Liver dystrophy

Liver dystrophy is a comatose condition caused by deep suppression of liver functions. The occurrence of hepatic coma is associated with the presence of various chronic diseases that affect the liver.

The liver is a very important organ that plays a significant role in fat metabolism processes. Fats contained in the food entering the human body, entering the intestines, are broken down under the influence of enzymes and enter the circulatory system. Together with the blood flow, they are transferred to the liver, where they are transformed into all sorts of substances necessary for the functioning of the body, such as triglycerides, phospholipids, cholesterol.

In case of excessive triglyceride content in the liver, fatty liver infiltration occurs. Fatty liver degeneration is often characterized by more than tenfold excess of the normal amount of triglycerides in the liver. The mass of these substances in the liver can be more than half the mass of the liver, while in the liver of a person not susceptible to this disease, they are usually no more than five percent. This condition is caused by a number of factors, including: consumption of foods with a high content of fatty acids, high intensity of those processes occurring in the liver that lead to the formation of a large amount of triglycerides, disruption of the transport function of triglycerides from the liver to adipose tissue. In a healthy state of the body, triglycerides usually accumulate in adipose tissue in the form of fat.

The nature of fatty deposits in the liver determines the classification of fatty liver degeneration into the following two types. Based on the size of the fat droplets in the liver, there is small-droplet and large-droplet degeneration.

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Causes of liver dystrophy

The causes of liver dystrophy are mainly due to the fact that this disease develops against the background of a significant decrease in the ability of liver cells to show the appropriate reaction caused by their interaction with insulin. Insulin is a hormone responsible for the delivery of glucose contained in the blood and tissue fluid to cells. Due to the fact that the liver cells become insensitive to the effects of insulin, a deficiency of glucose appears, which is extremely important for their normal functioning, and the liver cells begin to die. Over time, fatty tissue grows in place of the damaged cells. This tissue does not have the properties of specific liver tissue, which ultimately leads to a significant decrease in the efficiency of the normal functioning of this organ, one of the most important in the human body.

The absence of a proper response of liver cells to insulin action may be one of the manifestations of congenital hereditary pathology, and in addition to this, it often becomes a consequence of metabolic disorders in the patient's body. Insulin resistance may also appear as a result of the fact that there was an incorrect immune aggression towards the hormone insulin.

The causes of liver dystrophy also include factors related to a person’s lifestyle and diet, such as excessive consumption of foods with a high content of vegetable and animal fats, as well as low levels of physical activity.

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Symptoms of liver dystrophy

Symptoms of liver dystrophy in most cases are expressed to an extremely weak degree. Complaints of patients with this disease about any alarming phenomena associated with its presence, as a rule, are not expressed by them. The development of the pathological process is characterized by a slow progression and the obscurity of clinical manifestations. However, as the disease progresses, dull pain in the right hypochondrium may occur, nausea, vomiting may occur, and bowel movements are disturbed. In a small number of cases, liver dystrophy can manifest itself in severe abdominal pain, weight loss, itching and yellowing of the skin.

Symptoms of liver dystrophy in the toxic type of the disease and with massive necrosis are characterized by the occurrence of hyperplasia of the lymph nodes and spleen located near the portal vein. Manifestations of liver dystrophy are also multiple hemorrhages that can appear in the skin, in the mucous and serous membranes. There are necrotic phenomena and changes of a dystrophic nature occurring in the tissues, and also affecting the myocardium of the heart, the pancreas.

Against the background of toxic chronic liver dystrophy in the chronic form of this disease, when its relapses occur, postnecrotic cirrhosis of the liver may progress. As the disease progresses further, there is a possibility of a fatal outcome caused by liver failure or hepatorenal syndrome.

Fatty liver disease

Fatty liver disease is a syndrome that occurs due to the progression of fatty degeneration in liver cells. The course of this disease is characterized by the occurrence of a process of pathological accumulation of fatty deposits in liver cells in the form of fat droplets. The cause of the development of this disease affecting the liver in many cases are pathological processes occurring in the biliary and intestinal tracts. Risk factors for the development of fatty liver disease are also the presence of severe obesity in the patient, type 2 diabetes mellitus, malabsorption and maldigestive syndromes, regular abuse of alcoholic beverages. The development of fatty liver disease can be caused by the use of a number of drugs, such as: corticosteroids, tetracyclines, estrogens, as well as non-steroidal anti-inflammatory drugs. Fatty liver disease can also accompany the course of various viral hepatitis, occurring in a chronic form, in particular - hepatitis C.

