Steatohepatitis

Steatogepatitis is a transitional phase of the disease from steatosis to cirrhosis. This pathology affects the cells of the hepatic tissue, expressing an inflammatory process that develops on the basis of fatty dystrophy. The only good news is that this process still has a reversible character (in contrast to cirrhosis of the liver).

ICD-10 code

Since the code for ICD-10 (International Classification of Diseases) does not have a single designation, today the most common encoding is K76.0 - fatty liver degeneration, not classified elsewhere.

Causes of steatohepatitis

To effectively cope with the problem, it is necessary to have an idea of both the disease itself and the sources that generate it.

This pathology is an inflammation in the liver tissues that occurs against the background of the degeneration of the liver fat cells. Physicians divide into several types, which cause various pathologies. Causes of steatohepatitis.

1. Alcoholic genesis. Almost every third person who abuses alcoholic beverages can observe the development of this deviation.
2. Metabolic genesis - pathology based on disturbances in metabolic processes.
   1. Excessively large body weight.
   2. Deficiency of protein.
   3. Deficiency of insulin in the body, causing diabetes.
   4. Rapid weight loss.
   5. The hunger strike.
   6. Failure in lipid (fat) metabolism - dyslipidemia.
   7. Complete replacement of the patient's natural nutrition by parenteral food intake (bypassing the digestive organs). Primarily this is an intravenous route.
   8. Continuous and repeated administration of glucose into the vein.
3. Medicinal trace of the disease. A number of drugs can cause poisoning with chemical compounds (intoxication), as well as fatty infiltration, which is due to increased accumulation of lipid constituents in the liver cells. Such consequences can be observed after taking some medicines:
   1. Cytostatics that block the cell's ability to divide.
   2. Glucocorticoids, directly affecting the human hormonal background.
   3. A number of antibiotic drugs.
   4. Non-steroidal anti-inflammatory drugs (NSAIDs) used as analgesics, anti-inflammatory and antipyretic agents.
4. Provoke this deviation is also capable of surgical intervention, performed on the organs of the gastrointestinal tract, especially in the case of partial removal of the small intestine.
5. The reason for degeneration is diverticulosis, a deviation resulting from the formation of a sacciform appearance of the wall of the small intestine. At the same time there is an increased increase in the intestine of a colony of pathogenic microorganisms.
6. Wilson-Konovalov's pathology, associated with a change in the normal exchange of copper.
7. And a number of other factors. All sources of modern medicine are not yet known for certain.

[1], [2], [3], [4], [5], [6]

Symptoms of steatohepatitis

The symptomatology of alcoholic or non-alcoholic steatohepatitis is almost identical. Developing against the background of prolonged use of alcohol, which leads to malfunctions in metabolic processes (including lipid), the changes considered primarily affect the liver. After all, it is the "customs" of the body and, ingesting ethyl alcohol is being neutralized here. With a regular attack of alcohol, the body stops coping with the cleaning of the body, and begins to receive damage and its cells. They stop working, and fat gradually accumulates on the surface. Little by little, the cummulation process leads to an inflammatory process and if it is not treated, further progression can lead to a more severe disease - cirrhosis. This is an irreversible process, in which there is a degeneration of parenchymal hepatic tissue by fibrous connective structures, or stroma.

Similarly, the development of a non-alcoholic form also occurs, but only the catalyst of the problem changes.

The main symptoms of steatohepatitis:

• In the area of the location of the liver (under the right hypochondrium) begins to feel painful.
• There is a general weakness.
• Nausea.
• There is a loss of body weight.
• There may be signs of diarrhea.
• The skin becomes yellowish.
• But one of the main indicators of the pathology, both in the alcoholic and non-alcoholic traces of the disease is an increase in the size of the liver, which is easily determined even with palpation. When pressing on the diseased organ, the patient feels an increase in pain symptoms.

Non-alcoholic steatohepatitis

The name of the type of pathology speaks for itself - nonalcoholic steatohepatitis, that is, the source of non-alcoholic drinks became the catalyst for deviation from the norm. He has another term - metabolic.

