Liver Dystrophy

Dystrophy of the liver is a coma, the cause of which is deep depression of the liver. The occurrence of hepatic coma is associated with the presence of all kinds of diseases in a chronic form that affect the liver.

The liver is a very important organ that plays a significant role in the processes of fat metabolism. Fats contained in the food entering the human body, getting into the intestines, under the influence of enzymes are split and enter the circulatory system. Together with the blood flow, they are transferred to the liver, in which they transform into all kinds 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 infiltrates. Fatty degeneration of the liver is often more than tenfold higher than 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, whereas in the human liver, not usually subject to this disease, they are not more than five percent. This condition is caused by a number of factors, among them: consumption of foods that are high in fatty acids, high intensity of those processes that occur in the liver, which lead to the formation of a large number 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 as fat.

The nature of fat deposits in the liver causes the classification of fatty liver dystrophy according to the following two types. Based on the size, what droplets of fat in the liver get, there is small-drip and large-droplet dystrophy.

[1], [2], [3], [4]

Causes of liver dystrophy

The causes of liver dystrophy are mainly reduced to the fact that this disease develops against the background of a significant decrease in the ability of liver cells to exhibit an appropriate reaction caused by their interaction with insulin. Insulin is a hubbub, responsible for the delivery of glucose contained in the blood and in the tissue fluid to the cells. Due to the fact that the liver cells are immune to insulin action, glucose deficiency appears, which is extremely important for their normal functioning, and the liver cells begin to die. On the site of the cells that have been damaged, the fat tissue grows after a time. This tissue does not possess the properties of a specific hepatic tissue, which ultimately leads to a significant decrease in the effectiveness of the normal functioning of this organ, one of the most important in the human body.

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

The causes of liver dystrophy are also associated with the lifestyle and dietary habits of a person as an excessive intake of foods with a high content of vegetable and animal fats in them, as well as a low level of physical activity.

[5], [6]

Symptoms of liver dystrophy

Symptoms of liver dystrophy in most cases are expressed in an extremely weak degree. Patients with this disease complain about any disturbing phenomena associated with their presence, as a rule, they do not appear. The development of the pathological process is characterized by slow progress and not the manifestation of clinical manifestations. However, as the disease progresses, dull pain can occur in the right hypochondrium, nausea, vomiting may occur, and a stool is broken. In a small number of cases, liver dystrophy can be manifested by severe pain in the abdomen, weight loss, itching and icterus of the skin.

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

Against the backdrop of toxic chronic dystrophy of the liver in the chronic form of this disease, when its relapses occur, postnecrotic cirrhosis can progress. As the disease progresses further, there is a possibility of a lethal outcome caused by hepatic insufficiency or hepatorenal syndrome.

Fatty degeneration of the liver

Fatty degeneration of the liver is a syndrome caused by the progression of fatty degeneration in the liver cells. The course of this disease is characterized by the appearance of a process of pathological accumulation in the liver cells of fatty deposits that look like fatty drops. The cause of the development of this disease affecting the liver in many cases are pathological processes occurring in the biliary and intestinal tract. Risk factors for fatty liver disease are also the presence of obesity in the expressed form in the patient, the second type of diabetes mellitus, malabsorption and maldigestive syndromes, and regular abuse of alcoholic beverages. Lead to the development of fatty liver disease may be the effects of a number of medications, such as: corticosteroids, tetracyclines, estrogens, as well as medicines of the nonsteroidal anti-inflammatory group. Fatty degeneration of the liver besides this can accompany the course of various viral hepatitis occurring in chronic form, in particular - hepatitis C.

[7], [8], [9], [10]

Toxic dystrophy of the liver

Toxic dystrophy of the liver has as its manifestations massive progressive necrotic processes affecting the liver tissue. The disease, as a rule, is acute, and in some cases it can be present in the body in 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 fungi, causing arsenic poisoning, phosphorus compounds, etc. These intoxications are exogenous. To provoke toxic dystrophy of the liver can also endogenous intoxications. These include toxicoses that occur in women during the period when they are carrying a child, thyrotoxicosis. The cause of toxic dystrophy of the liver is often the disease with viral hepatitis, in which the disease develops as one of the manifestations of its lightning-fast form.