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Toxic liver dystrophy

Toxic liver dystrophy has as its manifestations massive progressive necrotic processes affecting liver tissue. The disease, as a rule, is acute, and in some cases can be present in the body in a chronic form, causing liver failure as the pathology progresses.

The cause of massive liver necrosis is mainly the effect of toxic substances contained in food products, including mushrooms, causing poisoning with arsenic, phosphorus compounds, etc. These intoxications are exogenous. Endogenous intoxications can also provoke toxic liver dystrophy. These include toxicoses that occur in women during the period when they are carrying a child, thyrotoxicosis. The cause of toxic liver dystrophy is often viral hepatitis, in which this disease develops as one of the manifestations of its fulminant form.

Toxic liver dystrophy causes changes in the body that are characteristic of each specific stage of the pathological progress of this disease. At first, the liver increases in size, this organ acquires either a flabby or dense consistency, it becomes characterized by a jaundiced tint. As the disease progresses, the liver decreases in size, and its capsule membrane becomes wrinkled. The liver tissue changes its color to grayish and takes on the appearance of a clay mass. At later stages, after the third week of the disease, the process of decreasing the liver in size continues, it acquires a reddish tint. The liver reticular stroma is exposed, in which dilated and blood-filled sinusoids are noted. Hepatocytes remain preserved only in the peripheral areas of the lobules. The above phenomena indicate the transition of liver dystrophy to the stage of red dystrophy.

The presence of toxic liver dystrophy that has progressed to a chronic stage is an extremely rare clinical case, but is associated with the likelihood of a fatal outcome for the patient due to progressive liver failure.

Acute liver dystrophy

Acute liver dystrophy is predominantly a complication developing against the background of an unfavorable course of Botkin's disease. Cases of the appearance of this disease in an autonomous form, as medical statistics show, are extremely rare.

To date, medical research in the field of studying the mechanisms of development of dystrophic phenomena in the liver has not led to a clear answer to the question of the cause of acute liver dystrophy. At present, the mechanisms of pathological progression of this severe disease affecting the liver have not yet been fully studied, and it remains unclear whether there is a correlation with the strength (virulence) of the virus, or whether there is an impact of some other factors.

The aggravated course of parenchymatous hepatitis may be caused by the presence of brucellosis, relapsing fever, syphilis, as well as pregnancy and its artificial termination. All this causes a high probability of hepatitis degeneration into a severe form of liver dystrophy.

Acute liver dystrophy at the initial stage recreates a clinical picture similar to the onset of Botkin's disease, which is associated with a significant deterioration in the general condition of the patient. In this case, the nervous system is mainly affected, which is manifested in the appearance of all sorts of disorders of brain activity. Patients begin to rave, toss and turn in bed, convulsions and vomiting occur. In some cases, the appearance of such conditions became the basis for the need to hospitalize the patient in a psychiatric clinic. On the other hand, a different, opposite reaction of the central nervous system to the development of the pathological process is possible. Apathy and a depressive state, a significant decrease in the vital tone of the body, increased drowsiness may appear. Up to the onset of an unconscious state and hepatic coma.

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Alcoholic liver disease

Alcoholic liver dystrophy is a disease caused by excessive consumption of alcoholic beverages over a long period of time exceeding 10-12 years. Alcohol, in immoderate quantities, entering the human body, has an extremely negative, hepatotoxic effect.

The appearance of alcoholic liver dystrophy may serve as a sign that fatty liver dystrophy or steatosis, cirrhosis, alcoholic hepatitis is taking place. In the overwhelming majority of cases, steatosis develops as the earliest stage of the progression of the pathological process in the liver due to alcohol abuse. After the regular intake of alcohol into the patient's body ceases, pathological changes due to steatosis developing in the liver return to normal within 2 to 4 weeks. Often, during the course of the disease, its symptoms may be absent, even slightly pronounced ones.

Alcoholic liver dystrophy has the same symptoms that characterize chronic alcohol intoxication. It is diagnosed due to the detection of enlarged parotid glands, the presence of Dupuytren's contracture, and palmar erythema. The presence of this disease in the patient's body is also indicated by the results of laboratory tests and liver biopsy.

Treatment of alcoholic liver dystrophy primarily involves the patient's complete cessation of alcohol consumption. A course of treatment with corticosteroids and essential phospholipids is prescribed. If the disease is in the terminal stage, a liver transplant may be indicated.

