The liver is an organ with many functions, including filtering toxins, storing energy, and regulating blood sugar. When healthy, it is reddish-brown. However, changes in its color, such as becoming pale or “white,” can signal underlying health conditions. The term “white liver” is not a formal medical diagnosis but a descriptive phrase describing certain liver changes.
Defining “White Liver”
“White liver” is a non-medical term that describes a liver with a pale or whitish appearance due to various conditions. This occurs when fat accumulates in liver cells, a condition known as hepatic steatosis or fatty liver disease. A healthy liver has minimal fat; over 5% to 10% fat by weight indicates a fatty liver.
Beyond fat, “white liver” can also refer to significant liver scarring, known as fibrosis or cirrhosis. Fibrosis involves excessive scar tissue formation as the liver repairs damage, altering its normal color and texture. As scarring progresses to cirrhosis, the liver hardens and changes structure, contributing to a paler or mottled appearance.
Underlying Causes
A “white” liver appearance primarily stems from fat accumulation or scarring. Fatty liver disease, the most common cause, includes alcohol-related fatty liver disease (ARLD) and metabolic dysfunction-associated steatotic liver disease (MASLD), formerly non-alcoholic fatty liver disease (NAFLD). ARLD results from heavy alcohol consumption, as the liver processes alcohol and generates harmful substances.
MASLD associates with metabolic risk factors like obesity, type 2 diabetes, high cholesterol, and high blood pressure. Rapid weight loss and certain medications also contribute to MASLD. When inflammation accompanies fat, it progresses to metabolic dysfunction-associated steatohepatitis (MASH), formerly non-alcoholic steatohepatitis (NASH), leading to fibrosis and cirrhosis. Chronic viral hepatitis (Hepatitis B and C), autoimmune liver diseases, and some genetic conditions also contribute to liver scarring, which can result in fibrosis or cirrhosis.
Recognizing the Signs and Confirmation
A “white liver” often presents with few or no early symptoms. When symptoms appear, they include fatigue, weakness, and a dull ache or discomfort in the upper right abdomen. As the disease progresses to advanced stages like cirrhosis, noticeable symptoms may develop, such as yellowing skin and eyes (jaundice), itchy skin, fluid buildup in the abdomen or legs (ascites or edema), and unexplained weight loss.
Diagnosis typically involves a combination of tests. Blood tests, including liver function tests, indicate liver problems. Imaging tests such as ultrasound, CT scans, and MRI can reveal the size, shape, and texture of the liver, and detect excess fat or scarring. Elastography is a specialized imaging technique that measures liver stiffness, indicating the degree of fibrosis. A liver biopsy, where a small tissue sample is taken for microscopic examination, precisely confirms diagnosis, determines cause, and assesses liver damage.
Treatment Approaches and Prognosis
Treatment for a “white liver” focuses on addressing the underlying cause and preventing further damage. For fatty liver disease, lifestyle modifications are important. This includes weight loss via a healthy diet and regular physical activity. Avoiding alcohol is important for alcohol-related liver disease and beneficial for MASLD.
While no specific medication is approved solely for MASLD, managing associated conditions like type 2 diabetes, high cholesterol, and high blood pressure with appropriate medications is important. In advanced stages with cirrhosis, complications are managed with medicines and procedures. For individuals with end-stage liver disease or liver cancer from cirrhosis, a liver transplant may be a life-saving option. The prognosis varies depending on the stage. Early detection and intervention can often prevent progression, while advanced cirrhosis carries more serious implications for life expectancy.