This type of disease is most often found in the fair sex, endowed with lush forms. Exactly excessive kilograms (obesity) and provoke its origin and progression. And as to provoke the disease is hereditary predisposition.

The reason can also be organic: the patient has a history of hypothyroidism, a violation of protein metabolism (it may be the result of improper "sitting" on various diets or overt fasting), diabetes mellitus. The source can be the patient's love for fatty foods.

The essence of the pathological mechanism is a violation of the metabolic response to endogenous or exogenous insulin (insulin resistance). This disease carries the danger not only of a high risk of developing cirrhosis, but also an increase in the likelihood of abnormalities in the work of the cardiovascular system, since the failure of lipid metabolism provokes accelerated progression of atherosclerosis.

Mostly a person with a fatty liver disease of non-alcoholic genesis, with chronic course, may not even know about his problem. In this case, the clinical picture is little pronounced and does not give a person special discomfort. In this situation, it can be recognized only with a preventive examination.

The situation is much more complicated when diagnosing inflammation of the liver structures with small vesicular lipid inclusions. This pathology can cause low blood pressure, pre-syncope and syncope, the appearance of internal bleeding or the development of cholelithiasis.

Alcoholic steatohepatitis

A pathology of this type is usually diagnosed in every third person who has a special predilection for the "green snake". In this case, it does not fundamentally drink strong drinks or low-alcohol beer.

Ethyl alcohol is split almost completely in the liver. But if there is a surplus of alcohol, the hepatic cells are not able to process it qualitatively. There is a malfunction, their cellular structure begins to deteriorate, pain symptoms appear. A person feels a loss in weight, jaundice of the skin appears, there is less frequent belching, loosening of the stool, heartburn.

At laboratory researches alcoholic steatohepatitis is shown by growth of quantity of hepatic tests, reduction of a level of a hemoglobin and development of a leukocytosis is observed.

Primarily, treatment of this type of disease involves refusal of alcohol, and then the patient is offered both medicamental treatment and dietary nutrition.

[7], [8], [9], [10], [11], [12], [13],

Fat steatohepatitis

This pathology, in addition to the above, has a number of other names: fatty liver or fatty liver, caused by degeneration or dystrophy of cellular structures. After the appearance in the sixties of the last century of biopsy, this pathology was isolated into a separate disease.

The main characteristic of the pathology under consideration is the appearance of lipid deposits in the cell or intercellular zone. The parameter of morphological character is the presence of triglycerides in the organ under consideration more than one tenth of the dry mass. Physicians, this pathology is divided into certain stages of progression: 1.

Increased lipid content of the hepatic cells. At the same time, the structure of the hepatocytes and their work remained intact, the mesenchymal (stromal-vascular) reaction of the cells was not observed. 2.

There is an increased lipid content of hepatocytes, the first signs of cellular necrosis appear, there is a mesenchymal (stromal-vascular) reaction of the cells. 3.

Pre-cirrhotic stage of development. There is an irreversible reconstruction of the lobular structure of the organ.

[14], [15], [16], [17], [18], [19], [20], [21]

Chronic steatohepatitis

The chronic character of steatohepatitis develops on the basis of a constant alcohol intoxication of the body and affects between 20 and 30% of people who suffer from alcohol dependence.

Almost completely, by oxidation with special enzymes, ethyl alcohol is metabolized in the hepatic tissues. Excessive alcohol load on the body causes a malfunction in the body, resulting in a slow inflammatory process, which leads to a deviation from the normal operation of a number of liver functions.

Such a patient begins to complain of pain in the right hypochondrium, yellowing of the skin and dyspeptic disorders.

If you do not make timely treatment, the chronic stage of the disease sooner or later, its progression can develop into cirrhosis, which no longer allows you to restore the original integrity and functionality of the liver.