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Diffuse liver dystrophy

Diffuse liver dystrophy is a pathological process developing in the parenchyma, which is the main tissue from which this organ is formed. In specific liver cells, hepatocytes, processes occur aimed at detoxifying toxic substances entering the body. Hepatocytes participate in digestion processes, their role in this is reduced to the secretion of bile, which contains a number of enzymes that break down fats in the gastrointestinal tract. Liver cells ensure the neutralization of harmful substances by transforming them into those that do not pose a threat to the normal functioning of the body, and which are subsequently excreted along with bile.

Diffuse liver dystrophy occurs because liver cells are not always able to process the poison entering the body. It happens that they cannot cope with the scale of intoxication, and as a result, poisoning leads to their death. Over time, the cells destroyed in this way are replaced by fibrous connective tissue. The more significant the degree of such liver damage, the more negatively it affects its ability to perform its functions.

As a rule, the development of diffuse pathological progress in the liver is accompanied by a similar process that also affects the pancreas, since the functions of these two organs are closely related to each other.

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Focal liver dystrophy

Focal liver dystrophy presents certain difficulties in diagnosing this disease due to the fact that although there is a deterioration in liver function, it is extremely difficult to record these pathological changes through laboratory tests.

Based on the causes that cause focal liver dystrophy, in each individual case, the presence of various objective and subjective symptoms and manifestations of this disease in each specific patient is characteristic.

Focal liver dystrophy, which occurs in particular as a consequence of regular intoxication with large doses of alcohol, manifests itself in such phenomena as shortness of breath, loss of appetite, etc. In some cases, patients note the occurrence of unpleasant sensations and heaviness in the right hypochondrium. Such symptoms are characterized by an increase in their intensity during movement.

Often, detection of fatty liver infiltration becomes possible only by magnetic resonance imaging (MRI) and computed tomography. These diagnostic methods are the most effective way to detect focal liver dystrophy in a patient.

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Granular liver dystrophy

Granular liver dystrophy is the most common type of protein dystrophic pathology. In this disease, the colloidal properties of the cellular cytoplasm are disrupted, in which the appearance of a granular protein is observed.

The causes that cause the appearance of this liver disease are: lack of adequate feeding in infancy, and in later age periods - the consequences of intoxication, the presence of infections, disruptions in the functioning of the circulatory system and lymph flow, as well as exposure to factors that can provoke tissue hypoxia.

As granular liver dystrophy develops, changes in protein cellular metabolism occur. As the pathological process of granular dystrophy progresses, the cytoplasm becomes swollen and cloudy, as a result of which this liver lesion is also characterized as cloudy swelling. The liver affected by this disease becomes flabby, and its blood supply is disrupted.

In the process of establishing a differential diagnosis, granular dystrophy must be separated from the physiological processes of protein synthesis in cells, during which granularity occurs in the protein.

Granular liver dystrophy is predominantly a reversible process, however, due to the severe course of the disease, there is a possibility of its degeneration into such forms as hyaline-drop or gyropic dystrophy, as well as necrosis.

Protein dystrophy of the liver

Protein dystrophy of the liver occurs as a result of a violation of protein metabolic processes and can be represented by amyloidosis, hyalinosis and granular dystrophy.

A characteristic feature of amyloidosis is that in the presence of this disease, a special protein amyloid substance is deposited in the tissues.

Hyalinosis is a type of protein dystrophy, which often occurs as a concomitant disease against the background of atherosclerosis. This pathology is characterized mainly by local localization, in particular, it can appear in the wall of the vessel when a thrombus is formed. Hyalinosis is characterized by the formation of translucent protein structures similar to cartilaginous hyaline tissue.

Protein dystrophy of the liver also takes the form of granular dystrophy, which means the appearance of drop-shaped and granular protein formations in the cellular protoplasm. When united into a single whole, these formations tend to completely fill the entire internal cellular space. With granular dystrophy of the liver, protein cellular structures are compacted, and the normal functioning of the cells is disrupted. Granular dystrophy is fraught with the occurrence of pathological changes of a necrotic nature and leads to cell death.

Hydropic liver dystrophy

Hydropic liver dystrophy, also known as dropsical dystrophy, has such a feature as the appearance of vacuoles in the cell containing cytoplasmic fluid. In the presence of this type of liver dystrophy, the parenchyma cells are enlarged, the nucleus in them acquires peripheral localization, in some cases its wrinkling or vacuolization is observed.

