Alcoholic fatty hepatosis

Fatty hepatosis occurs in 60-75% of patients with chronic alcoholism.

[1], [2], [3]

Causes of fatty hepatosis

The mechanism of development of alcoholic fatty hepatosis is as follows:

• the metabolism of ethanol comes with the use of large amounts of NAD, the same compound is also necessary for the final stage of oxidation of fatty acids; due to NAD deficiency, this process is disrupted, and fatty acids are accumulated in the liver with their transformation into neutral fats (triglycerides);
• ethanol contributes to the release of catecholamines that cause mobilization of fat from peripheral fat stores, increase the amount of fatty acids entering the liver;
• Ethanol disrupts the utilization of free fatty acids and triglycerides with muscle tissue.

[4], [5], [6], [7], [8], [9]

Symptoms and Diagnosis of Fat Hepatosis

Characteristic clinical and laboratory features of alcoholic fatty hepatosis:

• patients complain of a feeling of heaviness and raspiraniya, pain in the right hypochondrium and epigastrium; intolerance to fatty foods; general weakness, rapid fatigue, decreased efficiency, irritability; bloating; in 50% of patients there are no subjective manifestations;
• leading clinical sign - hepatomegaly; the liver is moderately increased, its consistence is dense-elastic or doughy, the edge is rounded; palpation can be moderately painful;
• functional tests of the liver are changed little, approximately 20-30% of patients experience a moderate increase in the activity of aminotransferases (ALAT, ASAT) and alkaline phosphatase in the serum, a slight increase in the blood levels of bilirubin and y-glutamyltranspeptidase; possibly a rise in blood levels of triglycerides, free fatty acids, lipoproteins;
• The ultrasound of the liver reveals the following characteristic signs: a liver enlargement, a uniform increase in echogenicity, an unclear liver contour, homogeneity of the structure (the structure is more tender, consists of many small identical points, as it were sprinkled with "semolina." However, according to AF Bluger (1984) ), it is also possible to identify acoustic heterogeneity of the liver in connection with the possible presence in its tissue of compaction sites of varying size and shape;
• radioisotope hepatology reveals a violation of secretory-excretory liver function;
• puncture liver biopsy is crucial in the diagnosis of fatty hepatosis. The diagnosis is reliable when at least 50% of hepatocytes contain fatty drops that push the hepatocyte nucleus and organelles to the periphery. These changes are most pronounced in the centrolobular zone;
• with abstinence from alcohol intake, fatty hepatosis undergoes a complete reverse development.

A special and rare form of fatty hepatosis in chronic alcoholism is the Zieve syndrome. It is characterized by the fact that a pronounced fatty liver dystrophy is accompanied by hyperbilirubinemia, hypercholesterolemia, hypertriglyceridemia, hemolytic anemia. Hemolysis of erythrocytes is caused by a decrease in the content of vitamin E in the blood serum and erythrocytes, a potent antioxidant factor. Reduction of antioxidant activity promotes a sharp activation of free radical lipid oxidation and hemolysis of erythrocytes.

Clinically, the Zieve syndrome occurs as acute alcoholic hepatitis with severe jaundice, pain in the liver, significant increase in body temperature, cholestasis syndrome.

AF Bluger and IN Novitsky (1984) report a special form of alcoholic fatty hepatosis - "massive obesity of the liver". This form is characterized by pronounced hepatomegaly, bright hepatic-cell insufficiency, cholestasis. Even death is possible.

When diagnosing alcohol fatty liver disease, it should be remembered that fatty hepatosis also develops with obesity, diabetes, protein deficiency, and medicinal liver damage.