[22], [23], [24], [25]

Steatohepatitis of minimal activity

Against the backdrop of universal automation, modern people are increasingly beginning to suffer from inactivity, which is developing against the backdrop of a sedentary lifestyle: from the floor to the floor on an elevator, a trip to work in transport. Many of our compatriots imagine their vacation only as a time lying on the couch in front of the TV. This approach to life can not but affect the state of the whole organism and the work of internal organs, in particular.

Fat and high-calorie food and an inactive way of life, all this adds up to the appearance of additional kilograms. But the fat cells begin to "settle" not only in the subcutaneous area, but also on the organs themselves. It is the lipid deposits in the cellular and intercellular zone of the kidney tissues that gives impetus to the progression of the pathology in question.

Moderate steatohepatitis

An easy or moderate degree of development of the disease is observed in 10.6% of cases, especially the manifested pathology against the background of progressive steatosis affecting hepatocytes of the periveneular zone and undergoing apoptotic changes.

The ongoing research and monitoring of numerous cases confirms recent medical assumptions about steatohepatitis as a bridge from steatosis to cirrhosis.

At a given degree of the disease, there is practically no pathological symptomatology, which prevents an early diagnosis. At this stage, the disease can be detected only accidentally during a preventive examination, so it should not be ignored.

Steatohepatitis in pregnancy

This pathology in a woman who has her baby, can have a genetic character (that is, a hereditary predisposition to the disease), or develop against a background of another liver disease that the girl may have had before the moment of conception.

A number of medications (vitamin and mineral complexes) can provoke the problem. A number of multivitamins for pregnant women have in their composition such chemical compounds that the female organism in a state of increased stress (which is pregnancy) can not process.

There are cases when, due to their incompetence, the doctor himself prescribes increased doses of drugs to a pregnant woman.

It should not be forgotten that due to many incorrect beliefs, some women and their relatives still believe that a pregnant woman should eat for two at that time, which can not affect the overall weight of the expectant mother. Hence the pathological deposits in the hepatic tissues and, as a result, the development of the disease considered in this article in the pregnant woman.

Diagnosis of steatohepatitis

The complexity of diagnosing the disease under consideration lies in the fact that it, in most cases, has a rather small rate of development, and for the time being does not have a clear clinical picture, without showing itself at all.

Predominantly, the only sign is pain on palpation, and for a specialist it is also an increase in the size of the liver, a compaction of its structure. Therefore, early detection of the disease is possible only during a visit to the doctor during the next preventive examination, or in case of a person's treatment of another problem.

If the patient already has reasons to worry, then it is not necessary to postpone the visit to a specialist.

Diagnosis involves a comprehensive approach to the problem, since such symptoms are inherent not only to one but several diseases:

1. Clarification of the patient's complaints by the specialist:
   • What symptomatology is discomfort.
   • How long ago attacks began.
   • What events preceded the next attack.
2. Studying an anamnesis.
3. What infectious diseases were ill.
4. What medicines were used.
5. Is there a hereditary predisposition.
6. And others.
7. External (physical) examination.
   • Presence of yellowed cornea of the eye and skin. The intensity of the hue.
   • The state of the epidermis is assessed for scratching.
   • Obtain an index of the weight of the patient, allowing to assess the presence of obesity.
8. The palpation of the pathological zone for the increase in the liver and the manifestation of pain symptoms.
   • Tapping and feeling the abdomen to determine the size of the spleen and liver.
   • The degree of soreness of the touch.
9. Due to the fact that alcohol can cause liver changes, the doctor can appoint a special study, the result of which should be the answer to the question of whether or not a person is addicted to alcoholic beverages.
10. Ultrasound examination of the liver. Here, the dimensional parameters of the organ, morphological and organic changes affecting its tissues are estimated.
11. Laboratory analyzes are performed to evaluate the quantitative components of immunoglobulin A, cholesterol, triglycerides, alkaline phosphatase, bilirubin and other parameters. Starting from the degree of deviation from the norm, we can speak about the presence of inflammation of this area.
    • General blood analysis.
    • Blood chemistry.
    • Examination of urine.
12. If necessary, tissue biopsy is performed, allowing to assess the level of pathological changes, and, consequently, the prescription of the inflammatory process.
13. In certain circumstances, a CT scan can be administered.
14. It may be necessary to consult more highly specialized specialists. For example, hepatologist, therapist, surgeon and so on.

