Fatty liver dystrophy

Steatosis of the liver - synonyms: fatty hepatosis, fatty liver dystrophy, fatty infiltration, lipodystrophy - is a liver disease that is characterized by focal or dispersed fat deposition in liver cells. It is considered a common pathology, often causing no symptoms. In some cases, it manifests itself as an inflammatory process with further development of cirrhosis and signs of liver failure.

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Causes of fatty liver disease

A small number of fat cells are present in the liver tissue of all healthy people. Their share is approximately 5%. Fatty dystrophy is spoken of if this percentage is more than 10. In advanced pathology, the amount of fat can be 50 percent or more.

Why does this happen? There could be many reasons, and here are some of them.

1. Long-term liver intoxication:

• due to excessive consumption of alcoholic beverages (the so-called alcoholic steatosis );
• as a result of prolonged use of medications, such as hormonal drugs, chemotherapy drugs, antibiotics, and anti-tuberculosis drugs.

2. Disrupted metabolic processes:

• hyperfunction of the adrenal cortex;
• thyroid disease;
• diabetes mellitus;
• obesity.

3. Improper nutrition:

• excessive consumption of fatty and sweet foods, which puts a lot of strain on the liver;
• chronic form of the inflammatory process in the pancreas or intestines;
• irregular meals, long-term strict diets, insufficient intake of proteins, vitamins and minerals from food;
• rare and small meals;
• regular overeating.

4. Insufficient oxygen supply to the body's tissues, which can be observed in respiratory pathologies or cardiovascular diseases.

The pathogenesis of the disease development can proceed in different ways. Thus, there can be two etiological causes of the disease.

Firstly, fats can accumulate in the liver when they enter the body in excess:

• due to excess fat in food;
• due to excess carbohydrates in food (carbohydrates stimulate the formation of fatty acids);
• due to an increase in the consumption of glucose reserves in the liver, which forces the body to remove fat reserves from the depot and deposit them in the liver tissue;
• due to underoxidation of fats, which can be observed in metabolic disorders and anemia;
• due to increased production of somatotropin, which occurs in diseases of the pituitary gland, in traumatic brain injuries, or in patients with diabetes.

Secondly, in some cases, fat does not leave the liver:

• with a deficiency of transport proteins, which help remove excess fat (in chronic alcoholics, with a lack of protein in the body);
• with a hereditary predisposition to insufficient protein synthesis;
• in case of chronic exposure to toxic substances (in alcoholics, drug addicts, in the presence of malignant diseases).

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Symptoms of fatty liver disease

The problem is that the disease does not manifest itself for quite a long time. For example, in the initial stages, when fat is just beginning to accumulate in the liver tissue, there are no external signs of fatty degeneration.

At the second stage of the pathology development, the fat "points" become larger, they tend to merge, which leads to necrosis of hepatocytes. Only from this moment the first signs of the disease begin to appear:

• feeling of weakness;
• sometimes – attacks of nausea;
• a feeling of heaviness in the area of the liver projection;
• increased gas formation;
• the emergence of an aversion to fatty foods;
• heaviness in the stomach;
• pain in the right hypochondrium without apparent cause.

At the third stage, which is considered a precursor to cirrhosis, the process of destruction of liver tissue begins. Connective tissue grows in its place, which leads to deterioration of liver function and disruption of bile flow. The following symptoms may be observed during this period:

• yellowing of the sclera of the eyes;
• yellowing of the skin;
• attacks of not only nausea, but also vomiting;
• the appearance of a skin rash.

In addition, there is a general decrease in immunity, which can provoke the addition of infectious and cold diseases.

Acute fatty liver disease of pregnancy

Acute fatty liver disease in pregnant women is one of the most serious complications that can occur during pregnancy. Fortunately, this disease occurs very rarely.

The following conditions of a pregnant woman can lead to the development of the disease:

• a state of uncontrollable vomiting;
• hepatosis with cholestasis;
• gestosis with hepatorenal syndrome;
• acute form of fatty hepatosis.

The first symptoms of the pathology appear in the period from 30 to 38 weeks of gestation, in rare cases – earlier. At first, there is a feeling of weakness, lethargy, with repeated nausea and vomiting, pain in the abdomen. After some time, heartburn joins in, the esophagus area becomes painful, especially when swallowing – this is explained by the formation of ulcers on the surface of the esophageal tube.

The next stage is jaundice, vomit becomes brown. Fluid accumulation in the abdominal cavity and anemia are often observed.

In this situation, the doctor must get his bearings in time and distinguish the onset of acute fatty degeneration from infectious diseases of the digestive system. Accurate diagnostics largely determine the further outcome of the disease, because not only the health but also the life of the expectant mother and her child is at stake.

