home Diseases What is fatty liver: symptoms and treatment at different stages. What is hydropic and balloon dystrophy?

What is fatty liver: symptoms and treatment at different stages. What is hydropic and balloon dystrophy?

Hepatosis is a collective name liver diseases, characterized by disruption of metabolic processes in hepatocytes ( liver cells) and, as a consequence, damage to the cell structure and intercellular substance, metabolic and organ function disorders ( dystrophy). According to the type of metabolic disorder, a distinction is made between fat and pigment ( pigment - a substance that gives color to body tissues) hepatosis.

Steatosis- this is pathological ( deviation from the norm) a condition in which fats accumulate in the cells of the body.

Fatty hepatosis () is the most common reversible chronic process in which in hepatocytes ( liver cells) there is excessive accumulation of lipids ( fat). Gradually, in the liver, an increasing number of cells are replaced by fat cells, which form adipose tissue. As a result of this, the liver increases in size, its color changes to yellowish or dark red, cells die, and fatty cysts form ( pathological cavities in tissue or organ with contents), organ functions are impaired. Very often fatty infiltration ( accumulation in tissues of substances that are not normally detected) liver goes into fibrosis ( reversible process of replacing normal tissue with rough scar tissue locally or throughout the organ), and then to cirrhosis ( irreversible, progressive liver disease in which healthy tissue is replaced by scar tissue).

Fatty hepatosis is a fairly common disease. On average, it affects 10% to 25% of the population in different countries, among them 75% - 90% are people suffering from obesity and diabetes. In Russia, every fourth person suffers from fatty hepatosis.

Anatomy of the liver

The liver is a vital unpaired organ, the largest gland ( organ that produces specific chemicals) in the human body. Located on the right in upper section abdominal cavity under the diaphragm. Sometimes the liver is located on the left side, which must be taken into account during ultrasound examination ( Ultrasound) organ. The liver has irregular shape, reddish-brown color, weight 1300 – 1800 grams in an adult. It consists of two lobes - the right lobe ( larger in size) and left ( smaller in size). To facilitate the determination of the liver zone during surgical and diagnostic procedures, the liver is divided into 8 segments. The segment is a pyramidal portion of the liver adjacent to the hepatic triad, which consists of a branch of the portal vein, a branch of the proper hepatic artery and a branch of the hepatic duct.

The cells that make up the liver are called hepatocytes. The structural and functional unit of the liver is the hepatic lobule. It has the shape of a prism and consists of liver cells ( hepatocytes), vessels and ducts. In the center hepatic lobule there is a central vein, and on the periphery there are bile ducts, branches of the hepatic artery and hepatic vein. Hepatocytes produce up to one liter of bile ( a liquid consisting of bile acids, water, cholesterol, inorganic compounds and involved in the digestion process) per day. Bile acids promote the breakdown and absorption of fats, stimulate small intestinal motility, as well as the production of gastrointestinal hormones. Through intrahepatic small capillaries ( channels) bile enters the larger bile ducts and then into the segmental ducts. The segmental ducts merge into the right ( from the right lobe of the liver) and left ( from the left lobe of the liver) bile ducts, which unite into the common hepatic duct. This duct connects with the gallbladder duct and forms a common bile duct, from which bile enters directly into the lumen of the duodenum.

The liver receives nutrients and oxygen from the blood from its own hepatic artery. But, unlike other organs, the liver also receives venous blood, saturated carbon dioxide and deprived of oxygen.

There are two venous systems in the liver:

Portal. The portal venous system is formed by the branches of the portal vein ( gate) veins. The portal vein is a large vessel into which blood enters from all unpaired organs of the abdominal cavity ( stomach, small intestine, spleen), and from the portal vein to the liver. The liver cleanses this blood of toxins, waste products and other substances harmful to the body. Blood cannot enter from the gastrointestinal tract ( gastrointestinal tract) into the general bloodstream without undergoing “filtration” in the liver.
Kavalnaya. It is formed from the totality of all the veins that carry blood from the liver. This venous blood is saturated with carbon dioxide and deprived of oxygen due to gas exchange between liver cells and blood cells.

