Fatty liver
Fatty liver, is a lesion caused by excessive accumulation of fat in liver cells due to various reasons. 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.
Classification of fatty liver.
Obese fatty liver
The degree of fat accumulation in the liver is directly proportional to the weight, and the rate of fatty liver sex change is as high as 61%-94% in severe obese people; after the weight of obese people is controlled, their fat infiltration is also reduced or disappeared. The treatment of this type of fatty liver should be based on adjusting the diet, the basic principle is “an appropriate two low”, that is, moderate protein, low sugar and low fat, usually pay attention to light diet, not too full, eat more fresh vegetables and fruits, limit the intake of calories. At the same time, we should strengthen exercise and actively lose weight, as long as the weight is reduced, the fat infiltration in the liver will be obviously improved.
Alcoholic fatty liver
According to the liver puncture biopsy of long-term alcoholics, 75%-95% of them have fatty infiltration. It has also been observed that the incidence of ethanolic fatty liver increases 5-25 times when drinking more than 80-160 grams of alcohol per day. After drinking alcohol, ethanol replaces fatty acids, causing fatty acids to accumulate and ketone bodies to accumulate in the body. This leads to hypoglycemia and sudden death in some patients. The development of this type of fatty liver is more dangerous, but mild alcoholic fatty liver can be reduced to normal transaminase levels after 4-6 weeks of quitting smoking and drinking.
Malnutrition fatty liver
Malnutrition and protein deficiency are important causes of fatty liver, mostly due to inadequate food intake or digestive disorders that prevent the synthesis of apolipoproteins, resulting in the accumulation of triglycerides in the liver and the formation of fatty liver. In patients with severe nutritional deficiency, protein-deficient edema, weight loss, skin pigmentation and fatty liver may be seen, but after a high protein diet, the fat in the liver is quickly reduced; or after amino acid input, the fatty liver is rapidly eliminated as protein synthesis returns to normal.
Diabetic fatty liver
Fatty liver can occur in an average of 50% of diabetic patients, most of whom are adult patients. Because 50%-80% of adult diabetic patients are obese, their plasma insulin levels and plasma fatty acids increase, and fatty liver changes are related to both the degree of obesity and excessive consumption of fat or sugar. These patients on the one hand actively take the etiological treatment, on the other hand require low sugar, low fat, low calorie and high protein diet, the patient fat calorie accounted for less than 25% of the total calorie is appropriate.
Fatty liver in pregnancy
The disease is severe and has a poor prognosis, with maternal and infant mortality rates of 80% and 70%, respectively. The clinical manifestations are severe vomiting, jaundice and abdominal pain, which are difficult to distinguish from fulminant viral hepatitis. The disease can be reversed by timely termination of pregnancy, and a few can be rescued by natural delivery or cesarean section.
Drug-related fatty liver
Certain drugs or chemical toxicants cause fatty liver by inhibiting protein synthesis, chemical drugs, western drugs such as tetracycline, adrenocorticotropic hormone, puromycin, ciclopirox, and arsenic, lead, silver, mercury, etc. Such fatty liver should be discontinued immediately and supplemented with supportive therapy if necessary until the fatty liver recovers.
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 diet high in sugar and calories tend to accumulate fat in liver cells; fatty liver is more likely to occur after receiving corticosteroid therapy. Fatty liver improves rapidly after controlling the infection or removing the cause. There are also so-called extra-gastrointestinal hypertrophic fatty liver, toxic fatty liver, and fatty liver caused by hereditary diseases. Fatty liver is a pathology that does not need to be treated as a separate disease, and is by no means without a cure. When you find out that you have fatty liver, you should go to the hospital as early as possible for serious examination, find out the cause of the disease and treat the cause, most of the fatty liver can be restored to normal.
According to the different physical qualities and different dietary habits that lead to the pathogenesis of fatty liver, fatty liver can generally be divided into obesity, over-eating fatty liver, post-hepatitis fatty liver, alcoholic fatty liver, nutritional deficiency fatty liver, drug fatty liver, diabetic fatty liver, pregnancy fatty liver and unexplained cryptogenic fatty liver.
Fatty liver is divided into mild fatty liver, moderate fatty liver and severe fatty liver according to its severity. Mild fatty liver has become a common problem for modern people. Mild fatty liver is the best time to treat fatty liver.
The so-called high-risk group of fatty liver refers to the group of people who have risk factors for the development of fatty liver and are more likely to develop fatty liver than the general population. The main groups at risk for fatty liver include obese patients, especially visceral fatty obese patients; diabetic patients, especially adult non-insulin-dependent diabetic patients; chronic heavy drinkers; hyperlipidemia, especially those with elevated blood triglycerides; long-term users of liver-damaging drugs; and individuals with a family history of obesity, diabetes and fatty liver. Given the advantages of ultrasound in diagnosing fatty liver, which is economical, rapid and non-invasive, regular ultrasound examination of the liver for people at high risk of fatty liver is the best method for early detection of fatty liver.
