Fatty liver, is a lesion caused by excessive accumulation of fat in the liver cells due to various reasons. Among them, triglycerides are the main lipids of fatty liver, which is diagnosed clinically when the fatty liver content exceeds 5% of the liver weight. According to the fat content, fatty liver can be divided into three types: light (containing 5% to 10% fat), medium (containing 10% to 25% fat) and heavy (containing 25% to 50% or >30% fat). Fatty liver disease is seriously threatening the health of the nation, becoming the second most common liver disease after viral hepatitis, and has been recognized as a common cause of insidious cirrhosis. Fatty liver is a common clinical phenomenon rather than an independent disease. Its clinical manifestations are asymptomatic in mild cases and aggressive in severe cases. In general, fatty liver is a reversible disease, and early diagnosis and timely treatment can often restore normalcy. Mild fatty liver is the best time to treat fatty liver.
I. 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, heavy obesity fatty liver lesion rate up to 61% to 94%. After the weight of obese people is controlled, their fatty infiltration is also reduced or disappeared.
2. Alcoholic fatty liver
In long-term alcoholics, 75% to 95% of liver puncture biopsies have fatty infiltrates. It has also been observed that the incidence of alcoholic fatty liver increases 5 to 25 times if the daily alcohol consumption exceeds 80 to 160 grams.
3. Rapid weight loss fatty liver
Fasting, excessive dieting or other rapid weight loss measures can cause a large increase in lipolysis in a short period of time, consuming glutathione in the liver and causing a large increase in malondialdehyde and lipid peroxides in the liver, which can damage liver cells and lead 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 in adult patients. Because 50% to 80% of adult diabetic patients are obese, their plasma insulin levels and plasma fatty acid increases, fatty liver changes both with 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 cause fatty liver by interfering with the metabolism of lipoproteins.
7. Fatty liver in pregnancy
Most of them develop at 34 to 40 weeks of gestation in the first child, and the condition is serious with poor prognosis, and the mortality rate of mother and child is 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 overly restrict their activities and consume a diet high in sugar and calories tend to accumulate fat in the liver cells. After controlling the infection or removing the cause, fatty liver improves rapidly. There are also the so-called extra-gastrointestinal hypertrophic fatty liver, toxic fatty liver, fatty liver caused by hereditary diseases, etc.
II. Clinical manifestations
1.Lack of appetite
Loss of appetite is one of the common symptoms of fatty liver. If you lose appetite for a long time, besides suspecting gastritis and other diseases, the possibility of fatty liver should also be considered.
2. Nausea, vomiting, abdominal distension
Mild fatty liver with liver function impairment may be accompanied by discomfort such as nausea and vomiting, aversion to oil, and upper abdominal fullness. The symptoms of nausea often appear alone.
3.Lassitude and fatigue
Moderate fatty liver or above can have the performance of tiredness and easy fatigue.
4.Spider nevus
Spider nevus is a vascular nevus formed by branching dilatation of the end of small skin arteries, which resembles a spider, so it is called spider nevus.
5.Vitamin deficiency
When fatty liver is combined with fat accumulation and vitamin deficiency in the diet, people are prone to multivitamin deficiency. This can be seen clinically as peripheral neuritis, tongue inflammation, stomatitis, skin bruising and hyperkeratosis. A few people may also have gastrointestinal bleeding, gum bleeding, epistaxis, etc.
6.Endocrine disorders
Occasionally, gynecomastia, testicular atrophy, erectile dysfunction, excessive menstruation and amenorrhea in women, and weight loss or gain in patients may be seen in people with severe fatty liver.
7.Jaundice
Jaundice is caused by the impaired metabolism of bilirubin in the body, resulting in an increased concentration of bilirubin in the blood, which penetrates into the tissues and stains the sclera, mucous membranes and skin yellow. The type of jaundice in fatty liver is often hepatocellular, and this type of jaundice is often accompanied by symptoms such as weakness, lethargy and loss of appetite. A small number of patients with fatty liver develop mild jaundice, which subsides after the fat in the liver is removed.
III. 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 in liver biopsy meet the pathological diagnostic criteria of fatty liver disease.
Anyone who has any of the above items 1 to 5 and item 6 or 7 can be diagnosed as fatty liver.
IV. Complications
Fatty liver can be an independent disease or a complication of certain systemic diseases.
1.Often complicated with other manifestations of alcoholism
Such as alcohol dependence, pancreatitis, peripheral neuritis, anemic tongue, 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, and women with amenorrhea and infertility.
V. Treatment
Fatty liver general treatment
1. Find out 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. Those who are over-nourished and obese should strictly control their diet to restore their physical fitness to normal. Diabetic patients with fatty liver should actively and effectively control blood sugar. Patients with malnourished fatty liver should increase nutrition appropriately, especially the intake of protein and vitamins. In short, remove the cause of the disease is conducive to cure fatty liver.
2, adjust the diet structure, advocate high protein, high vitamin, low sugar, low fat diet. Do not eat or eat 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 snacks, and no extra meals before bedtime.
