It's a condition most people have never heard of, but it's at epidemic proportions nationwide.
Carmen Kontz has non-alcoholic fatty liver disease. When Kontz was sick with another problem, doctors found it on a CT scan and bloodwork.
"They had been watching my liver for a while," Kontz said. "But, I never thought cirrhosis."
The condition is a spectrum, from just excess fat in the liver to inflammation and scarring, called cirrhosis.
"People tend to think, well, cirrhosis just means alcohol, and unfortunately, what we see now is the number one cause of liver transplant is going to be from the fatty liver disease," Dr. Robin Midian, a liver specialist at Allegheny General Hospital, said.
Excessive weight is the main risk factor.
A swollen, sore belly, a yellow tinge to irritated skin, nausea, loss of appetite, darkly colored urine and changes in bowel habits can be symptoms.
Most of the time, there are no symptoms at all.
Dr. Midian says one in three Americans has a fatty liver and may not know it.
"Scary to say that the symptoms occur unfortunately when it's too late, or when they're in the late stages," Dr. Midian said.
A CT scan or ultrasound can show the fat in the liver.
The only well-studied treatment is change in lifestyle, eating a diet rich in fruits, vegetables, nuts, avoiding sugar and carbohydrates, exercising and losing weight.
"We just don't address their liver. We have to address their diabetes, their heart disease, their risk for cancers, because that is important," Dr. Midian said.
"If I lose the weight, and take better care of myself, maybe I can stop it from progressing very fast," Kontz said. "I haven't done that well. I've only lost five pounds. But at least I'm losing."
Several drugs are on the horizon to decrease fat in the liver, the inflammation and the scarring, but FDA approval might be years away.
"Cirrhosis is an end stage liver disease, that really we don't have a cure for, other than liver transplant," Dr. Midian said. "We don't have enough livers available to treat these patients. It's an overwhelming problem."
At this point, Kontz doesn't need a transplant, but it's on her mind.
"I know that that's a possibility. I'm hoping that if I lose all the weight and it doesn't progress very fast, maybe I'll just get old first and not have to worry about it," Kontz said.