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

Treatment of steatohepatitis

Primarily, you need to determine the source of the changes. If the problem is alcohol, the first thing to do is to give up "bad" drinks.

In parallel, it is necessary to exclude the toxic effect on the body, raise the susceptibility to insulin, strengthen the immune forces, stabilize and lead to a normal lipid and other metabolic processes, restore the hepatoprotective abilities of the body.

The attending physician recommends to his patient a constant moderate physical load: walking, swimming, dancing, fitness and so on. If necessary, you should bring your weight back to normal.

With this pathology, the patient must necessarily revise his diet. Usually, the doctor appoints such a patient "Table number 5". Dietary nutrition should now become a habit for a lifetime. When returning to the "old life" (for example, drinking alcohol or illicit food), the disease has the property to return and manifest itself with renewed vigor.

There is also pharmacological therapy. To improve the susceptibility to insulin are appointed biguanides: metfogamma, bagomet, syfor, metformin - acry, glucophage, avandamet and others.

Hypoglycemic drug metformin - acry is prescribed exclusively for each patient, but not more than 3 g daily, divided into several receptions.

To the contraindications of the drug may include the presence in a person's history of diabetic ketoacidosis or diabetic precoma, coma, dysfunction of the heart, liver, respiratory organs and kidneys, acute impairment of cerebral circulation, as well as in case of hypersensitivity to the components of the drug.

To reduce the activity of aminotransferases and protect against the destruction of hepatocytes, the doctor prescribes drugs based on ursocholic acid: ursofalk, ursohol, urdoksa, ursodeoxycholic acid, ursosan. Capsules of ursodeoxycholic acid are taken inside by a daily dosage, which is calculated as 10-15 mg per kilogram of the patient's weight. The drug is swallowed before going to bed, without chewing, with enough water. Contraindications for the purpose of the drug in question are X-ray positive gallstones, increased intolerance to the human body of one or more components of the drug, atrophy of the gallbladder function and inflammation occurring in it and in the bile ducts, pancreatitis, as well as severe hepatic and / or renal dysfunction.

Hepatotropic drugs, normalizes the content of phospholipids: cholenzyme, allochol, tivortin, energyl, atoxyl, polysorb, phosphoglue, lyvolin forte, Essentiale forte, syrin, ribavirin, hepatomax and others.

Essentiale forte is prescribed in the starting dosage for adult patients and adolescents over 12 years, two capsules three times throughout the day. In this case, maintenance therapy involves the introduction of one capsule three times a day. The medicine is used directly during meals, not chewed, together with a small amount of water. The duration of therapy is at least three months. The drug is not prescribed when a hypersensitivity of the organism to its constituents is detected.

Drugs that control the amount of cholesterol in atherosclerosis - statins. It can be: pravastatin, cerivastatin, fluvastatin, atorvastatin, simvastatin, rosuvastatin, lovastatin and others.

Fluvastatin is given a starting amount of 20 mg once a day (in the evening). If necessary, or in the case of not achieving therapeutic efficacy, a doctor can double the dosage.

Contraindicated in the introduction of drugs in the active phase of liver disease, hypersensitivity to the components of the drug or persistent growth of cumulation of serum transaminases of unclear etiology, as well as the period of lactation and pregnancy.

The basis of therapy is diet, but if it does not bring a significant result, the doctor can enter into the protocol of treatment lipotropic drugs that allow to normalize metabolic processes and protect the liver from damage. It's silibinin, karsil, legalon, orgitox, legalon, selgon.

Hepatoprotector karsil is prescribed before eating with a sufficient amount of water. The duration of therapy is about three months.

In the case of mild and moderate liver damage, the drug is administered in a dosage of one to two dragees three times throughout the day, with a heavier lesion, four dragees, corresponding to 420 mg of the drug, three times a day.

Prophylactic dose - two - three pills a day.

