Fatty degeneration of the liver

Steatosis of the liver - synonyms: fatty hepatosis, fatty liver, fatty infiltration, lipodystrophy is a liver disease characterized by focal or dispersed fat deposition in the liver cells. It is considered a common pathology, often not causing any symptoms. In some cases, it manifests an inflammatory process with the further development of cirrhosis and signs of hepatic insufficiency.

[1], [2], [3], [4], [5], [6], [7], [8], [9],

Causes of fatty liver disease

A small amount of fat cells is present in liver tissue in all healthy people. Their share is approximately 5%. About fatty dystrophy speak in the event that such percent makes more than 10. At the started pathology the quantity of fat can make 50 and more percent.

Because of what is happening? The reasons can be many, and here are some of them.

1. Prolonged liver intoxication:

• due to excessive intake of alcoholic beverages (so-called alcoholic steatosis);
• due to prolonged use of drugs, for example, hormonal drugs, chemotherapy, antibiotics, anti-tuberculosis drugs.

2. Broken Exchange Processes:

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

3. Incorrect food:

• excessive craze for fatty and sweet food, which is a heavy load on the liver;
• a chronic form of the inflammatory process in the pancreas or intestine;
• irregular diet, long strict diets, insufficient intake of protein, vitamin and mineral substances;
• rare and small meals;
• regular overeating.

4. Insufficient intake of oxygen in the tissues of the body, which can occur in pathologies of the respiratory tract or cardiovascular diseases.

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

First, fats can accumulate in the liver with their increased intake into the body:

• because of excess of fats in food;
• because of an excess of carbohydrates in food (carbohydrates stimulate the formation of fatty acids);
• because of an increase in the consumption of glucose in the liver, which causes the body to withdraw fat stores from the depot and store them in the liver tissues;
• as a result of under-oxidation of fats, which can be observed in disorders of metabolism, anemia;
• due to increased production of somatotropin, which happens in cases of pituitary diseases, with craniocerebral trauma, or in patients with diabetes mellitus.

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

• with a deficiency of transport proteins that contribute to the removal of excess fat (in chronic alcoholics, with a lack of protein in the body);
• with a hereditary predisposition to insufficient synthesis of proteins;
• with chronic damage by toxic substances (in alcoholics, drug addicts, in the presence of malignant diseases).

[10], [11], [12], [13], [14]

Symptoms of fatty liver

The problem is that the disease does not detect itself for a long time. For example, in the initial stages, when fat begins to accumulate in the liver tissue, there is no evidence of fatty degeneration.

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

• feeling of weakness;
• sometimes - attacks of nausea;
• feeling of heaviness in the projection of the liver;
• increased gassing;
• the appearance of aversion to fatty foods;
• heaviness in the abdomen;
• soreness in the right hypochondrium for no apparent reason.

In the third stage, which is considered a harbinger of cirrhosis, the process of destruction of the hepatic tissue begins. Instead, it grows connective tissue, which leads to impaired liver function and impaired bile output. In this period, the following symptoms may occur:

• yellowing of the eye sclera;
• yellowing of the skin;
• attacks of not only nausea, but also vomiting;
• the appearance of skin rashes.

In addition, there is a general decrease in immunity, which can trigger the attachment of infectious and catarrhal diseases.

Acute fatty degeneration of the liver of pregnant women

Acute fatty liver dystrophy in pregnant women is one of the most serious complications that can arise during the gestation process. Fortunately, such a disease occurs very rarely.

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

• a state of indomitable vomiting;
• hepatosis with cholestasis;
• gestosis with hepatic-renal syndrome;
• acute form of fatty hepatosis.

The first symptoms of pathology occur even in the period from 30 to 38 weeks of gestation, in rare cases - before. Initially, there is a feeling of weakness, lethargy, with repeated nausea and vomiting, pain in the abdomen. After a while heartburn joins, the area of the esophagus becomes painful, especially when swallowed - this is due to the formation of ulcers on the surface of the esophageal tube.

At the next stage jaundice appears, vomit becomes brown. Often there is an accumulation of fluid in the abdominal cavity, anemia.