3, the appropriate increase in exercise to promote the consumption of body fat. Run every day, at least 6 kilometers a day to achieve weight loss. Sit-ups or fitness equipment exercise are very beneficial.
4, drug-assisted treatment, fatty liver is not terrible, early detection of active treatment, generally can be cured, and does not leave sequelae.
Fatty liver drug therapy
Chinese medicine to he shou wu and hawthorn is the best, these two drugs can reduce blood lipids, prevent cholesterol deposition in the liver. Our hospital developed Danjuana lipid-regulating soup has a better effect.
Western medicine is often used to protect liver cells, lipid removing drugs and antioxidants, such as vitamin B, C, E, lecithin, ursodeoxycholic acid, reduced glutathione, and certain lipid-lowering drugs, etc. The most popular drug is polydiphosphatidylcholine, which is orally administered under the trade name of Ezinfluenza.
Although there are many drugs mentioned above, most of them need further verification of their efficacy and safety, therefore, they should be used properly under the guidance of a doctor and should not be abused.
Most experts believe that the use of lipid-lowering drugs can aggravate fatty liver, because lipid-lowering drugs mobilize peripheral fat to the liver and then decompose it to achieve the purpose of lowering blood lipids.
Fatty liver exercise therapy
Exercise misconceptions should be corrected: “fatty liver is eaten out, more exercise, less diet, natural will be good”, this truth seems to be understood by everyone. As a result, some misconceptions have emerged. Such as: “I move every day, I do all the housework”; “usually I do not have time, I will go to the fitness center on holidays to exercise a half day”; “I have a lot of work every day, I have enough to consume, no need to make Other exercises” and so on. In fact, the appropriate exercise is based on the patient’s specific situation to develop an exercise treatment plan.
Which exercise programs are suitable?
Exercise programs for patients with fatty liver should be based on low-intensity, prolonged aerobic exercise. Powerful activities characterized by aerobic metabolism are more effective for fatty liver patients in reducing fat and promoting fat loss in the liver. Such as jogging, medium to fast walking (115-125/min), cycling, going up and down stairs, climbing hills, playing badminton, playing shuttlecock, patting pickleball, dancing, radio gymnastics, rope skipping and swimming can make sympathetic nerve excitation, decrease plasma insulin, and increase secretion of catecholamines, glucagon and growth hormone, inhibit triglyceride synthesis and promote lipolysis.
How long should I practice?
The duration of exercise with high intensity should be relatively short, while the duration of exercise with low intensity should be long. The combination of time and intensity should be considered according to the life background and obesity level of fatty liver patients. The amount of exercise is gradually increased and made constant, orderly and moderate, and the prescribed exercise targets must be completed at each exercise.
Take walking as an example, you can gradually increase from 5,000 steps/day to 7,000 to 10,000 steps, and then walk at a fast pace to increase the amount of exercise in stages; you can follow the principle of “3, 5, 7”, that is, 3,000 meters per day (within 30 min), 5 times per week, and the sum of pulse and age after each walk is 170.
Sixth, prevention
Fatty liver is an acquired disease caused by poor lifestyle, and it can be prevented. It is necessary to start from now, from daily life, to develop good habits and to understand some scientific knowledge of self-preservation of liver. “Eat a reasonable diet, control your weight, exercise in moderation, and use drugs with caution.” These sixteen key words to do, not only can reject fatty liver, but also obesity, high blood pressure, high blood sugar and so on.
1.Reasonable meals
Three meals a day should be reasonably arranged, to achieve a balance of coarse and fine nutrition, a 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 selection of drugs more carefully, beware of the toxic side effects of drugs, especially on the liver damage drugs should never be used to avoid further aggravation of liver damage.
Tetracycline, tetracycline fatty liver is mostly seen in pregnant women, 15 days of medication can occur, the death rate is up to 75%;
Long-term application of corticosteroids can cause Cushing’s syndrome with fatty liver;
Antineoplastic drugs such as puromycin and methotrexate can cause hepatic steatosis;
Lipid-lowering drugs, some lipid-lowering drugs, if used improperly, can aggravate fatty liver;
Some herbal and mineral medicines.
Anti-tuberculosis drugs, such as isoniazid.
4.Control weight
Internationally used formula for calculating human weight, and body proportion calculation (more suitable for Oriental people)
Standard weight = (height cm – 100) x 0.9 (kg)
Standard weight (female) = (height cm-100) x 0.9 (kg) – 2.5 (kg)
Normal weight: standard weight ± (how much) 10%.
Overweight: greater than the standard weight 10% less than the standard weight 20%.
Mild obesity: greater than standard weight 20% less than standard weight 30%.
Moderate obesity: greater than the standard weight 30% less than the standard weight 50%.
Severe obesity: more than 50% of the standard weight
5.In addition, the mood should be cheerful
Not angry, less irritated, pay attention to the combination of work and rest is also very important.