Toxic dystrophy of the liver causes changes in the body, which are characteristic for each particular stage of the pathological progress of this disease. In the beginning, there is an increase in the size of the liver, this organ acquires either a flabby or dense consistency, an icteric shade becomes characteristic of it. With the further course of the disease, the liver shrinks in size, and the capsular envelope becomes wrinkled. Hepatic tissue changes its color to grayish and acquires a clayey mass. At later stages, after the third week of the disease, the process of reducing the liver continues in size, it acquires a reddish hue. There is a denudation of the hepatic reticular stroma, in which there are enlarged and blood-filled sinusoids. Preserved hepatocytes remain only in the peripheral regions of the lobules. The resulted phenomena testify to the transition of hepatic dystrophy to the stage of red dystrophy.

The presence of toxic liver dystrophy that has passed to the chronic stage is an extremely rare clinical case, but it is associated with the probability of a lethal outcome of the patient due to progressive hepatic insufficiency.

Acute dystrophy of the liver

Acute dystrophy of the liver is primarily a complication that develops against the background of an unfavorable course of Botkin's disease. Cases of the emergence of this disease in an autonomous form, as evidenced by medical statistics, are extremely rare.

To date, medical research in the study of the mechanisms of the development of dystrophic phenomena in the liver has not led to an unambiguous answer to the question of the cause of acute hepatic dystrophy. At present, the mechanisms of the pathological progress of this serious disease affecting the liver are still not fully understood, and it remains unclear whether there is a correlation with the virulence (virulence) of the virus, or there are some other factors.

Lead to an aggravated course of hepatitis of the parenchymal nature may be the patient's disease with brucellosis, recurrent typhoid, syphilis, as well as the state of pregnancy and artificial interruption. All this causes a high probability of degeneration of hepatitis in a severe form of liver dystrophy.

Acute dystrophy of the liver at the initial stage recreates a clinical picture, similar to the onset of the development of Botkin's disease, which is associated with a significant deterioration in the general condition of the patient. At the same time, the nervous system is mainly affected, which is manifested in the appearance of all kinds of disorders of brain activity. Patients begin to rave, rush around the bed, convulsions and vomiting occur. In some cases, the emergence of such conditions became the rationale for the need to hospitalize a patient in a psychiatric clinic. On the other hand, another, opposite reaction of the central nervous system to the development of the pathological process is possible. Apathy and depression may appear, a significant decrease in the vitality of the body, there may be increased drowsiness. Up to the onset of unconsciousness and hepatic coma.

[11], [12], [13]

Alcoholic dystrophy of the liver

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

The appearance of alcoholic hepatic dystrophy can serve as a sign that there is fatty liver disease or steatosis, cirrhosis, alcoholic hepatitis. In the overwhelming majority of cases, as the earliest stage of the progress of the pathological process in the liver due to alcohol abuse, steatosis develops. After stopping the regular intake of alcohol into the patient's body, pathological changes due to the steatosis developing in the liver return to normal during a period of 2 to 4 weeks. Often during the course of the disease, there may be no symptoms at all

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

Therapeutic measures for alcoholic liver dystrophy consist primarily in the absolute cessation of alcohol consumption by the patient. A course of treatment with corticosteroids and essential phospholipids is prescribed. If the disease is in the terminal stage, liver transplantation can be indicated.

[14], [15], [16], [17], [18],

Diffusive liver dystrophy

Diffuse liver dystrophy is a pathological process that develops in the parenchyma, which is the main tissue from which this organ is formed. In specific hepatic cells, hepatocytes, processes occur that are aimed at detoxifying the toxic substances that enter the body. Hepatocytes take part in the digestive processes, their role here is reduced to the secretion of bile, in which there are a number of enzymes that break down fats in the gastrointestinal tract. Hepatic cells provide 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 results from the fact that liver cells are not always able to process the poison that enters the body. It happens that they can not cope with the scale of intoxication, and as a result, poisoning leads to their death. Over time, the cells thus destroyed are replaced by a fibrous connective tissue. The more significant the degree of such a lesion of the liver, the more it accordingly negatively 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 affecting also the pancreas, since the functions of the two organs are in close connection.