Contraindications include increased intolerance of the constituents of the medicine and an acute stage of poisoning of various etiologies.

If necessary, antibiotics are also prescribed, which allow to stop the reproduction and further development of the pathogenic microflora of the intestine.

Often used and cytoprotectors, pharmacological compounds, "putting" protection on the cells of the body. These are sucralfate, misoprostol, venter, sucrrafil, saitotec, alsuukral, sukrama.

Misoprostol is administered orally orally 0.2 grams four times a day, the last one immediately before going to bed. If necessary, the dosage can be changed, but this decision remains with the attending physician.

Contraindications include individual intolerance to the human body of one or more components of the drug, including to other prostaglandins and their analogues.

The standard of medical care for steatohepatitis

What can be said about the activities that should be performed in diagnosing the disease considered in this article. First of all, relatives and friends should support a person both morally and physically.

The first thing that is necessary is to maintain the doctor's prescribed diet - "Table No. 5". Not at all superfluous and even welcome is the fact that the whole family in terms of nutrition will support the sufferer.

Most often, this violation in the work of the liver is of a benign nature, proceeding slowly enough. But there are cases of degeneration into cirrhosis and liver failure. This is not allowed in any case. And the first stage of this path is the stopping of the inflammatory process that is progressing in the body.

In this case, it is necessary not only to establish the source of pathology, but also accompanying diseases that can affect the course of therapy, which consists of three main areas:

• Dietotherapy.
• Drug treatment.
• Moderate physical activity - exercise.

If possible, in parallel with this pathology, it is necessary to stop and a disease that can slow down the effectiveness of the course of treatment, or become a catalyst for its relapse.

• That is the standard of medical care:
• Inspection of the patient.
• Study of his anamnesis.
• Correct statement of the diagnosis and the reasons for its occurrence.
• Complex therapy, which allows to stop as the main problem, so, if possible, and the concomitant pathology.
• Clearly follow recommendations for dietary nutrition.

Diet with steatohepatitis

Modern medicine is difficult to imagine without using the numerous diets developed by specialists to stop a disease. Modern dietotherapy is a fairly tangible lever of influence on the pain zones. With the proper application and connection of various foods, it is possible to significantly improve the patient's body condition, as well as significantly shorten the duration of treatment and restorative therapy.

In the case of our problem, the doctor is assigned "Diet No. 5", the main feature of which is the exclusion from the diet of various smoked products, fried, sharp and fatty dishes. On the contrary, the number of foods rich in vitamins, useful minerals and trace elements should increase.

If the patient suffers from excessive weight, then his daily menu should be calculated in such a way that the body receives a sufficient number of necessary substances, while gradually getting rid of excess kilograms. It is also necessary to ensure that the weight is not lost too quickly - it is also not permissible.

The diet is selected individually, taking into account the severity of the clinical picture, a burdened history and individual characteristics of a person. Therefore, this appointment is a direct prerogative of a qualified specialist.

The daily diet should be hypocaloric and be calculated as 25 mg per kilogram of the patient's weight.

Products allowed to enter the diet:

• Not baked bakery products: cookies, bread on rye or wheat flour.
• Not very cool coffee (preferably with milk) or tea.
• Green tea.
• Sugar.
• Acceptance of a small amount of butter (not more than 50 grams per diem).
• Various vegetable and fruit juices, fresh, compotes, kurshony, fruit drinks.
• Sour cream, hard cheeses and cottage cheese (low fat content).
• Vegetable broths and on their basis soups with vegetables, you can add pasta, various cereals.
• Jam and jams.
• Oil of vegetable origin (not more than 50 g daily).
• Different porridges.
• Milk and dairy products with reduced fat content.
• Sweet fruits and berries, sour fruits should be avoided to reception.
• Meat products from lean pieces: rabbit, chicken, turkey, beef and so on. Poultry meat should be cooked and eaten without skin.
• Herbal teas and tinctures.
• Fresh and cooked vegetables.
• Natural honey.
• Different greens.
• Egg (better one protein) - no more than one per day.
• River fish.

