Fatty hepatosis is a liver disease associated with the accumulation of fat in it. This disease is rightly called the problem of civilized countries. It’s all the fault of the food style – high-calorie diets, excessive consumption of fats, refined carbohydrates, sweeteners and fructose, a passion for alcoholic beverages and a sedentary lifestyle. Previously, fatty hepatosis was not given due attention, since the disease is almost always asymptomatic. But now, with the advent of modern diagnostic methods and research data, we have to talk about the problem of liver obesity (this is another name for fatty hepatosis) more and more often. Let’s find out what this disease is, how to diagnose and treat it.
Causes and symptoms of fatty hepatosis. Stages of the disease
Hepatosis is a dystrophy of the liver. The process begins with the appearance of damaging factors. At first, the cells (hepatocytes) adapt to the changes and retain their functions. But the resource of the liver is not unlimited, although it can tolerate it for quite a long time. The resource of hepatocytes is depleted, metabolic processes are disrupted. As a result, the cells accumulate water, fats, proteins, carbohydrates, metabolic products, salts, peroxides, pigments, enzymes and other substances. The components of this” vinaigrette ” begin to interact with each other and form new compounds that should not be normal. Eventually, the cell is destroyed, and all its contents are released into the liver tissue, stimulating the activity of other cells. The destroyed cell is not able to recover and dies. If this process is not stopped in time, the liver is literally soaked with dead cells.
Depending on which type of metabolism is disturbed, there are carbohydrate, fat, protein or mineral liver dystrophy. Today we will analyze fatty hepatosis as the most common type of liver dystrophy.
At first, excess fat accumulates in the intercellular space, without getting into the liver cells.
In conditions of mass death of liver cells, an “emergency” mechanism is triggered. First of all, you need to save the remaining cells and the volume of the liver. At first, the changes are not very noticeable, but gradually the cells are literally pumped with fat. Under the microscope, you can see different degrees of” obesity ” of hepatocytes – pulverized, small-drop and large-drop dystrophy. An extreme degree of fatty dystrophy, in which a significant part of the hepatocytes is affected, can lead to cirrhosis of the liver. At the same time, liver cells are replaced by connective tissue, which is not able to perform important functions for the body. Cirrhosis of the liver, in fact, is the end stage of fatty hepatosis.
Very often, a person does not even suspect that his liver is sick, and only remembers when a significant part of the liver is affected. This is the main danger of fatty hepatosis.
Causes of fatty hepatosis
The disease is caused by various causes – metabolic disorders, toxic substances and diseases of internal organs:
- Alcohol. Toxic to the liver is a daily dose of pure ethanol-40 g for men and 20 g for women;
- Excessive consumption of carbohydrates and fats, and as a result, obesity;
- Diseases associated with metabolic disorders, in particular diabetes mellitus. Insulin stimulates lipogenesis – the formation of fat from carbohydrates. In this case, fat is deposited not only in the subcutaneous tissue, but also in the liver.
Obesity and diabetes occupy a leading place after alcohol among all the causes of the development of fatty liver dystrophy. Fatty hepatosis is diagnosed in 70% of patients with type II diabetes and in 91% of patients with obesity.
- Toxic substances – medicines (corticosteroids, estrogens, NSAIDs), poisons. Toxic effects have mercury compounds, boron, phosphorus, carbon, etc.;
- Excess lipids, which are in the blood at the same time, enter the liver and accumulate there;
- Disorders of the digestive system – diseases of the pancreas and intestines;
- Deficiency of protein, vitamin C, B vitamins and methionine.
- Disorders of bile outflow due to diseases of the gallbladder or biliary tract;
- Viral and bacterial infectious diseases. In chronic infections, fatty liver dystrophy is diagnosed in almost half of cases.
- Violation of the endocrine and nervous regulation of liver functions;
- Liver iron overload;
- Hereditary causes-a deficiency of enzymes involved in the metabolism of lipids.
The more risk factors present at the same time, the higher the likelihood of fatty liver disease, and the faster this disease will progress.
Symptoms of fatty hepatosis
As we have already said, in the vast majority of cases, the disease does not cause symptoms. The liver can not hurt, because there are no nerve endings. Discomfort and pain appear only when the liver is enlarged, when it begins to stretch the capsule and put pressure on the surrounding organs. In addition, the liver has a good margin of safety, is capable of self-healing, and the” surviving ” cells take over the function of the dead.
Sometimes fatty hepatosis still makes itself felt and is manifested by the following symptoms:
- Bitterness in the mouth
- Heaviness or pain in the right hypochondrium
- Nausea and vomiting
- Rashes and “unhealthy” skin color
- Fatigue and sleep disorders
Against the background of fatty hepatosis, diseases of the gallbladder (gallstone disease), heart, hypertension, diabetes mellitus, and pancreatitis can develop.
Complications of fatty hepatosis are hepatitis, fibrosis and cirrhosis of the liver.
Diagnosis of fatty hepatosis
Due to the asymptomatic course of the disease, in some cases, the diagnosis is made accidentally, during a routine preventive examination. Let’s look at the methods of examination that help to diagnose fatty hepatosis:
- Biochemical analysis of blood
With fatty hepatosis, there is a change in the values of liver samples:
- Bilirubin increased by 40-60%
- ALaT is 1.5-2 times higher than normal
- ASaT is increased by 1.5 times, but may be normal
- Albumin – below normal
In addition, the indicators of alkaline phosphatase, lipoproteins, triglycerides, cholesterol, and cortisol increase. Most often, insulin is higher than normal.