The main functions of the liver are:

Interesting Facts

The liver ranks second in weight among all organs ( average weight – 1500 g.).
70% consists of water.
In one hour, about 100 liters of blood passes through the liver and, accordingly, more than 2000 liters per day.
The liver performs more than 500 functions every day.
The liver could function for up to 300 years thanks to its unique property– ability to self-heal.
More than 25% of liver diseases are caused by alcohol consumption.
About a million chemical reactions occur in liver cells per minute.
Currently, more than 50 liver diseases are known.
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More than 11,000 transplants are performed annually ( transplant surgery) liver.

Forms and stages of hepatosis

To formulate accurate diagnosis, descriptions of the degree of liver damage and the prevalence of the pathological process, there are classifications of hepatosteatosis according to various criteria. This provides the physician with a more detailed understanding of the patient's illness, even if the physician is not familiar with the patient's medical history ( medical history).

Steatosis can be:

Alcoholic– pathological changes in the liver due to chronic alcohol intake.
Non-alcoholic(non-alcoholic steatohepatosis - NASH, non-alcoholic fatty disease - NAFD) – fatty degeneration of the liver, which occurs due to poor lifestyle, diet, and various concomitant diseases.

In fatty hepatosis there are:

Stage I – minimal obesity. Fat droplets accumulate in liver cells without damaging hepatocytes.
Stage II – moderate obesity. Irreversible processes occur in cells, leading to their destruction and death. Their contents enter the intercellular space. Cysts form ( pathological cavities).
Stage III – severe obesity. Pre-cirrhotic state ( cirrhosis is an irreversible chronic process of replacing liver tissue with scar tissue).

Based on the degree of damage to the liver structure, there are:

Focal disseminated – accumulation of small areas of fat in various departments liver with asymptomatic course.
Severely disseminated – accumulation of fat droplets in large quantities in various parts of the liver with the manifestation of symptoms.
Zonal – arrangement of lipids ( fat) in various parts of the hepatic lobules ( structural and functional units of the liver).
Diffuse – liver damage, in which the accumulation of fat occurs evenly throughout the entire lobe of the liver with the appearance of symptoms.

By etiology(cause of the disease)steatosis occurs:

Primary– congenital intrauterine metabolic disorder.
Secondary– metabolic disorder that appears as a consequence concomitant diseases, unhealthy diet and lifestyle.

Based on the microscopic picture of hepatosis, that is, pathological changes at the cellular level, the following are distinguished:

Small blob obesity– simple obesity, in which pathological processes already occur, but without damage to the liver cells.
Massive obesity– a more severe course of the disease, in which the structure of hepatocytes ( liver cells) is significantly damaged, which leads to their further death ( necrosis).

Morphologically(structure and shape of cells)highlight:

0 degree of steatosis– accumulations of fat appear locally in hepatocytes.
I degree of steatosis– accumulations of lipids ( fat) increase in size and merge into foci with damage to liver cells - up to 33% of affected cells in the field of view.
II degree of steatosis– accumulations of lipids of various sizes, which are distributed over the entire surface of the liver – 33–66% of liver cells ( small-droplet, large-droplet intracellular obesity).
III degree of steatosis– accumulation of fat occurs not only in the cells, but also outside them with the formation of a cyst ( pathological cavity in tissue), destruction and death of cells - more than 66% of affected liver cells in the field of view.

Causes of liver steatosis

Many factors lead to the development of pathological changes in the liver and disruption of its functions. Liver health is affected by lifestyle, diet, medication, heredity, concomitant diseases, viruses. Often, steatosis is caused not by one specific cause, but by a combination of several. Therefore, to establish the etiology ( causes) illness, the doctor must ask the patient in detail about his bad habits, diseases, medications that he took or is taking, and so on. A correctly identified cause will not only eliminate the factor itself and its detrimental effect on liver health, but also prescribe effective treatment. This will significantly increase the patient's chances of recovery.

The causes of steatohepatosis are divided into two large groups:

causes of alcoholic steatohepatosis;
causes of non-alcoholic steatohepatosis.