As pathological changes develop, the cell becomes overfilled with liquid and its ultrastructures decompose. The cell becomes like a water-filled container and essentially represents one solid vacuole with a bubble-shaped nucleus placed in it. This phenomenon, which is a sign that characterizes colliquative necrosis, is called balloon dystrophy.

Hydropic liver dystrophy can only be detected by examination using a microscope, since the appearance of tissues and organs does not show any visual changes.

The prognosis for this disease appears to be unfavorable due to the fact that hydropic liver dystrophy significantly disrupts the functioning of this organ. A negative prognostic factor is also the fact that the outcome of this disease is focal or total cell necrosis.

Yellow liver dystrophy

Acute yellow liver dystrophy may occur during pregnancy as one of the complications associated with it. It is caused by a state of acute intoxication, in which this disease is an aggravating factor in the development of infection processes in the body.

Jaundice in a woman during the period in which she is carrying a child, as well as in the presence of other liver pathologies in addition to liver dystrophy, such as cholecystitis and the presence of stones in the liver, can also be present as an autonomous disease provoked by autointoxication of the body. This condition is known as toxicosis associated with pregnancy.

Yellow liver dystrophy is one of the most serious toxicosis of pregnancy. The disease is caused by severe intoxication with products of metabolic processes occurring during pregnancy, which differ in features other than those of metabolism occurring in the normal state of the body. Pathological progress at the beginning of its development is characterized by the appearance of jaundice, which is preceded by a period of severe, often very prolonged vomiting. Over time, the condition is aggravated by the fact that the skin and sclera acquire a pronounced icteric appearance, clouding of consciousness occurs, delirium and excessive excitation of the nervous system may occur. There is a possibility of multiple subcutaneous hemorrhages, the presence of cyrosine and lecithin is detected in the urine, the amount of which tends to significantly decrease, and in addition, there is a decrease in liver dullness. Due to further deterioration of the general condition of the patient, there is a possibility of death after a few days.

Parenchymal liver dystrophy

Parenchymatous liver dystrophy is based on the development of the associated pathological process of changes in the chemical-physical and morphological characteristics inherent in cellular proteins. The essence of such disorders of cell functioning is the process of hydration, to which the cytoplasm is subjected as a result of the fact that coagulation, denaturation, or, on the contrary, the phenomenon of colliquation takes place in the cell. In cases where protein-lipid bonds are disrupted, membrane cellular structures are characterized by the occurrence of destructive processes in them. The consequences of such changes consist in the development of necrotic processes of coagulation - dry, or colliquation - wet nature.

Parenchymatous liver dystrophy is classified according to its varieties as:

• Hyaline droplet
• Hydropic
• Corneal dystrophy.

Parenchymatous liver dystrophy may also include granular dystrophy, which is characterized by the appearance of protein granules in the parenchyma cells. This type of liver dystrophy is characterized by an increase in the volume of the organ affected by this disease, its acquisition of a flabby consistency and a dull appearance on the section. The latter feature is why granular liver dystrophy is also called dull or cloudy swelling.

Diagnosis of liver dystrophy

Diagnosis of liver dystrophy is associated with a number of difficulties arising due to the fact that traditional laboratory research methods in this case often prove ineffective, even despite the fact that with this disease affecting the liver, the inevitable deterioration in the functioning of this organ becomes obvious.

The clinical picture of dystrophic liver pathology is usually asymptomatic, so the main sign that allows us to assume the presence of this disease in the body is an increase in the size of the liver. Since the echogenicity of the liver tissue during ultrasound examination does not differ significantly from normal values, sometimes even with a tendency to increase, this prevents accurate and unambiguous differentiation with cirrhosis or liver fibrosis. By means of ultrasound, it becomes possible to identify areas that are characterized by increased echogenic characteristics, while areas of low absorption coefficient are determined by computed tomography. CT and magnetic resonance imaging are among the most effective methods for recognizing dystrophic pathology in the liver. They are most effective for determining focal fatty infiltration of the liver.

Diagnosis of liver dystrophy also involves conducting a histological examination of biopsies in order to establish the presence of an excessive amount of fatty formations in this organ.

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Treatment of liver dystrophy

Since in such a matter as the treatment of liver dystrophy, it is of great importance to establish an accurate differential diagnosis and, based on this, prescribe certain treatment measures, in order to exclude hepatitis during diagnosis, which is the most severe stage of this disease, a liver biopsy is usually prescribed. Unfortunately, to date, there is no such non-invasive technique that would provide the opportunity to diagnose hepatitis with a high degree of accuracy, or to determine the degree with high reliability and prescribe appropriate treatment for non-alcoholic fatty liver dystrophy.