[19], [20], [21], [22], [23]

Focal dystrophy of the liver

Focal hepatic dystrophy presents certain difficulties in diagnosing this disease due to the fact that although there is a deterioration in the functioning of the liver, it is extremely difficult to document these pathological changes through laboratory studies.

Proceeding from the reasons that caused focal hepatic dystrophy, in each individual case, the presence of various objective and subjective symptoms and manifestations of this disease in each individual patient is characteristic.

Focal hepatic dystrophy, arising in particular as a result of regular intoxication with large doses of alcohol, is manifested in such phenomena as the appearance of shortness of breath, deterioration of appetite, etc. In some cases, patients note the occurrence of unpleasant sensations and severity in the right hypochondrium. Such symptoms are characterized by an increase in their intensity during movement.

Often, the detection of fatty liver infiltration becomes possible only when conducting magnetic resonance imaging (MRI) and computed tomography. These diagnostic techniques are the most effective way to detect a patient's focal liver disease.

[24], [25]

Granular dystrophy of the liver

Granular dystrophy of the liver is the most common type of protein dystrophic pathology. With this disease, the colloidal properties of the cellular cytoplasm are violated, in which the appearance of a grain-like protein is observed.

The causes of this hepatic disease are: the lack of full-fledged feeding in infancy, and in later age periods - the effects of intoxication, the presence of infections, impaired functioning of the circulatory system and lymph flow, as well as the influence of factors that can provoke hypoxia tissue.

As grainy liver degeneration develops, protein cellular metabolism changes. With the progress of the pathological process of granular dystrophy, the cytoplasm acquires a swollen and clouded appearance, as a result of which this liver damage is also characterized as a turbid swelling. Affected by this disease, the liver acquires a flabby consistency, blood circulation is disturbed in it.

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

The granular dystrophy of the liver is mainly a reversible process, but due to the severe course of the disease, it is possible to degenerate into such forms as hyaline-droplet or gyroscopic dystrophy, as well as necrosis.

Protein dystrophy of the liver

Protein dystrophy of the liver arises as a result of disturbances in 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 amyloid protein substance is deposited in the tissues.

Hyalinosis is a kind of protein dystrophy, which often takes place as a concomitant disease against the background of atherosclerosis. This pathology differs mainly local localization, in particular, it can appear in the vessel wall during the formation of a thrombus. Hyalineosis is peculiar to form translucent protein structures like cartilage hyaline tissue.

Protein dystrophy of the liver also takes the form of granular dystrophy, which means the formation of droplet and grain-shaped protein formations in the cell protoplasm. Uniting in a single whole these formations tend to completely fill the entire internal cellular space. With granular dystrophy of the liver, protein cellular structures become denser, and the normal functioning of cells is disrupted. Grainy dystrophy is fraught with the appearance of pathological changes necrotic character and leads to cell death.

Hydropic dystrophy of the liver

Hydropic dystrophy of the liver, also known as waterborne dystrophy, has the feature that the cell contains vacuoles that contain cytoplasmic fluid. In the presence of this type of hepatic dystrophy parenchyma cells differ in larger sizes, the nucleus in them acquires a peripheral localization, in some cases its wrinkling or vacuolization is observed.

With the development of pathological changes, the cell is overflowed with liquid and its ultrastructures decompose. The cells become like a water-filled container, and in fact they represent one continuous vacuole with a nucleus in the form of a bubble. A similar phenomenon, which is a symptom characterized by colliquated necrosis, is called - balloon dystrophy.

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

The prognosis in the presence of this disease is unfavorable because hydrophilic liver dystrophy significantly affects the functioning of this organ. A negative prognostic factor is also the fact that the outcome of this disease is focal or total necrosis of cells.