Causes of alcoholic steatohepatosis

Alcohol intake is the only cause of alcoholic steatosis . The accumulation of fat droplets in liver cells occurs under the influence of ethanol ( pure alcohol, the content of which is indicated as a percentage on alcoholic products) with chronic alcoholism or excessive alcohol consumption. Large doses are considered to be 30–60 grams of ethanol per day. Under the influence of alcohol, liver cells die faster than they are renewed. During this period, excess scar tissue forms in the liver. The supply of oxygen to cells is significantly reduced, causing them to shrink and die. Protein formation in hepatocytes decreases, which leads to their swelling ( due to the accumulation of water in the cells) and hepatomegaly ( pathological enlargement of the liver). Heredity, protein deficiency in food, hepatotropic ( characteristic of the liver) viruses, concomitant diseases, obesity and others.

Causes of non-alcoholic steatohepatosis

In addition to alcohol abuse, a number of other factors can lead to steatosis.

Causes of non-alcoholic steatosis

Risk factors are:

female;
age over 45 years;
body mass index ( BMI is the ratio of weight in kilograms to the square of height in meters) more than 28 kg/m2;
hypertonic disease ( high blood pressure);
diabetes (a disease caused by a lack of insulin, a pancreatic hormone responsible for lowering blood sugar levels);
ethnicity - Asians are most susceptible to the disease, and African Americans have a lower risk;
burdened hereditary history - the presence of a disease in relatives or factors transmitted genetically.

Symptoms of liver hepatosis

Steatohepatosis may long time be asymptomatic. It is often discovered by chance during annual medical examinations and diagnostic procedures for other diseases. In the initial stages of hepatosis, the patient does not present any complaints. With the progression and involvement of an increasingly larger area of the liver in the pathological process, the functions and structure of the organ begin to be disrupted. This leads to the appearance of symptoms.

Symptoms of hepatosis

Stage of steatohepatosis	Symptom	Development mechanism	Manifestation
*Stage I*	*Asymptomatic*	–	–
*Stage II*	*Pain syndrome* *(set of symptoms)*	The liver has no pain receptors ( proteins that receive information from the stimulus and transmit it to the analyzing center). Pain occurs when the liver increases in size and its capsule stretches ( membrane covering the liver).	Discomfort, heaviness in the right hypochondrium, appearing regardless of food intake. A feeling of compression of organs, pain when palpating the liver.
	*Weakness*	Weakness and malaise are caused by a lack of energy due to impaired nutrient metabolism.	Body aches, constant feeling of fatigue.
	*Nausea* *(constant or paroxysmal)*	Develops due to digestive disorders associated with a lack of bile-forming function of the liver. With a lack of bile, the process of fat digestion is disrupted, as a result of which food can stagnate in the gastrointestinal tract, which leads to nausea.	Discomfort, discomfort in the area of the stomach and esophagus. Aversion to food, smells. Increased salivation.
	*Decreased appetite*	Many liver functions associated with metabolism are disrupted, which leads to an incorrect assessment by the body of the supply of nutrients and the need for them, and stagnation of food in the gastrointestinal tract. Also, appetite decreases with nausea.	No feeling of hunger, reducing the number of times you eat and its volume.
	*Decreased immunity* *(the body's defenses)*	The liver plays an important role in maintaining immunity. Her disease leads to disruption of this function.	Frequent colds, exacerbation of chronic diseases, viral infections, inflammatory processes.
*Stage III*	*Yellowness of the skin and visible mucous membranes*	An increase in bilirubin, a yellow pigment, in the blood, as a result of the liver’s inability to bind it and remove it from the body.	Skin, oral mucosa, sclera of the eyes ( dense outer shell) acquire a yellow color of varying intensity.
	*Itching*	When liver function is impaired, bile acids are not excreted in the bile, but enter the blood. This leads to irritation nerve endings on the skin and the appearance of itching.	Severe burning sensation of the skin. Intense itching, often occurring at night.
	*Skin rashes*	The detoxification function of the liver is impaired. Under the influence of toxins and waste products of the body, a rash appears. Hemostasis is impaired ( a complex biosystem that maintains blood in a liquid state during normal conditions, and in case of violation of the integrity of the blood vessel, helping to stop bleeding), the fragility of blood vessels increases.	Small spots on skin all over the body. Hemorrhagic rash ( minor hemorrhages).
	*Manifestations of dyslipidemia* *(lipid metabolism disorder)*	As a result of a violation of fat metabolism,	Xanthomas – a disease that appears when fat metabolism is disrupted and is manifested by focal skin formations consisting of cells with fatty inclusions. Xanthelasmas – flat xanthomas appearing on the eyelids. Lipoid arc of the cornea – circular deposition of fats in the outer shell of the eye.

