Overview.
Nonalcoholic fatty cirrhosis is an advanced stage of nonalcoholic fatty liver disease (NAFLD). With the prevalence of obesity and metabolic syndrome and its non-alcoholic steatohepatitis (NASH), this disease has emerged as an important cause of cirrhosis in Western developed countries. The disease is most common in the elderly population with obesity and metabolic syndrome, and weight loss and medication are the main therapeutic measures.
Causes
The main causes of this disease are obesity, hyperlipidemia, insulin resistance, diabetes mellitus and metabolic syndrome, oxidative stress, lipid peroxidation injury and hepatic microcirculatory disorders.
Symptoms
Patients with this disease do not have a history of long-term alcohol consumption, and often have a history of non-alcoholic steatohepatitis, which is often accompanied by portal hypertension, hepatic hypoplasia and cirrhosis complications, type 2 diabetes mellitus, atherosclerotic cardiovascular and cerebrovascular diseases, and other manifestations. Patients may have symptoms such as discomfort in liver area, emaciation, abdominal distension, fatigue, low urine, yellow urine, diarrhea, etc. Capillary dilatation, spider nevus, dark color, abdominal wall varicose veins, ascites, double lower limb edema can be seen on the face, and in the late stage, it is often combined with hemorrhage, coma, infection, renal failure, which is life-threatening, and even develops into hepatocellular carcinoma and dies.
Examination
1. Laboratory examination
Serum total bilirubin and albumin levels and prothrombin time can reflect the reserve state of liver function. Alpha-fetoprotein test can screen hepatocellular carcinoma.
2. Endoscopy
Screening for esophageal and fundal varices.
3.Imaging examination
Liver ultrasonography, CT, magnetic resonance imaging (MRI) can evaluate the degree of cirrhosis and screen for hepatocellular carcinoma.
4.Histopathologic examination
Diffuse hepatic fibrosis with structural alteration of liver lobules to form pseudolobules, including NASH combined cirrhosis, steatohepatocirrhosis and cryptogenic cirrhosis.
This includes NASH combined cirrhosis, steatosis and cryptogenic cirrhosis.
Diagnosis
1. Patients often have a history of non-alcoholic fatty liver disease or non-alcoholic steatohepatitis.
2. Patients often have portal hypertension, hepatic hypoplasia and other complications of cirrhosis.
3. Laboratory tests show abnormal liver function.
4. Histopathological examination may show diffuse hepatic fibrosis with structural reconstruction of hepatic lobules to form pseudolobules.
Treatment
1. Surgical weight loss
If there is no liver failure, moderate or severe esophageal – fundal varices, severe obesity, drug weight loss is ineffective, upper gastrointestinal weight loss surgery is feasible.
2.Drug treatment
If there is no obvious liver damage, hepatic insufficiency or decompensated cirrhosis, patients can safely use angiotensin II receptor blockers, insulin sensitizers and statins to reduce blood pressure, prevent and control sugar and fat metabolism disorders and arteriosclerosis.
3. Prevention and treatment of complications
According to the clinical needs, relevant measures should be taken to prevent and control the complications of cirrhosis, portal hypertension and liver failure.
4. Liver transplantation
Liver transplantation can be considered for patients with non-alcoholic steatohepatitis combined with liver failure, decompensated cirrhosis and non-alcoholic fatty liver disease complicated with hepatocellular carcinoma. Metabolic risk factors and their comorbidities should be comprehensively evaluated before liver transplantation, and the treatment of metabolic syndrome still needs to be strengthened after surgery in order to minimize the recurrence of NAFLD and improve the survival rate of patients.
Prognosis
The disease has a poor prognosis and is susceptible to death from liver failure, hepatocellular carcinoma and complications related to portal hypertension. Malignant tumors and cardiovascular and cerebral vascular diseases are also important factors leading to disability and death.