Clinical manifestations
The clinical manifestations of fatty liver are diverse. Mild fatty liver is often asymptomatic and easily overlooked. It has been recorded that more than 25% of patients with fatty liver may be clinically asymptomatic. Some of them only have fatigue, and most patients with fatty liver are fat, so it is more difficult to detect mild self-conscious symptoms. As a result, most patients with fatty liver are now found incidentally during physical examinations. Moderately severe fatty liver has similar manifestations to chronic hepatitis, including 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, with a 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, leukocytosis, and easy to be misdiagnosed as acute abdomen and operated by caesarean section. When the fat vesicles rupture, the fat particles enter the blood can also cause brain and lung vascular fat embolism and sudden death. If hepatocellular fat accumulation compresses the hepatic sinusoids or small bile ducts, portal blood flow and bile excretion are blocked, resulting in portal hypertension and bile stasis. Due to acute chemical poisoning, drug poisoning or acute fatty liver in pregnancy, the clinical manifestations mostly show acute or subacute hepatic necrosis, which can be easily confused with severe hepatitis. 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. A small number of patients may also have gastrointestinal bleeding, gum bleeding, and epistaxis. Patients with severe fatty liver can have ascites and lower limb edema, electrolyte disorders such as hyponatremia and hypokalemia, etc. The manifestations of fatty liver are varied, and in case of diagnostic difficulties, liver biopsy can be performed to confirm the diagnosis.
Degree of lesion
According to the degree of histopathological changes in the liver, there are four general categories
I. Simple fatty liver: the lesion of the liver is only fatty degeneration of the hepatocytes. Fatty liver is classified into diffuse fatty liver, focal fatty liver, and diffuse fatty liver with normal liver islets according to the extent of hepatocyte lipidosis.
Second, steatohepatitis: it refers to the inflammation of hepatocytes that occurs on the basis of hepatocellular steatosis. According to statistics, this condition occurs in about 40% of cases with long-term heavy alcohol consumption, while steatohepatitis generally rarely occurs in non-alcoholic fatty liver.
Third, fatty liver fibrosis: refers to the fibrotic changes that have occurred around the liver cells. The degree of fibrosis is related to the persistence of the causative factors and the severity of the fatty liver. Alcoholic liver fibrosis can occur on the basis of simple fatty liver, while non-alcoholic occurs on the basis of steatohepatitis. If liver fibrosis continues to develop, the lesion becomes fatty cirrhosis.
Fourth, fatty cirrhosis: fatty cirrhosis is the result of the gradual development of fatty liver disease to an advanced stage. In recent years, with the increase of alcoholic liver disease and non-alcoholic liver disease, fatty cirrhosis has occupied the second place of the causes of cirrhosis in China (the first place is viral hepatitis and cirrhosis). The incidence of cirrhosis in alcoholic hepatitis is more than 50%, and a small percentage of non-alcoholic fatty liver can also develop into cirrhosis.
How to deal with fatty liver?
Fatty liver is the excessive accumulation of fat in the liver. Once you have a fatty liver, what should you do?
First, 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. 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 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.
Secondly, adjust the diet structure, advocate high protein, high vitamin, low sugar and low fat diet. Do not eat or eat less animal fats and sweets (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.
Also, properly increase exercise to promote body fat consumption. Run every day, at least 6 km per hour to achieve weight loss. Sit-ups or fitness equipment exercise are very beneficial.
Finally, medication-assisted treatment, fatty liver is not terrible, early detection of active treatment, generally can be cured, and does not leave sequelae. It is worth pointing out that the prevention of fatty liver should start with children, especially only children, who are given whatever they want to eat and have little activity, and once they become “fatty dun”, they are afraid of having fatty liver.
Drug treatment
So far, there are no effective drugs for the prevention and treatment of fatty liver in Western medicine. Chinese medicine can be recommended to experienced Chinese doctors. Generally 1-3 months can be cured, ultrasound is the basis for testing the effect. Western medicine is often used to protect liver cells, lipid removing drugs and antioxidants, such as vitamin B, C, E, lecithin, ursodeoxycholic acid, silymarin, inosine, coenzyme A, reduced glutathione, taurine, carnitine orotate, hepatale, and certain lipid-lowering drugs (e.g., hepatic thresholds), etc. Although there are many of these drugs, most of them need further verification of their efficacy and safety, so they should be used properly under the guidance of a doctor and should not be abused. However, in general, if it is only fatty liver and not hepatic encephalopathy, vitamins B, C, E, lecithin, inosine, coenzyme A, reduced glutathione, taurine, carnitine orotate and other vitamins and endogenous amino acids among the above drugs are very safe and do not rebound after stopping the drugs like biphenyldiphenhydramine.
Take lipid-lowering drugs with caution in patients with fatty liver
Not all patients with fatty liver have high blood lipids. Fatty liver is generally divided into two categories, one is alcoholic fatty liver, only a small percentage of these patients may have increased blood lipids. The other category is non-alcoholic fatty liver, which has more complex causes, including obesity, diabetes, hyperlipidemia, drugs and genetic factors, and about 40% of fatty liver with unknown causes. In other words, even among patients with NAFLD, only a fraction of them have elevated blood lipids. Obviously, taking lipid-lowering drugs for fatty liver patients who do not have high blood lipids does not make any sense for the treatment of fatty liver.
Patients with fatty liver should not use lipid-lowering drugs rashly even if they have hyperlipidemia. This is because most lipid-lowering drugs can make the lipids in the blood concentrate in the liver for metabolism, and the liver with fatty liver already has a fat metabolism disorder, so it is more difficult to deal with the sudden arrival of lipids from the blood, and it can only accumulate them in the liver again, which will undoubtedly aggravate the fatty liver. In addition, doctors have observed that long-term abuse of lipid-lowering drugs can lead to portal phlebitis and periportal fibrosis, and can even promote the development of fatty liver to cirrhosis.
In alcoholic fatty liver with or without hyperlipidemia, the best treatment option is to stop drinking, mostly without lipid-lowering drugs. In obesity-induced fatty liver and diabetic fatty liver with hyperlipidemia, if no coronary heart disease exists, the main focus should be on diet control, increasing exercise and treating the primary disease. Patients with simple fatty liver can recover without any medication as long as they carefully abstain from alcohol (including beer), limit their weight and change their poor lifestyle.