Diagnosis of hepatosis

To determine the type, stage, and form of steatosis, it is necessary to conduct a series of examinations. The doctor will select best practices diagnostics individually for each patient.

Diagnosis of the disease includes:

history taking ( information about the patient’s life, medical history and others);
inspection;
laboratory examination methods ( general blood test and biochemical blood test);
instrumental examination methods ( ultrasound examination, computed tomography, magnetic resonance imaging, liver biopsy, elastography).

History taking

Taking an anamnesis is basic in diagnosing the disease. A conversation with the patient is the first stage of the examination. The more detailed the anamnesis is collected, the easier it will be for the doctor to identify the cause of the disease, select treatment, diet and give correct recommendations on lifestyle changes.

At the appointment, the doctor will analyze:

Patient complaints– complaints of pain, discomfort, heaviness in the right hypochondrium, vomiting, nausea.
History of present illness– the time when the first symptoms appeared, how they manifested themselves, how the disease developed.
Anamnesis of life– what concomitant diseases does the patient have, what kind of lifestyle does he lead, what diseases has he suffered? surgical interventions, what medications you have taken or are taking and for what period.
Family history– what diseases did the immediate family suffer from?
History of the patient's diet– what foods the patient prefers, how often he eats, what diet he follows, are there any allergies to foods, does he drink alcohol ( threshold – 20 g/day for women and 30 g/day for men).

Inspection

After collecting anamnesis, the doctor proceeds to examine the patient, during which he tries to identify various signs liver diseases.

During the patient examination:

The skin and visible mucous membranes are carefully examined, the yellowness of the skin, mucous membranes and its intensity, the presence of scratching and rashes are assessed.
Percussion is performed ( tapping) and palpation ( probing) abdomen to determine the size and tenderness of the liver.
Alcohol dependence is also defined - ethicism ( chronic alcohol use). With alcoholism, the patient will have a puffy face, tremors ( trembling) hands, unkempt appearance, smell of alcohol.
The degree of obesity is determined. To do this, they use various formulas for calculating a person’s normal weight, depending on gender, age, body type, and determine the degree of obesity using tables.

To determine the degree of obesity, the following are used:

Body mass index ( BMI). This is an objective factor that evaluates the suitability of a person’s height and weight. The calculation formula is very simple - BMI = m / h 2, that is, it is the ratio of a person’s weight in kilograms and height in m 2. If the index is 25 - 30 kg/m2, the patient is overweight ( pre-obesity), if the BMI is more than 30, the patient is obese.
Calculation of ideal body weight ( BMI). This formula also takes into account the patient’s gender and determines his optimal weight, which should be adhered to. Calculated using the formulas – BMI = 50 + 2.3 x ( 0.394 x height in cm – 60) – for men and BMI = 45.5 + 2.3 x ( 0.394 x height in cm – 60) - for women.
Measuring your waist circumference with a measuring tape. Used to predict complications and disease risk. If a woman’s waist circumference is more than 80 centimeters, and a man’s is more than 94 centimeters, then the risk of diabetes and hypertension increases ( high blood pressure) and grows with every additional centimeter.
Ratio of waist circumference to hip circumference. For women, the norm for the ratio of waist circumference to hip circumference is less than 0.85, for men – less than 1.0. Studies have shown that people with an apple body type ( waist wider than hips) are more predisposed to various diseases than people with a “pear-shaped” body type ( hips wider than waist).

General blood analysis

The procedure consists of taking blood from a vein and analyzing it using special laboratory equipment.

