us reporting a lack of appetite, bloating and yellowing eyes that indicated jaundice. “Doctor, I haven't been feeling well before. I have been losing weight steadily, get a mild abdominal pain from time to time, my legs swell up and I am constantly fatigued. Could I be suffering from something else,” he asked. These were all early symptoms of cirrhosis, where his liver was damaged by chronic inflammation. He had an undiagnosed fatty liver, where fat accumulation keeps damaging the organ.

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This led to scarring, which eventually disrupted the liver's structure and blood flow, resulting in cirrhosis — a more advanced and potentially irreversible stage of liver damage. His abdominal obesity and diabetes had compounded matters.

How fast does the liver get damaged?

This differs on a case by case basis. For example, someone with chronic hepatitis C and high alcohol intake may develop cirrhosis within 10-15 years, whereas others with milder or well-managed liver conditions may take decades, or never reach that stage at all. NAFLD, which is common because of sedentary lifestyles and poor diets, may also progress silently over 10 to 20 years.

Why can't we sense liver damage?