Etiology
1.Obesity fatty liver
The degree of fat accumulation in the liver is proportional to the weight. 30% to 50% of obesity combined with fatty liver, the rate of fatty liver lesions in heavy obesity is as high as 61% to 94%. After the obese person’s weight is controlled, his fat infiltration is also reduced or disappeared.
2.Alcoholic fatty liver
Long-term alcoholics liver puncture biopsy, 75% to 95% have fat infiltration. There are also observations that the incidence of alcoholic fatty liver increases 5 to 25 times when drinking more than 80 to 160 grams of alcohol per day.
3.Fast weight loss fatty liver
Fasting, excessive dieting or other rapid weight loss measures can cause a large increase in lipolysis in the short term, consuming glutathione (GSH) in the liver, causing a large increase in malondialdehyde and lipid peroxides in the liver, damaging liver cells and leading to fatty liver.
4.Malnutrition fatty liver
Malnutrition leading to protein deficiency is an important cause of fatty liver, mostly due to insufficient food intake or digestive disorders, which cannot synthesize apolipoproteins, resulting in the accumulation of triglycerides in the liver and the formation of fatty liver.
5.Diabetic fatty liver
About 50% of diabetic patients can occur fatty liver, which is more adult patients. Because 50% to 80% of adult diabetic patients are obese, their plasma insulin levels and plasma fatty acid increases, fatty liver change is related to both the degree of obesity, and eating too much fat or sugar related.
6.Drug fatty liver
Certain drugs or chemical toxins cause fatty liver by inhibiting protein synthesis, such as tetracycline, adrenocorticotropic hormone, puromycin, cyclamate, thujone, and arsenic, lead, silver, mercury, etc. Lipid-lowering drugs can also form fatty liver by interfering with the metabolism of lipoproteins.
7.Gestational fatty liver
The disease is serious and has a poor prognosis, with maternal and infant mortality rates of 80% and 70%, respectively.
8.Fatty liver caused by other diseases
Fatty liver can also occur during infections such as tuberculosis, bacterial pneumonia and sepsis. Patients with viral hepatitis who excessively restrict their activities and consume a high-sugar, high-calorie diet tend to accumulate fat in liver cells; after receiving corticosteroid therapy, fatty liver is more likely to occur. Fatty liver improves rapidly after controlling the infection or removing the cause, and there are also so-called extra-gastrointestinal hypertrophic fatty liver, toxic fatty liver, and fatty liver caused by hereditary diseases.
Clinical manifestations
(1) The clinical manifestations of fatty liver are diverse. Only fatigue is present, and most patients with fatty liver are fat. Most patients with fatty liver are found by chance during physical examination. Moderate or severe fatty liver has manifestations similar to chronic hepatitis, which may include loss of appetite, fatigue, nausea, vomiting, and vague pain in the liver area or right upper abdomen.
(2) Mild enlargement of the liver may be painful to touch, with slightly tough texture, blunt edges and smooth surface, and a few patients may have splenomegaly and liver palms. When there is excessive fat deposition in the liver, it can cause severe pain or pressure pain in the right upper abdomen, fever, increased white blood cell count and misdiagnosis as acute abdomen and caesarean operation. In addition, patients with fatty liver also often have changes of peripheral neuritis such as tongue inflammation, stomatitis, skin bruising, numbness in the extremities, and abnormal sensation in the extremities.
(3) A few patients may also have gastrointestinal bleeding, gum bleeding, epistaxis, etc. Patients with severe fatty liver can have peritoneal effusion and lower limb edema, electrolyte disorders such as hyponatremia and hypokalemia, etc. The manifestations of fatty liver are diverse, and in case of diagnostic difficulties, liver biopsy can be done to confirm the diagnosis.
Diagnosis
1, no history of alcohol consumption or alcohol consumption equivalent to 140 grams of ethanol per week for men and 70 grams for women.
2.Exclude viral hepatitis, drug-related liver disease, total parenteral nutrition, hepatomegaly and other specific diseases that can lead to fatty liver.
3.In addition to the clinical manifestations of the primary disease, there are non-specific symptoms and signs such as weakness, dyspepsia, vague pain in the liver area, and hepatosplenomegaly.
