The patient, male, 33 years old, likes sweet food, has a history of heavy drinking, in recent years, loss of appetite, fatigue, nausea, vomiting, often dry mouth after drinking, bitter mouth, yellow urine and other symptoms, local examination of high blood lipids, repeated medication effect is not good, general condition is good, laboratory tests: hepatitis B antibody positive, AST: 73U/L, ALT: 81U/L, high blood lipids; ultrasound shows: liver shape is large, the peritoneum is less light The ultrasound showed that the liver was large in shape, with a slightly coarse parenchymal light spot, severe fatty liver, gallbladder: 8.1×3.8 wall was not light, spleen was 5.9cm thick, and the diagnosis was alcoholic fatty liver. So what exactly is fatty liver? Ren Hongyu, Department of Gastroenterology, Wuhan Union Medical College Hospital
With the improvement of people’s living standard, excessive intake of foods high in fat and sugar causes excess nutrition, overweight and obesity due to excessive accumulation of fat in the body, which becomes a factor of fatty liver that cannot be ignored, but is not the only cause. The current prevalence of weight loss, excessive hunger can also cause liver metabolic disorders, resulting in a large accumulation of fat in the liver, can also “starve” out fatty liver. Long-term hunger or gastrointestinal tract digestion and absorption disorders, resulting in a lack of protein in the body, a lack of raw materials for the formation of apolipoproteins, triglycerides in the liver accumulation and fatty liver. Excessive alcohol consumption can “drink” fatty liver, a lot of long-term alcohol consumption: ethanol can cause hepatocyte metabolic disorders, so that lipid acid synthesis increases, oxidation decreases, the blood lipid acid content increases. In addition, the drinker’s appetite is reduced, and the intake of choline in food is reduced, which inevitably makes the liver lipoprotein synthesis is blocked, and leads to excess triglycerides difficult to remove, resulting in fatty liver. In addition, certain drugs and chemicals, such as overdose or close contact with tetracycline, arsenic, silver, mercury, trichlorethylene, carbon tetrachloride, yellow phosphorus, barbiturates, aflatoxin, etc., can block the synthesis of apolipoproteins, and triglycerides in the liver cannot be metabolized and excreted, thus causing fatty liver accumulation in the liver. According to statistics, about 50% of diabetic patients can develop fatty liver, and about 25% of fatty liver patients have diabetes. When suffering from inflammatory infections, tuberculosis, bacterial pneumonia and sepsis, the integrity of the hepatocyte membrane is disrupted, resulting in abnormal fat metabolism in the liver or hepatocyte hypoxia and fatty liver. Others: Cushing’s syndrome, hyperthyroidism, anterior pituitary hyperfunction, chronic ulcerative colitis, Crohn’s disease, ulcer disease, chronic hepatitis and pregnancy can affect fat metabolism and lead to fatty liver.
The clinical manifestations of fatty liver are diverse, and mild fatty liver has no clinical symptoms and is easy to be ignored. According to statistics, more than 25% of fatty liver patients can be clinically asymptomatic, and some only have a feeling of fatigue, so at present, fatty liver patients are mostly found by chance during physical examination. Moderately severe fatty liver has similar manifestations to chronic hepatitis, such as loss of appetite, fatigue, nausea, vomiting, weight loss, and vague pain in the liver or upper right abdomen. Mild enlargement of the liver may be painful to the touch, slightly tough, with blunt edges and smooth surface, and a few patients may have splenomegaly and liver palms. When there is too much fat deposition in the liver, it can swell the liver peritoneum and pull the liver ligament, which can cause severe pain or pressure pain in the right upper abdomen. What are the risks of fatty liver?