In order to obtain reliable results, the following rules must be observed :

Blood sampling is carried out in the morning on an empty stomach ( no earlier than 12 hours after eating);
dinner the day before should be light and early, without coffee or strong tea;
Alcohol, fatty foods, and some medications are eliminated for 2–3 days;
physical activity and sauna visits are excluded per day;
tests are taken before x-ray examination and massage.

A general blood test may reveal:

Possible anemia ( anemia). With anemia, the number of red blood cells decreases ( red blood cells) – less than 4.0 x 10 12 /l in men and less than 3.7 x 10 12 /l in women. The amount of hemoglobin also decreases ( oxygen carrier protein) – less than 130 g/l in men and less than 120 g/l in women.
Signs of possible inflammation. The number of leukocytes in the blood increases ( white blood cells) – more than 9.0 x 10 9 /l, ESR increases ( erythrocyte sedimentation rate) – more than 10 mm/hour in men and more than 15 mm/hour in women.

Blood chemistry

The procedure for collecting blood for biochemical analysis is identical to the procedure for collecting blood for a general analysis. Only the lack of dinner the night before is added to the restrictions ( more than 12 hours of fasting), discontinuation of lipid-lowering drugs ( lowering blood lipid levels) medications two weeks before the analysis.

At biochemical research blood may reveal:

Increased transaminase activity ( ). The level of aspartate aminotransferase increases ( ACT) more than 31 U/L in women and more than 41 U/L in men and alanine aminotransferase ( ALT) more than 34 units/l in women and more than 45 units/l in men. An increase in their concentration in the blood indicates the process of destruction of liver cells.
Dyslipidemia ( protein metabolism disorder). The concentration of cholesterol increases ( fat-like component of all cells) more than 5.2 mmol/l. HDL concentration decreases ( lipoproteins – complexes of high-density proteins and fats, “good cholesterol”) less than 1.42 mmol/l in women and less than 1.68 mmol/l in men. The concentration of LDL increases ( low-density lipoproteins, “bad cholesterol”) more than 3.9 mmol/l.
Disturbance of carbohydrate metabolism. Hyperglycemia is observed ( increased blood sugar levels) more than 5.5 mmol/l.
Hepatocellular failure ( decreased function). Albumin concentration decreases ( major blood protein) less than 35 g/l, blood clotting factors. This indicates the inability of the liver to produce proteins and provide hemostasis ( hemostasis is a complex biosystem that maintains blood in a liquid state under normal conditions, and if the integrity of a blood vessel is compromised, it helps stop bleeding).

Ultrasonography ( Ultrasound)

Ultrasonography (Ultrasound) – non-invasive ( without penetrating the human body and violating the integrity of the skin, tissues, and blood vessels) research method. The essence of the method is to deliver ultrasonic waves into the human body. These waves are reflected from the organs and captured by a special sensor, with subsequent display of the image on the monitor. The denser the structure of an organ or medium, the fewer waves pass through it and the more they are reflected. On the screen, such tissues and organs look brighter and lighter. A special gel is applied to the patient on the right side of the liver to facilitate the sliding of the sensor. An image of the liver is then obtained on a screen. The doctor describes the results. This is an absolutely painless and harmless procedure, so there are no contraindications to ultrasound.

Indications for liver ultrasound are:

increased liver size upon palpation;
liver tenderness on palpation ( palpation);
changes in biochemical blood test.

An ultrasound examination of the liver may reveal:

Hyperechogenicity ( increased reflection of waves from tissues) liver- this indicates compaction of organ tissue.
Enlarged liver ( hepatomegaly) – as a result of inflammatory processes and accumulation of fatty deposits in the liver.
Fatty infiltration ( accumulation in tissues of substances that are not normally present) more than 30% of the liver– all changes in the liver are detected on ultrasound only when fatty degeneration exceeds 30% of the organ’s area.
Alternation of hyperechoic areas ( with increased reflection of waves from tissues) and hypoechoic ( with reduced reflection of waves from tissues) – dense areas reflect the rays, less dense areas absorb them, which indicates the heterogeneity of liver damage.