- Ultrasound and MRI of the liver. These research methods are accessible and painless. However, they do not allow you to diagnose the mild severity of the disease. In addition, with a high body mass index (BMI), it is difficult to conduct an ultrasound, due to the significant amount of adipose tissue.
A more modern method of examining the liver is ultrasound elastography. This diagnostic method allows you to assess the elasticity of liver tissue, which helps to determine the stage of the disease. In fatty hepatosis, it is important to know whether the replacement of liver cells with connective tissue has occurred. This helps to establish the correct diagnosis and prescribe treatment.
- Since fatty hepatosis is closely associated with the risk of developing diabetes, the doctor may recommend that you pass the same tests that are given when you suspect diabetes:
- Fasting glucose level
- The level of insulin on an empty stomach
- Pikalyovsky hemoglobin
- Glucose Tolerance Test
- Liver biopsy it is crucial for the diagnosis of fatty liver hepatosis. The biopsy is performed under the control of ultrasound after preliminary anesthesia. With the help of a special needle, a puncture is carried out and the material is taken for examination. The biopsy (test material) is processed and fixed. Then it is examined with a high-precision microscope.
A biopsy can determine the extent of liver cell damage.
This is what fat hepatosis looks like under a microscope:
Liver tests are not strictly specific for liver diseases. That is, changes in the level of bilirubin, ASaT, ALaT, alkaline phosphatase and other indicators can be a manifestation of diseases of other organs. Blood biochemistry allows you to make an accurate diagnosis in 30-50% of cases. A biopsy is a more accurate method, which confirms the diagnosis in 98% of cases.
Treatment of fatty hepatosis
Treatment of fatty hepatosis is aimed at normalizing metabolic processes, stimulating the processes of detoxification and removal of harmful substances from the body, restoring liver cells, relieving inflammation and slowing down the process of replacing liver tissue into connective tissue.
Liver treatment is not an easy task that requires a comprehensive approach. Simply put, not everything depends on the drugs. Liver health is primarily about diet and lifestyle changes.
Consider the methods of treatment of fatty hepatosis, which offers modern medicine:
- Exclusion of hepatotoxic drugs and alcohol.
- Treatment of obesity.
- It is important to understand that weight loss should not be fast – a maximum of minus 1 kilogram per week. Rapid loss of adipose tissue leads to a worsening of the course of adipose hepatosis. The ideal option for treating obesity is the Mediterranean diet-eating seafood with olive oil and fruit.
- A low-carb diet should be combined with increased physical activity. At the same time, the calorie deficit should be at the level of 500-1000 calories per day.
- Food and beverages containing fructose, as well as fast food should be excluded.
- For liver diseases, the classic Pevsner diet No. 5 is recommended.
In some cases, a change in lifestyle and a decrease in body weight can restore the liver without any medications.
- Omega-3 fatty acids. Currently, there are studies that confirm a decrease in the level of high-density lipoptroteins (the so-called “bad” cholesterol) while taking foods and dietary supplements (fish oil) containing omega-3. However, these data are still not sufficiently convincing for the inclusion of omega-3 fatty acids in the list of first-line drugs for the treatment of fatty hepatosis.
- Statins are used to normalize the blood lipid spectrum. However, to date, there are no studies that would allow us to talk about the recovery of the liver in fatty hepatosis against the background of taking statins.
- Vitamin E in a daily dose of 800 mg improves the condition of the liver. However, such a high dosage increases the risk of cancer. Therefore, most often for the treatment of fatty hepatosis, 400 mg of vitamin E per day is recommended.
- Ursodeoxycholic acid (UDCA) protects liver cells, controls their death, is an antioxidant, reduces the susceptibility of liver cells to inflammation, has a choleretic effect. Numerous studies confirm its effectiveness in the treatment of liver diseases, including fatty hepatosis.
The effectiveness of UDCA increases in combination with vitamin E and statins.
- Essential phospholipids (EF) protect liver cells, repair their membrane, and reduce the intensity of inflammation. It is worth noting that EF is better used for the purpose of prevention, since with already existing fatty liver dystrophy, EF is ineffective, at least in monotherapy.
- Ademetionine is a donor for the synthesis of liver cell membranes and other important components that are necessary for the removal of lipids from hepatocytes.
- Betaine is an antioxidant that reduces inflammation and prevents the accumulation of lipids in the liver.
- Metformin is a hypoglycemic drug widely used for the treatment of diabetes mellitus. Increases the sensitivity of tissues to insulin, promotes the proper distribution of adipose tissue, reduces the accumulation of lipids in liver cells, normalizes lipid metabolism.
- Glycyrrhizic acid has a pronounced anti-inflammatory effect, restores the function of liver cells and enhances the protective properties of essential phospholipids. Thus, preparations based on glycyrrhizic acid and essential phospholipids are taken together to enhance the effect.
- Milk thistle extract is a plant preparation, the active component of which is silymarin. There is some evidence that milk thistle relieves inflammation and prevents the replacement of liver cells with connective tissue. However, the mechanism of action of milk thistle extract has not yet been studied.
To sum up, we can say that there is no single standard of treatment for fatty hepatosis. It all depends on the individual situation – the stage of the disease, the severity of liver changes and the presence of concomitant diseases. It is also difficult to predict the duration of treatment. For a successful outcome, a diet and a healthy lifestyle are no less important than taking medications and following the doctor’s recommendations.
Diet and proper lifestyle is the key to the health of the liver!