Dishes should be cooked on the basis of boiled products, steamed or baked.

Prohibited foods for inclusion in the diet:

• It is necessary to limit or remove all products from the dough. These are pancakes, cakes, pancakes, fried cakes and so on.
• Steep broths: meat, mushroom, fish.
• Chocolate, cocoa and coffee.
• Heavy root systems for the digestive system: radish and radish.
• Fish fatty varieties.
• Pickled vegetables.
• Animal and culinary fats.
• From greens: spinach, sorrel, onion green.
• Salo and fatty meat.
• Spicy sauces and condiments.
• Mustard and horseradish.
• Sour varieties of fruits and berries.
• Smoked meat.
• Meat and canned fish.
• Creams.
• Strong tea.
• Eggs (especially yolks), cooked hard-boiled or in the form of fried eggs (fried).
• Ice cream, especially on the basis of palm oil.
• Alcohol and carbonated drinks.
• Very cold and too hot food.

[32], [33], [34], [35]

Prevention of steatohepatitis

Nobody will argue that any disease is better to prevent than to fight its consequences. Therefore, in the organization of one's life, it is necessary to perform a number of simple rules and the probability of occurrence and development of the disease under consideration will significantly decrease, tending to zero.

• It is necessary to monitor your weight, it should be close to normal. Obesity badly affects the work of all systems and organs of the human body.
• Do not mindlessly sit down and on various diets: starvation or a sharp loss in weight also does not work.
• Do not get involved in the consumption of alcoholic beverages.
• With special care, take medication, having carefully studied the instructions attached to them.
• You should be very careful about those products that are consumed. If the human diet is close, and when treating the pathology fully correspond to the dietary "Table No. 5", then "provocation" from the side of the diet will not be expected. Especially this restriction applies to oily and improperly processed food.
• It is necessary to undergo timely treatment of diseases such as diabetes mellitus, viral infections, correction of dyslipidemic disorders.
• Regular preventive examination is necessary.

Forecast of steatohepatitis

To predict the consequences of a disease, you can only know his clinic, the severity of the course and the individual characteristics of the organism of the victim. If we are talking about the alcoholic form of the problem under consideration, then, in the presence of large vesicular deposits in the cellular tissues, we can speak of an increase in the probability of degeneration into cirrhosis. While a non-alcoholic process, characterized by a low rate of development, gives a similar result in 15-18% of cases. At the same time this rebirth is stretched in time and can reach up to ten years.

The same result of the forecast depends on the activity of the person in the organization and the maintenance of preventive recommendations.

[36], [37], [38]

Steatohepatitis and the army

The disease under consideration is not the basis for exemption from service in the ranks of the Armed Forces. But modern doctors know that the cause of hepatitis can become not only an infection, but also a violation of metabolic processes in the human body, as in the case of a metabolic disorder, fatty degeneration develops and, as a consequence, steatohepatitis.

Therefore, these two diseases quite often go hand in hand side by side and if there is evidence of a history of a conscript of chronic hepatitis, this is precisely the fact that gives reason to not involve such young people in the Army.

More details on this list can be found in Pozdlone about Viaskovo-Likarska expertise in the Ukrainian Forbidden Forces. Ministry of Defense of Ukraine; Order, Regulation, List [...] on 14.08.2008 № 402 », following the link rada.gov.ua

Life is beautiful and some representatives of human society try to take from it to the maximum: abundant fatty foods, alcohol, even in a shop in a neighboring house - by car. If the rest - then the restaurant and lying on the couch or on the couch on the beach. And then start to wonder - steatohepatitis - what it is and where it came from. There is a well-known proverb: "Take care of your honor from the youth." In the light of the problem discussed in this article, it is necessary to reinterpret: "Take care of your health from the youth". Correct active way of life, healthy diet, balanced combination of physical activity and rest will protect yourself from many health problems. Do not ignore regular check-ups. This will allow, if pathology already exists, to recognize it early on. In this case, the problem will be much easier to repair and without serious consequences.