CT scan ( CT)

CT scan ( CT) – non-invasive ( without penetration into the human body and without damaging the integrity of the skin, tissues and blood vessels) examination method. This method is based on the passage of X-rays through the human body from various points and from different angles, which allows you to create a three-dimensional and layer-by-layer image of organs on the monitor.

To conduct the examination, the patient must remove all clothing, jewelry, and removable dentures and put on a special gown. Then he is placed on a bed with a scanning system shaped like a circle. This system is placed in the liver area, after which the scanning probe makes rotational movements, passing X-rays through the patient's body. To improve the quality of imaging, the doctor can do a CT scan with a contrast agent, which will more clearly display the structures of the organ on the screen.

Computed tomography is shown:

with focal ( local) liver damage;
with unsatisfactory ultrasound results ( ultrasound examination);
if necessary, a more detailed, layer-by-layer image;
in the presence of formations, cysts ( pathological cavities in the tissue).

Carrying out a computed tomography(CT)contraindicated:

for mental illness;
at inappropriate behavior patient;
if the patient’s body weight is more than 150 kilograms;
during pregnancy.

With hepatic steatosis, computed tomography may reveal:

decreased X-ray density of the liver due to fat accumulation;
compaction of liver vessels compared to its tissue;
focal accumulations of fat.

Magnetic resonance imaging ( MRI)

Magnetic resonance imaging is also a non-invasive method. Its essence is as follows. When placed human body In a strong electromagnetic field, the hydrogen nuclei in his tissues begin to emit special energy. This energy is captured by special sensors and displayed on a computer monitor.

To undergo the procedure, the patient must remove all clothing, jewelry, dentures, and anything that contains metal. He is placed on a bed that slides into the MRI machine. After the procedure, an image of the organ appears on the monitor, which the doctor can study in detail in all positions, sections and from different angles.

Indications for magnetic resonance imaging are:

the need for more detailed visualization of liver structures;
presence of cysts, neoplasms;
greater accuracy in tissue imaging compared to computed tomography, which is more suitable for studying bone structures.

Contraindications to magnetic resonance imaging are:

mental illness;
patient inadequacy;
presence of a pacemaker ( a machine in the heart that helps control the heartbeat);
presence of metal implants ( dental or bone implants);
claustrophobia ( fear of closed, cramped spaces);
presence of tattoos containing iron in the ink;
The patient's weight is more than 160 kilograms.

In case of fatty liver infiltration, MRI can reveal:

liver hardening;
liver enlargement;
cysts and neoplasms, determine their size and location;
heterogeneity of the liver structure;
focal or diffuse accumulations of fat.

Liver biopsy

Biopsy ( excision of a section of an organ for further study under a microscope) liver is an invasive method of examination, that is, it violates the integrity of the skin, organs, and blood vessels. To carry out the procedure, the patient is positioned on the diagnostic table. He undergoes an ultrasound examination of the liver to determine the area from which tissue will be taken for study. After the doctor determines the required area for biopsy, the procedure itself begins. The area of skin in the liver area is treated with an antiseptic ( disinfectant). Be sure to numb the skin in the area of the puncture. The doctor will explain how you will need to breathe during the procedure. Then a special needle is inserted into the liver area for a biopsy under ultrasound guidance ( ultrasound examination) and excise a small area of organ tissue. Excised area ( biopsy) are sent to the laboratory for examination under a microscope.

After the biopsy, the patient must be monitored by medical staff for four hours. He is strictly forbidden to get up. A cold compress is applied to the puncture area. There will be slight discomfort in this area for some time. A day later the ultrasound is repeated ( ultrasonography) liver, general and biochemical blood tests.

Indications for biopsy(excision of a section of an organ for further study under a microscope)liver are:

Destruction of hepatocytes ( liver cells) for an unknown reason, identified during a biochemical blood test in patients over 45 years of age.
The need to determine stage and degree fatty liver disease liver.
Differential diagnosis ( exclusion of other diseases) steatosis and other concomitant liver diseases.
The need for a detailed study of cell structure.
Suspicion of fibrosis ( reversible replacement of normal organ tissue with scar tissue) or cirrhosis ( irreversible replacement of organ tissue with scar tissue).
Determining the severity of steatohepatosis, fibrosis, cirrhosis, when other methods are less informative.
Carrying out surgical operations for obesity or removal of the gallbladder.
Absolute contraindications to computed tomography and magnetic resonance imaging.