The doctor in this situation should orient in time and distinguish the onset of development of acute fatty degeneration from infectious diseases of the digestive system. Accurate diagnosis largely determines the further outcome of the disease, because not only health is at stake, but also the life of the future mother and her child.

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

Forms

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

• Focal disseminated dystrophy of the liver is a pathology in which the fat points are located little by little on different parts of the liver organ. Usually this form is not distinguished by any symptoms.
• The expressed disseminated fatty degeneration of the liver is a form of the disease, when the inclusions of fat are many and located throughout the body. The first signs of the disease may appear.
• Zone dystrophy is a form of dystrophy in which points of fat can be found in certain lobes (zones) of the liver.
• Diffuse fatty degeneration of the liver - a pathology, when there is a uniform fat filling of the entire hepatic lobe. Symptomatic in this form is already quite pronounced.
• Alcoholic fatty degeneration of the liver can take place in a rare special form called the Zieva syndrome. This form is characterized by the following features:
  • the symptoms appear sharply and are pronounced brightly;
  • a blood test indicates an increase in bilirubin (a yellow bile substance formed from erythrocytes);
  • increases the level of cholesterol in the blood;
  • increases the amount of triglycerides (fatty foods that damage small capillaries);
  • the amount of hemoglobin (due to the mass destruction of erythrocytes due to the increasing deficiency of tocopherol, which forms and accumulates in the hepatocytes) decreases noticeably.

Also, depending on the form, they pour out acute and chronic dystrophy.

• In chronic fatty liver dystrophy, the smallest droplets of fat accumulate in the cytoplasm of liver cells, which gradually combine into larger droplets, or into a large vacuole that fills the cytoplasm completely and displaces the nucleus to the cellular margin. When most of the hepatic tissue is damaged, a diagnosis of "fatty hepatosis" is established. This condition is characterized by the fact that the liver cells, filled with a large amount of fat, burst with the formation of fatty cysts.
• Acute fatty degeneration of the liver is marked by rapid development, rapidly growing symptoms, often turning into cirrhosis or other complex hepatic pathologies. Such a disease is usually due to severe hepatitis, deep intoxication of the body (eg, poisoning with fungi or chloroform), alcoholism. Symptoms of acute form are always pronounced: an increase in liver size, large temperature fluctuations in one direction or another, convulsive and delusional conditions, bleeding. The condition of patients is usually severe and requires immediate specialized medical attention.

[19], [20], [21], [22], [23], [24], [25]

Diagnosis of fatty liver disease

• Collection of complaints, questioning the patient about the symptoms of the disease.
• Interrogation of the patient about his way of life, about the presence of bad habits, about other concomitant diseases.
• Examination of the patient, palpation of the stomach and liver region, tapping the area of the liver and spleen.

Conducting laboratory studies:

• general blood test (erythrocytopenia, hemoglobinemia, thrombocytopenia, anemia, leukocytosis);
• biochemistry of blood (evaluation of the functional capacity of the pancreas, gallbladder);
• analysis of the consequences of alcoholism (level of immunoglobulins, measurement of the mean erythrocyte volume, transferrin level, etc.);
• Assessment of the content of markers for viral hepatic pathologies;
• general examination of urine;
• stool analysis.

Conducting instrumental diagnostic procedures:

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

Additional consultations of specialists of a narrow medical profile - this can be a gastroenterologist, a narcologist, a surgeon, etc.

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

Treatment of fatty liver disease

Special treatment regimen as such with fatty liver is not present. Therapeutic measures provide for the exclusion of provoking factors and stabilization of metabolic processes, restoration of liver tissue and elimination of toxic effects on hepatocytes. In combination with drug treatment, the patient is explained the need to lead a healthy lifestyle and proper nutrition.

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

1. Means consisting of essential phospholipids, for example, a drug based on phosphatidiaethanolcholine, which is able to create protection for liver cells. These medicines include Essentiale, Hepabos, Essley, etc.
2. Means that relate to sulfoamino acids (Heptral, Dibikor, etc.);
3. Means based on plant components (Karsil, Liv 52, artichoke extract, etc.).

