- What happens in the hepatic parenchyma?
- Classification of
- Gravity severity
- Causes of
- Mechanisms for the development of non-alcoholic hepatosis
- Symptoms of steatohepatosis
- What is needed for diagnosis?
- How is the treatment performed?
- Related Videos
The name of the pathological condition of the liver "fatty hepatosis" requires decoding for people far from medicine. Hepatoses - a whole group of diseases with a violation of metabolic processes in hepatocytes. They are not accompanied by inflammation, transformation into malignant growth, but destroy the structure of the organ, the structure of cells and intercellular substance. This leads to suppression of the functions of the hepatic tissue.
One of the varieties of hepatosis - the accumulation of fat in cells - is called "steatosis", "fatty liver disease", "steatohepatosis", "fatty degeneration, infiltration."All synonyms of fatty hepatosis reflect metabolic diseases of the liver. It is very important to note that the initial stages of this process are reversible. Timely detection can cure fatty liver hepatosis.
The fatty form of hepatosis is considered the most common. In different countries it affects from 10% to 25% of the population. Of these, up to 95% are chronic alcoholics, 75-90% of patients with severe obesity( body mass index 30 or more,), diabetes mellitus.
When examining punctate liver fatty degeneration is detected in ¼ cases of
What happens in the hepatic parenchyma?
Changes in the liver occur gradually. Cells accumulate fatty inclusions, the amount of fat becomes excessive and destroys the cell membrane. Most scientists believe that all changes occur simultaneously in the entire body( diffuse process).Some hepatologists distinguish a particularly dangerous zone for the deposition of fat - the portal portal outlet area, insist that it is here in the liver that focal dystrophy of the focal type is possible.
The stages distinguish:
- I( initial) with a minimum number of droplets of fat in the cells, when there is no damage to hepatocytes;
- II( moderate damage) - irreversible processes start, accumulations of fatty inclusions destroy cell membranes, pass into the intercellular space. Due to the limitations, cystic cavities filled with fat are formed.
- III( pre-cirrhotic) - the destroyed parenchyma is replaced with scar tissue: first reversible fibrosis, then progressive cirrhosis.
By origin, steatosis is divided into alcoholic - occurs in individuals with chronic alcoholism, non-alcoholic( synonymous with "non-alcoholic fatty disease") - is formed with various diseases affecting the metabolism of fats, malnutrition, lifestyle. It is also distinguished:
- primary metabolic disorder, inherited by the child, under the influence of a mother's pathological pregnancy;
- is secondary, formed over a lifetime.
Depending on the prevalence of the obesity process, the types of lesions are distinguished:
- disseminated focal - in the parenchyma small parts of adipose tissue scattered in different lobules accumulate, usually clinical signs of fatty liver hepatosis are absent;
- disseminated expressed - the mass of fatty inclusions grows, affects the entire organ, manifestations appear in the form of symptoms;
- zonal - a rare lesion in certain departments;
- diffuse - immediately the changes increase not in a single cell, but completely in the hepatic lobe.
Cytological and histological studies of liver biopsy have allowed scientists to isolate the picture of fatty liver dystrophy in the form of deposits: small droplets - small fat lumps do not destroy hepatocytes, large droplets cause damage to cell membranes, this structure violation inevitably leads to necrosis( cell death).
Body is enlarged( hepatomegaly), surface inspection changes the color from burgundy to yellowish
Degrees of severity
The degree of liver damage can be judged by a morphological study of parenchyma tissue, a radionuclide technique for the absorption of isotopes only by healthy cells.0 - separate focal accumulations of fat are detected, I - foci increase, merge, with microscopy, up to 33% of hepatocytes are detected with inclusions in the field of vision.
II - from 33 to 66% of the cellular composition is affected, both small-drop and large-droplet intracellular steatosis is observed. III - obesity goes beyond the cells, cysts with cavities, different types of destruction( dystrophic, necrosis, fibrosis) are subjected to more than 66% of hepatocytes.
Causes can be divided into exogenous( external) and endogenous( internal).Exogenous to the body are the intake of toxic substances for the liver. The process proceeds according to the type of acute or chronic poisoning. Acute fat degeneration is observed by physicians when exposed to:
- arsenic salts;
- fluoride compounds;
- once taken significant doses of alcohol or surrogate;
- toxins of poisonous mushrooms.
The chronic course arises from the uncontrolled intake of certain medications, domestic alcoholism and alcoholism, constant malnutrition( lack of protein, vitamins), professional poisoning with carbon tetrachloride, organophosphorus compounds.
Addiction in women occurs faster
Endogenous causes are formed inside the body of a sick person suffering from thyroid gland pathology, Itenko-Cushing syndrome, diabetes, endocrine obesity. In such cases, the symptoms of fatty liver hepatosis are signs of complication, severe course of the underlying disease, are regarded as secondary.