Before sending a patient for a biopsy and prescribing treatment for liver dystrophy, including treatment for fatty liver dystrophy, the recommendations of medical specialists boil down to the fact that the patient must, first of all, change his lifestyle. Since this liver lesion is characterized by increased insulin-resistant characteristics, such changes in the patient's lifestyle imply a number of measures aimed primarily at eliminating or minimizing the effects of such a negative factor. A special diet and nutrition regimen are prescribed, along with an increase in the amount of physical activity.

The diet involves reducing the total caloric content of the daily diet, minimizing the consumption of those products that contain fructose in large quantities, as well as those with a high content of fatty acids.

To improve the absorption of insulin and its more effective action, physical exercise is useful, which also helps to get rid of excess fatty tissue in the internal organs and helps to reduce the negative effects caused by fatty liver disease.

Diet for liver dystrophy

Diet for liver dystrophy is one of the important factors in combating this disease and successful healing.

The diet allows for the consumption of foods containing large amounts of vitamins, fiber, pectin, and carbohydrates without significant restrictions. The fat content in food in the daily diet should not exceed 70 grams. This diet also involves the exclusion of cholesterol-containing foods and minimal consumption of table salt.

It is recommended to eat only boiled or steamed foods. Although fried foods are on the list of categorical prohibitions for dystrophic liver pathology, you can cook meat and fish dishes in the oven. As for fish, it should be noted that it is recommended to avoid its particularly fatty varieties.

As for drinks, cocoa, coffee and soft carbonated drinks are excluded from the diet.

Diet for liver dystrophy - an approximate list of dishes that are acceptable and recommended for consumption is given below.

First courses can be represented by borscht, soups made from cereals, vegetables, and also milk.

For the second course you can eat boiled or steamed meat or lean fish.

Any vegetables can be used as side dishes, again – boiled or steamed, vegetable salads made from boiled onions, cabbage, carrots.

Sometimes you can diversify your diet with ham and mild cheese, a steamed omelet, or no more than one boiled egg per day.

From porridges you can make buckwheat, semolina, oatmeal, and in addition to this – rice.

The diet for liver dystrophy includes condensed and whole milk, yogurt, kefir and low-fat cottage cheese.

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Prevention of liver dystrophy

Prevention of liver dystrophy involves purposeful avoidance of adverse factors that can lead to the development of such liver pathology. The likelihood of developing this liver disease is significantly reduced by giving up a number of bad habits. First of all, nicotine addiction, intemperance in drinking alcoholic beverages, overeating, a sedentary lifestyle, and spending a lot of time in front of a television screen.

Positive preventive factors for maintaining the activity of the whole organism in high vitality and preventing the occurrence of pathological phenomena in the internal organs, in particular, in the liver, are a sensible systematic approach to establishing the entire routine of life, organizing a correct diet with the presence in a balanced diet of all the nutrients and elements necessary for the body, and with the limitation of excessively hot and fried foods, smoked foods, and canned foods.

In such a matter as the prevention of liver dystrophy, it is also important to control your body weight and maintain your body mass index within the optimum range.

Regular physical activity in the form of sports – walking, jogging, swimming, etc. – seems beneficial for the functioning of the liver. A body weight close to optimal helps to avoid overstraining the liver functions, as well as the vital functions of the entire body.

Liver dystrophy prognosis

The prognosis for liver dystrophy, if the disease is not complicated by all sorts of accompanying complications, is favorable. Patients in most cases retain their ability to work.

Liver dystrophy with pronounced characteristics of the pathological process leads to a decrease in resistance to infections entering the body, can cause worse tolerance of anesthesia and surgical interventions, and contribute to a longer postoperative recovery period.

If progressive trends in the impact of factors leading to hepatotoxicity persist: metabolic disorders or hyperlipidemia, there is a possibility of further worsening of the development of inflammation, leading to the development of micronodular cirrhosis of the liver and NASH.

The prognosis of liver dystrophy with the use of dietary restrictions and the rejection of bad habits in the application to patients with fatty liver dystrophy was distinguished by a tendency to maintain their working capacity and a satisfactory state of the body. Nevertheless, from time to time, such observed patients complained of a significant decline in strength and vitality, especially during periods associated with long-term work requiring significant stress.

A negative prognostic factor was that some patients showed degeneration of the disease into liver cirrhosis.