Heptral is given in the form of injections, in an amount of 400 to 800 mg per day for 14-20 days. Then go to 2-4 tablets a day.

Essentiale is taken 600 mg three times a day. The course should not be less than 2-3 months. After 20-30 days of treatment, the dosage is somewhat reduced, to 300 mg three times a day.

Alpha-lipoic acid (Alpha-lipone) 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 at 600 mg / day.

Artichoke - Hofitol - has a choleretic and hepatoprotective effect, normalizes metabolism. Hofitol appoint 3 tablets three times a day before meals. Duration of therapy - up to 1 month.

Preparation Liv 52 take 1-2 tsp. Twice a day, or in tablet form - 2-3 tablets up to 4 times a day for half an hour before meals.

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

Alternative medicine can successfully use:

• powder and cinnamon sticks - help to reduce the amount of glucose and cholesterol in the blood, prevent the accumulation of fat in the liver;
• Curcuma - a wonderful antioxidant, increases the production of bile, lowers the level of glucose in the blood;
• Milk thistle - eliminates spasms in the gallbladder, removes toxic substances, restores hepatocytes. You can take and pharmacy products with milk thistle - it's a plant oil, or a ready-made drug Gepabene (appoint one capsule three times a day);
• sorrel - helps to remove bile, stabilizes its production. Reduces the fat content in the liver.

Nutrition for fatty liver dystrophy

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, then he is recommended to follow a diet (but not strict) with a weight loss of about 0.5 kg per week. Moderate physical activities are welcome: classes on a stationary bike, swimming, walking.

Diet for fatty liver is not just important - it plays a leading role in the effectiveness of patient treatment. In medical institutions, diet table No. 5 is usually prescribed, with the use of protein foods up to 120 grams per day, restriction of animal fat, as well as a sufficient number of liver products, cottage cheese, cereals (oatmeal, buckwheat, millet, wild rice). Welcome vegetable food - fruits and vegetables, greens, all kinds of cabbage.

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

We should not forget about the drinking regime: in the absence of contraindications, you should drink at least 2 liters of water per day, mainly in the morning.

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

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

It is also recommended to abandon sweets, white pastries, shop and fatty sauces, margarine, sausages, fatty meats and lard. Try to eat only natural fresh foods, with a minimum of sugar.

Prevention

Prevention of the disease is relatively simple and includes such basic points as the exclusion or restriction of the reception of alcoholic beverages and proper nutrition. Patients at risk for liver disease should be vaccinated against hepatitis.

Regularly it is necessary to undergo preventive examinations, especially if there are suspicious symptoms such as weakness, discomfort in the right hypochondrium, nausea and a decrease in appetite. If a person has noticed signs of jaundice, then immediately visit a doctor. For fatty liver disease it is very important to carry out diagnostics and treatment on time.

Particular attention should be paid to liver health in people at risk:

• people who drink alcohol;
• patients who have had viral infectious diseases of the liver;
• patients with chronic diseases that require constant intake of any medication;
• people working in hazardous enterprises;
• Persons with hereditary predisposition to liver disease;
• people who adhere to strict diets with protein restriction or sitting on "hungry" diets;
• when there are helminths in the body.

Do not ignore the symptoms of liver disease - even if the organ is okay, it is better to check it once more and consult a doctor.

Forecast

The course of the disease is largely dependent on its origin. If there is no inflammatory process and hepatocytes are not damaged, the pathology in most cases is not aggravated. However, if there are signs of hepatitis, then sooner or later dystrophy grows into cirrhosis of the liver. Such complication is most often found in the elderly, with a marked violation of metabolic processes, with obvious obesity, diabetes.

With timely prescribed treatment and the implementation of all the doctor's recommendations, fatty liver disease can be reversible. Over time, the patient will be able to return to the ordinary way of life. But in life-threatening situations or when the prescription of a doctor is ignored (continued use of alcohol, the presence of inaccuracies in the diet, constant intoxication of the body), the life expectancy can be significantly reduced. With the progression of the disease, cirrhosis of the liver develops, a person becomes disabled.

[31], [32]