Contraindications to liver biopsy are:

patient refusal;
Availability purulent processes in the liver, intra-abdominal cavity;
infectious skin lesions in the area of biopsy;
mental illness;
increased tendency to bleed;
focal liver lesions ( tumor);
tense ascites ( accumulation of large amounts of fluid in the abdominal cavity).

A liver biopsy will determine:

Degree of steatosis ( 0, 1, 2, 3 ) and type of lesion ( large blob obesity, small blob obesity).
The presence of structural changes in tissue and their stages ( fibrosis, cirrhosis).
The presence of other liver diseases that accompany steatosis.
Inflammatory processes that cannot be detected by most non-invasive methods.

Elastography

Elastography ( elastosonography) is a non-invasive method of studying the liver, which is performed using a special device - “Fibroscan”. It allows you to assess the degree of fibrosis ( reversible process of replacing normal organ tissue with scar tissue). Is an alternative invasive method– liver biopsy.

Its operating principle is similar to that of ultrasound. The doctor presses on the area of the organ being examined with a special sensor and evaluates the elasticity of the tissue from the image before and after compression. Areas of tissue that have changed in structure contract differently ( due to unequal elasticity) and are displayed on the screen in different colors. Stretch fabric appears in red and green, while stiffer fabric appears in blue. Normally, liver tissue is elastic, but with structural changes ( fibrosis, cirrhosis) its elasticity decreases significantly, the fabric becomes denser and stiffer. The less elastic the tissue, the more pronounced the fibrosis. The procedure is safe and painless, therefore it has no contraindications. It is not performed in pregnant women and patients with ascites, due to the lack of information.

Indications for liver elastography are:

diagnosis of liver fibrosis;
establishing the stage of fibrosis.

Elastography reveals:

structural changes in the liver in the form of fibrosis or cirrhosis;
severity of fibrosis ( F0, F1, F2, F3, F4 on a special scaleMETAVIR);
severity of steatosis ( minimal, mild, moderate, severe).

Patients with fatty liver disease should periodically repeat diagnostic procedures. This will allow you to evaluate the effectiveness of the prescribed treatment, therapeutic diet, physical activity. It will also prevent the progression of the disease with complications such as fibrosis ( reversible replacement of healthy tissue with scar tissue) and cirrhosis ( irreversible replacement of tissue with scar tissue with damage to the structure and function of the organ).

Periodic medical control

Indicators	Periodicity
Monitoring weight loss, effectiveness of treatment, diet and physical activity.	Twice a year.
Biochemical analysis ( ALT, AST, cholesterol) and general blood test.	Twice a year.
Glycemic level ( blood sugar).	Daily for patients with diabetes and every 6 months for others.
Ultrasound ( ultrasonography) liver.	Twice a year.
Liver elastography ( Fibroscan).	Once a year.
Liver biopsy.	Every 3 – 5 years, depending on the results.
Consultation with a hepatologist.	The first year - once every six months, then annually.
Consultation with a nutritionist, cardiologist, endocrinologist.	Annually, and in the presence of heart disease, endocrine system much more often.
Other methods.	According to the doctor's testimony.

Treatment of hepatosis with medications

Specific treatment fatty liver disease does not exist. Treatment is mainly aimed at eliminating or reducing the negative impact of the causes that contribute to fatty liver degeneration, as well as strengthening the body as a whole, protecting and restoring liver cells ( hepatocytes), maintaining diseases in a compensated state ( a condition when the body adapts to the disease, which leads to minimal negative impact of the pathological process). The dosage and duration of treatment are selected by the doctor individually for each patient, taking into account weight, concomitant diseases, stage and degree of his disease.