4, There may be metabolic syndrome such as overweight/visceral obesity, increased fasting glucose, dyslipidemia, hypertension, etc.
5.Serum aminotransferase and glutamyl transpeptidase levels may be mildly to moderately increased, usually with elevated alanine aminotransferase as the main cause
6.The liver imaging performance meets the imaging diagnostic criteria of diffuse fatty liver
7. Histological changes of liver biopsy meet the pathological diagnostic criteria of fatty liver disease.
Fatty liver can be diagnosed if any of the above items 1 to 5 and 6 or 7 are present.
Complications
Fatty liver can be an independent disease or a complication of certain systemic diseases.
1. It is often complicated by other manifestations of alcoholism
Such as alcohol dependence, pancreatitis, peripheral neuritis, anemic linguitis, alcoholic hepatitis, liver cirrhosis, etc.
2.Overnutrition type fatty liver
Such as: obesity, diabetes, hyperlipidemia, hypertension, coronary atherosclerotic heart disease (referred to as coronary heart disease), gout, gallstone disease, etc.
3.Malnutrition fatty liver often coexists with chronic wasting diseases
Such as tuberculosis, ulcerative colitis, etc.
4.Acute fatty liver in pregnancy
It is often complicated by renal failure, hypoglycemia, pancreatitis, sepsis, diffuse intravascular coagulation (DIC), etc.
5.Patients with severe fatty liver
There can be peritoneal effusion and lower limb edema, and others can have spider nevus, gynecomastia, testicular atrophy, impotence, amenorrhea and infertility in women.
Treatment
1.General treatment
(1) Identify the cause of the disease and take targeted measures. For example, those who drink a lot of alcohol for a long time should stop drinking. Excess nutrition, obese people should strictly control the diet, so that the physical ability to restore normal. Diabetic patients with fatty liver should actively and effectively control blood sugar. Patients with malnutrition fatty liver should increase nutrition appropriately, especially the intake of protein and vitamins. In short, removing the causes of the disease is conducive to curing fatty liver.
(2) Adjust the diet structure Advocate high protein, high vitamin, low sugar and low fat diet. No or less animal fat, sweet food (including sugary drinks). Eat more green vegetables, fruits and fiber-rich foods, as well as lean meat, river fish and soy products with high protein, no snacking and no extra meals before bedtime.
(3) Increase exercise appropriately Promote the consumption of body fat. Walking, sit-ups or fitness equipment exercise are very beneficial.
(4) selenium supplementation Can make the activity of glutathione peroxidase in the liver reach normal level, which plays a good role in nourishing and protecting the liver. liver support tablets made of selenium malt powder and Schisandra as the main raw material have the health care function of immunomodulation, and have auxiliary protective effect on chemical liver injury, and have the effect of nourishing, protecting and protecting the liver.
2.Drug treatment
So far, there is no effective drug for prevention and treatment of fatty liver in western medicine, and long-term conditioning treatment with Chinese medicine is better. Western medicine is often used to protect liver cells, lipid removing drugs and antioxidants, such as vitamins B, C, E, lecithin, ursodeoxycholic acid, silymarin, inosine, coenzyme A, reduced glutathione, taurine, carnitine orotate, hepatocyte, and certain lipid-lowering drugs, etc.
Prevention
1.Rational diet
Three meals a day should be reasonably arranged to achieve a balance of coarse and fine nutrition, and sufficient amount of protein can remove fat in the liver.
2.Appropriate exercise
Adhere to physical exercise every day, depending on their own physique to choose the appropriate sports, such as jogging and playing badminton and other sports. To start with a small amount of exercise gradually and gradually reach the appropriate amount of exercise to strengthen the consumption of body fat.
3, careful use of drugs
Any drugs entering the body have to be detoxified by the liver, in the choice of drugs more carefully, beware of the toxic side effects of drugs, especially for the liver damage drugs should never be used to avoid further aggravation of liver damage.
4.In addition, the mood should be cheerful
Not angry, less irritated, pay attention to the combination of work and rest is also very important.