Yellow dystrophy of the liver

Yellow dystrophy of the liver in acute form can occur during pregnancy as one of the associated complications. Its cause is the state of acute intoxication, in which this disease is an aggravating factor in the development of the development of infection in the body.

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

Yellow dystrophy of the liver is one of the most serious in severity of toxicosis of pregnancy. The disease is caused by severe intoxication products of metabolic processes occurring during pregnancy, which differ in other features than in the metabolism that occurs 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 long vomiting. Over time, the condition is aggravated by the fact that the skin and sclera acquire a pronounced icteric appearance, there is a clouding of consciousness, there may be states of delirium and excessive excitation of the nervous system. There is the possibility of multiple subcutaneous hemorrhages, in the urine, the amount of which shows a tendency to a significant reduction, the presence of cytosine and lecithin is detected, and in addition there is a decrease in hepatic dullness. Due to further deterioration in the general condition of the patient, there is a possibility of death after a few days.

Parenchymal dystrophy of the liver

Parenchymal dystrophy of the liver is the basis for the development of the pathological process associated with it, changes in the chemical-physical and morphological characteristics inherent in cellular proteins. The essence of such violations of the functioning of cells is the process of hydration, to which the cytoplasm undergoes as a result of the fact that coagulation, denaturation takes place in the cell, or, on the contrary, the phenomenon of colliquation. In those cases in which there is a violation of protein-lipid bonds, membrane cellular structures are characterized by the appearance in them of destructive processes. The consequences of such changes are the development of necrotic processes of coagulation - dry, or colliquative - wet character.

Parenchymal dystrophy of the liver is classified by its varieties as:

• Hyaline-drop
• Hydropic
• Horny degeneration.

To parenchymal liver dystrophy can also be attributed and granular dystrophy, which is typical of the appearance in cells of the parenchyma of protein grains. This type of hepatic dystrophy is characterized by an increase in the body affected by this ailment, the acquisition of a flabby consistency and a dim outward appearance on the cut. The last mentioned feature causes the fact that granular dystrophy of the liver is also called a dim or turbid swelling.

Diagnosis of liver dystrophy

Diagnosis of liver dystrophy is associated with a number of difficulties arising from the fact that, traditional methods of laboratory research in this case often fail, even though in this liver-damaging disease, the inevitable deterioration in the functioning of this organ becomes evident.

The clinical picture of a dystrophic hepatic pathology, as a rule, differs asymptomatic, therefore the main sign allowing to assume presence in an organism of the given disease is the increase in the sizes of a liver. Since the echogenicity of the hepatic tissue during ultrasound examination does not differ to any significant degree from normal indices, sometimes even with a tendency to increase, this prevents accurate and unequivocal differentiation with cirrhosis or liver fibrosis. Through ultrasound, it becomes possible to identify areas that have increased echogenic characteristics, while low-absorption zones are determined by computer tomography. CT and magnetic resonance imaging are one of the most effective methods for recognizing dystrophic pathology in the liver. They are most effective for determining fatty infiltration of the liver of the focal type.

Diagnosis of liver dystrophy is also in the conduct of a histological examination of biopsy specimens in order to ascertain the presence in this body of excessive amounts of fatty formations.

[26], [27], [28], [29], [30], [31]

Treatment of liver dystrophy

Since the treatment of liver dystrophy is of great importance in this matter, the setting of an exact differential diagnosis and, on the basis of this, the appointment of certain therapeutic measures, in order to exclude hepatitis, which is the most serious stage of this disease, when diagnosed, a liver biopsy is usually administered. To date, unfortunately, so far, there is no such non-invasive technique that with a high degree of accuracy provided an opportunity to diagnose hepatitis, or with great confidence to determine the extent and prescribe appropriate treatment of fatty liver of non-alcoholic origin.

Before sending a patient to a biopsy and prescribing treatment for liver dystrophy, including the treatment of fatty liver dystrophy, the recommendations of medical specialists boil down to the fact that the patient needs, first of all, to change his lifestyle. Since this liver lesion is characterized by increased insulin resistance characteristics, such changes in the patient's life-style include a number of activities aimed primarily at eliminating or minimizing the effect of such a negative factor. Prescribed compliance with a special diet and diet, in conjunction with an increase in the number of physical exertion.

The diet assumes a reduction in the total calorie content of the daily diet, minimizing the consumption of those foods in which fructose is present in a large amount, as well as with a high content of fatty acids.

To improve the absorption of insulin and its more effective action, exercise is useful, which in addition helps to get rid of excessive fat in the internal organs and helps to reduce the negative phenomena caused by fatty liver dystrophy.

Diet in liver dystrophy

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

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

It is prescribed to eat foods that are exclusively boiled or cooked for steaming. Although fried foods are on the list of categorical prohibitions in the dystrophic liver pathology, it is possible to prepare meat and fish dishes in the oven. As for fish, it should be noted that it is recommended to abandon its particularly fatty varieties.

With regard to drinks for the exception of the diet, cocoa and coffee, soft fizzy drinks, fall.

Diet in the case of liver dystrophy - an exemplary list of dishes that are acceptable and recommended for use is given below.

The first dishes can be presented with borsch, soups from cereals, vegetables, and also dairy.

On the second dish you can eat boiled or steamed meat or low-fat fish.

As a side dish, you can use any vegetables, again - boiled or cooked steamed, vegetable salads from boiled onions, cabbage, carrots.

Sometimes you can diversify the diet with ham and cheese of mild varieties, an omelette cooked for a couple or not more than one boiled egg a day.

From porridge - you can cook buckwheat, semolina, oatmeal, and in addition - rice.

In a diet with hepatic dystrophy included condensed and whole milk, yogurt, kefir and cottage cheese with a low degree of fat content.

[32], [33], [34],

Prevention of liver dystrophy

Prevention of liver dystrophy involves a deliberate avoidance of the effects of adverse factors that can lead to the onset of such hepatic pathology. To a large extent reduces the likelihood of the development of this liver disease, the rejection of a number of bad habits. First of all - from nicotine addiction, intemperance in the use of alcoholic beverages, overeating, sedentary lifestyle and spending a long time before the television screen.

Positive preventive factors for maintaining the activity of the whole organism in a high vitality and preventing the occurrence of pathological phenomena in internal organs, in particular in the liver, is a meaningful systematic approach to the establishment of the whole life order, the organization of a proper diet with the presence in the balanced diet of all necessary for the organism useful substances and elements, and with the restriction of over-hot and fried foods, smoked products, and canned products.

Important in such an issue as prevention of liver dystrophy is also control over body weight and maintaining its body mass index within the optimum.

Beneficial to the functioning of the liver is a regular physical load in the form of sports - walking, jogging, swimming, etc. Approximate to the optimal body weight contributes to the exclusion of overexertion of liver functions, as well as the vital activity of the whole organism.

Prognosis of liver dystrophy

The prognosis of liver dystrophy in the event that the disease is not burdened by the presence of all sorts of accompanying complications is favorable. Patients in most cases remain operational.

Dystrophy of the liver with sharply expressed characteristics of the pathological process leads to a decrease in resistance to infections that enter the body, can cause worse tolerability of anesthesia and surgical interventions, and contribute to a longer period of postoperative recovery.

With persisting trends in the effects of factors that lead to hepatotoxicity: metabolic or hyperlideal metabolic disorders, there is a possibility of further aggravation of inflammation, leading to the development of micronodular liver cirrhosis and NASH.

The prognosis of liver dystrophy with the application of dietary restrictions and the rejection of bad habits in the application to patients with fatty liver hepatic dystrophy differed in the tendency to maintain their ability to work and a satisfactory state of the body. Nevertheless, the time about such a time from these observed patients complained of a significant decline in strength and vitality, especially during periods associated with prolonged work requiring considerable stress.

A negative prognostic factor was the fact that in some patients there was a degeneration of the disease into cirrhosis of the liver.