Fatty liver patients are often accompanied by hyperlipidemia, which increases blood viscosity and can induce or aggravate hypertension, coronary heart disease, which can easily lead to sudden death due to myocardial infarction, and can also lead to encephalopathy fatty liver syndrome, also known as visceral steatosis encephalopathy. The mechanism is still unclear, and the death rate is as high as 70-80%. Severe cases of fatty liver can lead to cirrhosis, liver failure, and liver cancer. The end result of various liver diseases is often cirrhosis, and fatty liver is no exception, with a higher chance of cirrhosis secondary to hepatocellular. Acute gestational fatty liver disease has a high mortality rate. The clinical manifestations are often similar to those of acute severe liver, which can lead to acute liver failure, pancreatitis, renal failure, systemic coagulation abnormalities and rapid death, mostly in pregnant women in their first pregnancy. Fatty liver can induce or aggravate diabetes mellitus. Diabetes mellitus and fatty liver are a pair of difficult brothers and sisters, and having both will make the treatment more difficult and accelerate the development of the disease. Hepatitis B combined with fatty liver accelerates the progression to cirrhosis. The liver is the largest reticuloendothelial cell phagocytic system. Fatty degeneration or necrosis of liver cells reduces the immunity of the liver. The stomach, intestines, liver and gallbladder are all important organs of the digestive system. The body’s intake of the three major nutrients needs to be metabolized by the liver in order to be used by the body. Fatty liver patients with impaired liver function will involve the spleen, gallbladder, stomach and intestines over time, causing damage to the body’s digestive system.
What are the tests for fatty liver?
1. Anthropological indicators: including height, weight, waist circumference, etc. For the assessment of weight loss effect of obese people, waist circumference is more indicative than weight. Standard weight is equal to height (cm) minus 105, obesity = (actual weight – standard weight)/standard weight * 100%, over 20%-25% of the standard weight is called obese, morbid obesity usually means over 75%-100% of the standard weight.
2. Serological examination: including liver function, blood lipid, blood sugar and insulin resistance.
The sensitivity of ultrasound is 67% and the specificity is 77%, if the fatty liver is less than 30%, ultrasound is difficult to detect. MRI is more sensitive than CT for evaluating steatosis in the liver, but is more expensive than CT. Considering the limited diagnostic improvement and the high cost of CT and MRI, ultrasound is still the most commonly used method to diagnose fatty liver.
4. Liver biopsy: Liver biopsy is the gold standard for the diagnosis of fatty liver and can distinguish simple fatty liver from steatohepatitis and can evaluate the degree of liver fibrosis. However, it is an invasive test that can cause patient discomfort, and for this reason, the need for liver biopsy to diagnose fatty liver is currently controversial.
Simple fatty liver is the early stage of the disease and can be completely restored to normal if detected early and treated promptly. Fatty liver is divided into mild, moderate and severe, and mild fatty liver is the best time to treat fatty liver.
1. General treatment
Aerobic exercise, such as jogging, medium to fast walking (115-125 steps/minute), cycling, going up and down the stairs, playing badminton, etc. are more effective for people with fatty liver to lower fat and lose weight and promote fat elimination in the liver. Exercise time is best chosen in the afternoon or evening, the frequency of exercise to 3-5 days a week is more appropriate, the specific should be based on the implementation of the degree of obesity, spare time and other factors to decide. Secondly, adjust the diet structure, improve protein, high vitamin, low sugar, low fat diet. Eat less animal fat, sweets and sweet drinks. Eat more green vegetables, fruits, vitamin-rich food, and high-protein food, etc.
2. Drug treatment
So far, there is no effective drug for prevention and treatment of fatty liver in western medicine. These drugs should be used under the guidance of a doctor and should not be abused.
3. Electrophysiological therapy
This is a new development in domestic treatment in recent years, liver disease treatment instrument using biomechanical pump method for human meridians and acupuncture points, through vibration of the abdominal wall muscles and liver envelope, to enhance the fat metabolism of the liver, promote the transfer of fat in the liver, improve the blood microcirculation of the liver and spleen, and promote the recovery of fatty liver.
Regardless of the etiology of fatty liver, some patients can develop steatohepatitis and liver fibrosis, eventually leading to cirrhosis, therefore, early and effective prevention and treatment of fatty liver is necessary. It is also advisable for patients with severe fatty liver to take scientific medication under the guidance of a doctor.
Liu Zheng, Ren Hongyu, Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology