The concept of fatty liver disease
Fatty liver disease is the second most common disease after viral hepatitis and is a clinical syndrome dominated by hepatocellular steatosis due to genetic-environmental-metabolic stress and other related factors. Fatty liver disease is a pathological concept that refers to fat content in the liver greater than 5% of the wet weight of the liver, or steatosis of more than 30% of hepatocytes in the microscopic field of view.
Classification of fatty liver disease
According to the history of excessive alcohol consumption or not, there are two categories: alcoholic fatty liver and non-alcoholic fatty liver.
According to the progression of the disease and pathological changes are divided into: simple fatty liver, steatohepatitis, fatty liver fibrosis and liver cirrhosis.
Susceptibility factors of fatty liver disease
1.Overweight or obesity, type II diabetes, abnormal glucose tolerance and hyperlipidemia.
2. Long-term alcohol consumption of more than five years, with ethanol amount ≥ 40 g/day for men and ≥ 20 g/day for women (i.e. 100 ml of 50 degree liquor per day for men and 50 ml of 50 degree liquor per day for women) or a history of heavy alcohol consumption of more than 80 g/day within two weeks (i.e. more than 200 ml of 50 degree liquor per day).
Clinical manifestations of fatty liver disease
In addition to the clinical manifestations of the primary disease, symptoms such as weakness, abdominal distension, vague pain and ache in the liver area may appear, which may be accompanied by hepatosplenomegaly; elevated serum transaminases, r-glutamyl transpeptidase, triglycerides, etc. in biochemical examination, and echogenic attenuation of the liver can be seen in ultrasound examination.
Diagnosis of fatty liver disease
Excluding hepatitis B, hepatitis C, hepatomegaly, various childhood metabolic diseases, autoimmune hepatitis, and biliary stasis diseases, the diagnosis can be made based on medical history, clinical manifestations, biochemical examination and imaging examination (ultrasound, CT), but it cannot accurately reflect the severity of impaired liver function and the presence of intrahepatic inflammation and fibrosis. Therefore, only histological examination of the liver can clarify the grading and staging of fatty liver disease. Liver biopsy is the most sensitive and specific method to provide prognostic information. Patients older than 45 years, combined visceral obesity, type II diabetes, elevated serum ALT and TG, and AST/ALT >1 require liver biopsy to assist in the diagnosis.
Prognosis of fatty liver disease
Non-alcoholic fatty liver has a better prognosis.
The prognosis for non-alcoholic steatohepatitis is poor, with about 30-40% combined with progressive liver fibrosis and 10-15% with cirrhosis.
Treatment of fatty liver disease
The first step: for basic treatment.
1. lifestyle changes, such as diet, exercise, alcohol abstinence and smoking cessation.
2.Removal of etiology and causative factors, discontinuation of hepatotoxic drugs and avoidance of exposure to hepatotoxic substances, as well as correction of intestinal flora disorders.
3.Control the primary underlying disease or concomitant diseases.
The second step: for adjuvant treatment with liver-protective drugs.
For patients with steatohepatitis to prevent and control intrahepatic inflammatory necrosis and fibrosis to stop the progression of chronic liver disease.
Third step: for the prevention and treatment of decompensated cirrhosis and liver failure and its complications, when liver transplantation may be the only effective treatment option to save lives.