Treatment entirely depends on the ability to achieve compensation of the metabolic syndrome, eliminating the main striking factor. The causes of fatty hepatosis are usually divided into alcoholic and non-alcoholic. Under the influence of alcohol, the metabolism inside the hepatocytes changes. Lack of oxygen leads to a decrease in the processes of fission of fats, proteins are not synthesized, the coenzymes( vitamins) necessary for biochemical reactions are lost, the possibility of obtaining energy disappears.
Non-alcoholic fatty liver dystrophy accounts for 9% of all cases of steatosis. It is caused by:
- malnutrition( preferential use of fatty foods and sweets);
- heredity( hepatocytes do not cope with the load);
- is a sedentary lifestyle;
- transferred infectious diseases;
- depletion in hungry diets or in the absence of proper nutrition;
- complications of stomach surgery for the treatment of obesity;
- chronic diseases that change the metabolism and lead to abrupt abnormalities.
More often, the "culprits" of steatosis in the liver are several causes at once. Uniting, they cause the accumulation of triglycerides by weight exceeding 10% of the body weight. In women, changes occur much faster and more often. Diffuse distribution of fatty inclusions begins when the fat mass reaches 25% of the total weight of the liver.
Mechanisms for the development of non-alcoholic hepatosis
To decide how to treat fatty liver hepatosis, it is necessary to interfere with metabolic processes with confidence, without new attacks on other organs and systems. To do this, you need to know what mechanisms cause the accumulation of fat to such an extent that they affect hepatocytes.
Under the influence of
nutrition Hepatosteatosis develops when a significant amount of fats and carbohydrates enters with food, and the liver does not cope with processing, excretion. This process contributes to the lack of vitamins, which are indispensable enzymes in biochemical reactions. Therefore, to the accumulation of fats are equally inclined as people who eat abundantly fatty foods, and starving vegetarians.
With drug-induced hepatosis
The liver is the main organ that assists in the assimilation and manifestation of the expected medicinal action of medications. In hepatocytes, biotransformation processes occur in substances more accessible to the body, detoxication of toxic constituents.
The drug is considered to be the best, but the dose can not be increased.
The most dangerous effects on liver cells:
- hormonal drugs( corticosteroids, contraceptives);
- antitumor drugs( cytostatics that suppress the process of dividing cancer cells);
- analgesic and antipyretic non-steroidal anti-inflammatory drugs.
They have a direct toxic effect on the liver. How much will be expressed the reaction of the liver in advance is difficult to predict. Therefore, doctors are guided by a strictly optimal dosage and limited course of appointment. Usually recommend after treatment measures to support the liver.
In diseases of the digestive system and operations
The main toxic effect on the liver is the slag that accumulates in the blood. Products of tissue decay, undigested substances, entering the parenchyma require urgent processing and overload the organ. This mechanism is typical for the effects of toxins and poisons.
In case of injuries, parasitic invasions of
In response to a bruise in the liver, the parenchyma structure is broken, cystic cavities are formed, the number of working cells is reduced. The ingestion of parasites into the hepatic blood flow forms abscesses, inflammation around the cysts, destroys the hepatocytes.
Genetically determined fermentopathies cause the inability of liver cells to process fat. Anomalies of blood vessels, bile ducts hamper the nutrition of hepatocytes, in the conditions of hypoxia, metabolic processes decrease.
Signs of steatohepatosis
Symptoms of fatty liver dystrophy may not occur for a long time. Clinical signs are divided into the expected stages of the process. At the beginning of the disease - no complaints. In the second stage, the patient feels unpleasant pressure in the hypochondrium to the right, general malaise, weakness.
It should be noted that in the hepatic tissue there are no painful receptors( endings of the nerves through which the signals go), they are located in the capsule. Therefore, pain occurs when stretching and increasing the organ. In the first stage this does not happen, but with the second the volume of the parenchyma increases and dull constant pain begins. Painful palpation in the hypochondrium right.
There are signs of fatty hepatosis, which are a consequence of digestive disorders, lack of bile acids, coenzymes, protein( lack of appetite, nausea, aversion to food smell, weight loss, vomiting).This increases the salivation. The drop in immunity is indicated by frequent colds, the attachment of a viral infection.
In the third stage - the changes are more pronounced. The pigmental exchange suffers, therefore the skin and mucous membranes take a yellowish shade, the urine becomes darker, the feces become lighter. The ingestion of bilirubin and bile acids causes severe itching. Due to the fragility of the walls of the vessels and the reduction of coagulation, a rash appears in the patient's body in the form of hives or spotted.
Confirmed violations of the metabolism of fats are xanthomas( small adipose tissue on the skin of the face, chest, hands), xanthelasma( flat-shaped adipose tissue, located on the eyelids), in the outer shell of the eyes, a "lipoidal arc"( deposition of fatty inclusions in the cornea).
In pregnant women, hepatosis is rarely detected, not earlier than the third trimester, it is believed that it is provoked by hormonal changes and is transmitted by inheritance, on the maternal line
What is needed for diagnosis?
The diagnosis depends to a large extent on the information received from the patient about the spread of violations among relatives, propensity to alcoholism, the nature of nutrition and professional activities. Inspection allows you to identify skin changes, color sclera, enlargement of the liver. We weigh and measure the volume at the abdominal level. According to these indices, the ratio of the patient's body weight to the norm by age and height is calculated.
The blood tests reveal:
- anemia and inflammation( decrease in hemoglobin, erythrocytes, leukocytosis and acceleration of ESR);
- biochemical changes in liver function( a decrease in the level of alanine and aspartic transaminases, high cholesterol, triglycerides, low-density lipoproteins);
- impaired pigmentation - growth of indirect bilirubin;
- decrease in protein content due to albumins and the growth of glucose.
With ultrasound of the liver, a lighter body image is detected, the denser the tissue, the more reflected ultrasound waves. You can accurately identify the size, contours of the liver, the presence of internal formations( cysts, abscesses, tumors).Fatty infiltration of the liver is determined by the regeneration of 30% or more of the body weight.
Computer and magnetic resonance tomography allows you to more accurately structure the identified formations, foci, and differential diagnosis. Elastography provides an opportunity to identify the initial manifestations of fibrosis. A special sensor makes the doctor pressure on the liver area, and he records the elasticity of the tissue. With fibrosis and cirrhosis, it falls significantly.
To determine the stage of fatty hepatosis and the degree of lesion of the parenchyma, it is possible only by biopsy of the material obtained by puncturing the liver. The procedure is carried out in specialized clinics under the supervision of ultrasound. The patient is under observation for at least four hours with a cold warmer on the right hypochondrium. A detailed morphological analysis of the tissue is done by laboratory technologists. They determine the percentage of changes with respect to healthy cells.
Inhomogeneity of reflection of waves indicates the presence of sites with different tissue densities
How is the treatment performed?
Treatment of fatty liver hepatosis includes a set of measures. The doctor's recommendations necessarily concern the correct diet and diet. The patient should remember that at the stage of fibrosis, you can restore most of the parenchyma of the organ. Motor activity helps change the metabolism, divert some of the incoming substances into physical work, reduce weight.
The diet is chosen taking into account weight, age, concomitant diseases. Its task is maximum shaking of the hepatic parenchyma while providing the body with all the necessary substances. The most popular special diet is table 5 according to Pevsner's classification. On the background of obesity, a table is prescribed. 8. Reducing the body weight significantly reduces the risk factors for the further development of hepatosis in hypertension, diabetes mellitus.
- The patient's diet provides for a certain balance of the basic substances( proteins in the daily ration should be 110-130 g, carbohydrates are reduced to 200-300 g), in spite of the disturbed metabolism 80 g of fats( 30 of them% of the composition should be plant);
- it is necessary to drink water 1,5-2 l;
- is limited to salt( up to 6-8 g), sugar( not more than 30 g);
- the frequency of food consumption is adjusted to 6-7 times a day, servings should be kept small( 250 g), supper 3 hours before bedtime, monitor overeating and long breaks;
- should exclude the preparation of dishes roasting, use only boiled, steamed, baked dishes or stews.
Prohibited foods and beverages that cause increased bile secretion, irritation of the gastric mucosa:
- spicy seasonings;
- fatty meat and fish;
- carbonated beverages;
- yeast dough, fresh pastry;
- tea, a drink with chicory, coffee and cocoa.
From alcoholic drinks it is necessary to refuse
In a feed the basic place is given to vegetable dishes, fruit, unsweetened juices, berries, steam products from low-fat meat, cottage cheese, fish, sour-milk products.
Treatment with medicines
There is no specific treatment for fatty hepatosis. The doctor selects drugs for long-term use, not containing toxic substances. Treatment of fatty liver dystrophy is not without medicines with hepatoprotective properties( derivatives of ursodeoxycholic acid, phospholipids, amino acids and others).
It should be remembered that a lot of proposals and advertising far from the true proven effectiveness of these drugs. Advise the right tool can only a specialist with experience of use. Statins can normalize fat metabolism, but are not suitable for long-term use. According to recent studies, they are associated with the manifestation of aggressive behavior in patients, especially sensitive women.
Antioxidants and vitamins are necessary as constituents of biochemical reactions( Mexidol, A, C, E).Improve nutrition of hepatocytes. If necessary, tablets are prescribed to reduce weight, increase bile secretion, normalize the glucose level. About whether it is possible to cure fatty hepatosis folk remedies read in this article.
In most cases, the cause of hepatosis can not be completely eliminated. The most important is supportive therapy and a constant diet. Continued use of alcohol leads to irreversible cirrhosis of the liver. Medical recommendations help to delay this process.
I'm very fat after second birth. Now I weigh 85 kg. I try to stick to the diet, but the weight does not decrease. I read your article and got scared for the liver. I thought the most important thing in obesity is the stress on the heart, and then there is still no less dangerous problem.
Not fat at all, I drink it. Nothing hurts me. What in vain for doctors to walk!
Youth! Take care of the liver while there is hope. My husband can not help. We suffer with ascites and cirrhosis.