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Forms

As the disease progresses, various structural changes in the tissues occur in the liver. This allows us to conditionally divide the pathology into several forms of progression:

• Focal disseminated liver dystrophy is a pathology in which fat points are located little by little in different areas of the liver organ. Usually, this form does not differ in any symptoms.
• Severe disseminated fatty liver disease is a form of the disease when there are quite a lot of fat deposits and they are located throughout the entire organ. The first signs of the disease may appear.
• Zonal dystrophy is a form of dystrophy in which fat spots can be found in certain lobes (zones) of the liver.
• Diffuse fatty liver disease is a pathology in which the entire liver lobe is uniformly filled with fat. Symptoms in this form are already quite pronounced.
• Alcoholic fatty liver disease can occur in a rare, special form called Ziewe syndrome. This form is characterized by the following symptoms:
  • symptoms appear suddenly and are clearly expressed;
  • a blood test shows an increase in bilirubin (a yellow bile substance formed from red blood cells);
  • the level of cholesterol in the blood increases;
  • the amount of triglycerides (fatty products that damage small capillaries) increases;
  • the amount of hemoglobin drops noticeably (due to the massive destruction of red blood cells due to the increasing deficiency of tocopherol, which is formed and accumulates in hepatocytes).

Also, depending on the form, there are acute and chronic dystrophies.

• In chronic fatty liver disease, tiny droplets of fat accumulate in the cytoplasm of liver cells, which gradually combine into larger droplets or into a large vacuole that completely fills the cytoplasm and displaces the nucleus to the edge of the cell. When most of the liver tissue is affected, the diagnosis is "fatty hepatosis." This condition is characterized by liver cells filled with a large amount of fat bursting to form fatty cysts.
• Acute fatty liver disease is characterized by rapid development, rapidly increasing symptoms, often developing into cirrhosis or other complex liver pathologies. This disease is usually a consequence of severe hepatitis, deep intoxication of the body (for example, mushroom or chloroform poisoning), alcoholism. Symptoms of the acute form are always sharply expressed: an increase in the size of the liver, large temperature fluctuations in one direction or another, convulsive and delirious states, bleeding. The condition of patients is usually severe and requires immediate specialized medical care.

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Diagnosis of fatty liver disease

• Collection of complaints, questioning the patient regarding the symptoms of the disease.
• Questioning the patient about his lifestyle, the presence of bad habits, and other concomitant diseases.
• Examination of the patient, palpation of the abdomen and liver area, tapping the area where the liver and spleen are located.

Conducting laboratory tests:

• general blood test (erythrocytopenia, hemoglobinemia, thrombocytopenia, anemia, leukocytosis);
• blood biochemistry (assessment of the functional capacity of the pancreas and gallbladder);
• analysis of the consequences of alcoholism (immunoglobulin levels, measurement of mean corpuscular volume, transferrin levels, etc.);
• assessment of the content of markers for viral liver pathologies;
• general urine test;
• stool analysis.

Conducting instrumental diagnostic procedures:

• Ultrasound scanning of abdominal organs, assessment of the external boundaries and general condition of the liver organ;
• esophagogastroduodenoscopy method – endoscopic examination of the digestive system;
• liver puncture for biopsy and further histological examination (removal of a sample of liver tissue for analysis);
• computed tomography method – obtaining layer-by-layer x-ray images of the liver;
• magnetic resonance imaging method;
• elastography method – ultrasound analysis for assessing the depth of liver fibrosis;
• retrograde cholangiography method – a procedure for obtaining X-ray images after the introduction of a contrast agent into the biliary system (usually prescribed for cholestasis).

Additional consultations with specialists in a narrow medical field - this could be a gastroenterologist, narcologist, surgeon, etc.

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Treatment of fatty liver disease

There is no specific treatment regimen as such for fatty liver disease. Therapeutic measures include eliminating provoking factors and stabilizing metabolic processes, restoring liver tissue and eliminating toxic effects on hepatocytes. In combination with drug treatment, the patient is explained the need for a healthy lifestyle and proper nutrition.

Treatment of the disease with medications is carried out with such drugs as membrane stabilizers and antioxidants. Drugs for fatty liver disease can be divided into several groups:

1. Products consisting of essential phospholipids, such as drugs based on phosphatidylcholine, which can create protection for liver cells. Such medications include Essentiale, Hepabos, Essliver, etc.
2. Products that belong to sulfoaminoacids (Heptral, Dibicor, etc.);
3. Products based on plant components (Carsil, Liv 52, artichoke extract, etc.).

Heptral is prescribed as injections, in quantities of 400 to 800 mg per day for 14-20 days. Then switch to 2-4 tablets per day.

