Alcoholic fatty hepatosis

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

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Causes of fatty hepatosis

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

• ethanol metabolism occurs using large amounts of NAD, the same compound is also necessary for the final stage of fatty acid oxidation; due to a deficiency of NAD, this process is disrupted, and fatty acids accumulate in the liver with their transformation into neutral fats (triglycerides);
• ethanol promotes the release of catecholamines, which cause the mobilization of fat from peripheral fat depots and increase the amount of fatty acids entering the liver;
• Ethanol disrupts the utilization of free fatty acids and triglycerides by muscle tissue.

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Symptoms and diagnosis of fatty liver disease

Characteristic clinical and laboratory features of alcoholic fatty hepatosis:

• patients complain of a feeling of heaviness and distension, pain in the right hypochondrium and epigastrium; intolerance to fatty foods; general weakness, rapid fatigue, decreased performance, irritability; bloating; 50% of patients have no subjective manifestations;
• the leading clinical sign is hepatomegaly; the liver is moderately enlarged, its consistency is dense-elastic or doughy, the edge is rounded; palpation can be moderately painful;
• liver function tests are slightly changed, approximately 20-30% of patients have a moderate increase in the activity of aminotransferases (ALT, AST) and alkaline phosphatase in the blood serum, a slight increase in the content of bilirubin and y-glutamyl transpeptidase in the blood; an increase in the level of triglycerides, free fatty acids, and lipoproteins in the blood is possible;
• Ultrasound of the liver reveals the following characteristic signs: enlargement of the liver, uniform increase in echogenicity, blurring of the liver contour, homogeneity of structure (the structure is more delicate, consists of many small identical points, as if sprinkled with "semolina". However, according to A. F. Bluger (1984), it is also possible to detect acoustic heterogeneity of the liver due to the possible presence of areas of compaction of various sizes and shapes in its tissue;
• radioisotope hepatography reveals a violation of the secretory-excretory function of the liver;
• liver biopsy is crucial in diagnosing fatty hepatosis. The diagnosis is reliable when at least 50% of hepatocytes contain fat droplets that displace the nucleus and organelles of the hepatocyte to the periphery. These changes are most pronounced in the centrilobular zone;
• When abstaining from alcohol consumption, fatty hepatosis undergoes complete reversal.

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

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

A. F. Bluger and I. N. Novitsky (1984) report a special form of alcoholic fatty hepatosis - "massive fatty liver". This form is characterized by pronounced hepatomegaly, severe hepatocellular insufficiency, and cholestasis. Even a fatal outcome is possible.

When diagnosing alcoholic fatty liver disease, it should be remembered that fatty liver disease also develops with obesity, diabetes, protein deficiency, and drug-induced liver damage.