Essentiale is taken 600 mg three times a day. The course of treatment should be at least 2-3 months. After 20-30 days of treatment, the dosage is slightly reduced to 300 mg three times a day.

Alpha-lipoic acid (Alpha-lipon) is administered intravenously in an amount of up to 900 mg per day for a month. After 2 weeks from the start of treatment, infusions can be replaced by oral administration of 600 mg/day.

An artichoke-based remedy, Hofitol, has a choleretic and hepatoprotective effect and normalizes metabolism. Hofitol is prescribed 3 tablets three times a day before meals. Duration of therapy is up to 1 month.

The drug Liv 52 is taken 1-2 teaspoons twice a day, or in tablet form - 2-3 tablets up to 4 times a day half an hour before meals.

In addition to medications, vitamin supplements such as vitamin E, ascorbic acid, niacin and vitamin B2 are prescribed to reduce liver intoxication.

From traditional medicine the following can be successfully used:

• cinnamon powder and sticks – help reduce the amount of glucose and cholesterol in the blood, prevent the accumulation of fat in the liver;
• turmeric is an excellent antioxidant, increases bile production, lowers blood glucose levels;
• milk thistle – eliminates spasms in the gallbladder, removes toxic substances, restores hepatocytes. You can also take pharmacy drugs with milk thistle – this is the plant oil, or the ready-made drug Gepabene (prescribed 1 capsule three times a day);
• sorrel – helps remove bile, stabilizes its production. Reduces fat content in the liver.

Diet for fatty liver disease

One of the factors in the development of fatty liver disease is a sedentary lifestyle combined with overeating. Therefore, it is very important to monitor your diet and maintain a normal weight. If the patient is obese, he is recommended to follow a diet (but not a strict one) with a weight loss of about 0.5 kg per week. Moderate physical activity is welcome: exercise bike, swimming, walking.

Diet for fatty liver disease is not just important – it plays a leading role in the effectiveness of patient treatment. Medical institutions usually prescribe diet table No. 5, with the consumption of protein food up to 120 g per day, limiting animal fat, as well as a sufficient amount of products useful for the liver – cottage cheese, cereals (oatmeal, buckwheat, millet, wild rice). Plant foods are welcome – fruits and vegetables, greens, all types of cabbage.

Instead of meat products, it is recommended to eat fish and seafood. It is advisable to avoid fried food - steam, boil or bake dishes, with a minimum amount of butter (it is better to replace it with vegetable oil).

One should not forget about the drinking regime: in the absence of contraindications, one should drink at least 2 liters of water per day, preferably in the first half of the day.

It is necessary to limit or exclude fatty dairy products: whole milk, sour cream, cheeses. Low-fat kefir, fermented baked milk, yogurt are allowed for consumption.

Alcoholic drinks will have to be excluded completely! In addition to alcohol, carbonated drinks are also prohibited.

It is also recommended to give up sweets, white pastries, store-bought and fatty sauces, margarine, sausages, fatty meats and lard. Try to eat only natural fresh products with a minimum amount of sugar.

Prevention

Prevention of the disease is relatively simple and includes such basic points as eliminating or limiting alcohol consumption and proper nutrition. Patients at risk for liver disease are recommended to be vaccinated against hepatitis.

Regular preventive examinations should be performed, especially if suspicious symptoms such as weakness, discomfort in the right hypochondrium, nausea and loss of appetite are present. If a person notices signs of jaundice, they should immediately visit a doctor. For fatty liver disease, it is very important to conduct diagnostics and treatment in a timely manner.

People at risk should be especially careful about their liver health:

• persons who consume alcohol;
• patients who have had viral infectious liver diseases;
• patients with chronic diseases that require constant intake of certain medications;
• people working in hazardous industries;
• persons with a hereditary predisposition to liver disease;
• people who follow strict diets with limited protein or are on “starvation” diets;
• if there are helminths in the body.

You cannot ignore the symptoms of liver disease - even if everything is fine with the organ, it is better to make sure of this once again and consult a doctor.

Forecast

The course of the disease largely depends on its origin. If there is no inflammatory process and the hepatocytes are not damaged, then the pathology in most cases does not worsen. However, if there are signs of hepatitis, then sooner or later the dystrophy develops into cirrhosis of the liver. This complication is most often encountered in old age, with severe metabolic disorders, with obvious obesity, diabetes mellitus.

With timely treatment and following all the doctor's recommendations, fatty liver disease can be reversible. Over time, the patient will be able to return to a normal lifestyle. But in advanced situations or when ignoring the doctor's instructions (continued drinking, nutritional errors, constant intoxication of the body), life expectancy can be significantly reduced. As the disease progresses, cirrhosis of the liver develops, the person becomes disabled.

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