Treatment goals and main drugs

Therapeutic strategy	Group of medicines	Name	Mechanism of therapeutic action
*Protection of liver cells from the negative effects of many factors, as well as restoration of the structure and function of hepatocytes* *(liver cells)*	*Hepatoprotectors* *(drugs that protect liver cells from damage)*	*Essential* *Phospholipids* *(phospholipids – components of the cell wall):* livenciale; essliver forte; phosphogliv; results about; antraliv.	Phospholipids are a structural element of cell walls. Taking these drugs helps restore and preserve hepatocytes, prevents the replacement of normal liver tissue with scar tissue, that is, the appearance of fibrosis and cirrhosis.
		*Natural preparations* (vegetable)origin: allohol; karsil; liv-52; hepabene; legal; silymar; maxar.	Provides antioxidant protecting cells from damaging effects active forms oxygen) action. They have a choleretic effect, preventing stagnation of bile and increased load on the liver. Stimulate the production of proteins, promoting reparative processes ( cell functions to correct and restore) hepatocytes.
		*Ursodeoxycholic acid preparations* *(the least aggressive, natural component of bile, which does not have a toxic effect on cells):* ursofalk; urdoxa; ursodesis; Livodex.	Improves the immunological functions of the liver. They enhance the formation and excretion of bile, preventing the formation of gallstones. Prevents cell death under the influence of toxic bile acids. Delays the spread of fibrosis ( reversible process of replacing healthy tissue with scar tissue). Reduce cholesterol levels ( a component of cell membranes, the excess of which leads to an increased risk of developing cardiovascular diseases).
		*Amino acid derivatives* *(amino acids are the main structural component of proteins):* prohepar; heptor; hepa-merz; lecithin.	Helps improve local blood circulation in the liver. Restore damaged structures of cells and areas of the liver. Delay the formation of connective tissue ( cicatricial) tissue in the liver. Accelerate protein metabolism in liver diseases with parenteral ( intravenous) food. Reduce ammonia levels ( toxic metabolic product) in blood.
		*dietary supplement* *(biologically active additives):* oats; hepagard active.	Contains natural ingredients. Helps accelerate decay ( breakdown of fats into simpler substances) fats, which protects the liver from fatty infiltration ( accumulation of substances in tissues that are not normally present). Removes toxins, eliminates spasms, and has an anti-inflammatory effect.
*Increased cell sensitivity to insulin* *(pancreatic hormone that promotes glucose absorption)*	*Hypoglycemic* (lowering blood sugar levels)facilities	metformin.	Normalizes and reduces body weight. Reduces LDL concentration ( low-density lipoproteins - “bad cholesterol”, which contribute to the development of cardiovascular diseases) and fats in the blood. Increases tissue sensitivity to insulin, which promotes better absorption of glucose.
		Siofor.	Normalizes lipid metabolism ( fat), reduces the concentration of total cholesterol and LDL ( low-density lipoproteins, “bad cholesterol”).
*Reduced lipid levels* *(fat)*	*Hypolipidemic* (reducing the concentration of lipids in the blood)facilities	*Statins:* atorvastatin; rosuvastatin.	Reduce the concentration of cholesterol and lipoproteins ( complexes of proteins and fats) in blood. Enhance the uptake and breakdown of LDL ( low-density lipoproteins - “bad cholesterol”).
*Reduced lipid levels* *(fat)*		*Fibrates:* hemofibrate; clofibrate.	Reduce the amount of lipids ( fat) in the blood, LDL, cholesterol. At the same time, it increases HDL content ( high density lipoproteins - " good cholesterol", preventing the development of heart and vascular diseases). They have serious side effects, so they are used less often.
*Weight loss*	*Other lipid-lowering drugs*	orlistat.	Suppresses the breakdown and absorption of fats from the gastrointestinal tract, which leads to weight loss.
*Weight loss*	*Other lipid-lowering drugs*	sibutramine	Accelerates the onset of a feeling of fullness and maintains this feeling for a long time, which leads to a decrease in the frequency of food intake. Increases energy consumption.
*Antioxidant action* *(protecting cells from destruction during oxidative processes, that is, due to excessive exposure of cells to reactive oxygen species)*	*Antioxidants*	*Antioxidants include:* Mexidol; vitamins A, E, C.	Regeneration processes are stimulated ( recovery), the processes of cell destruction are stopped, microcirculation is improved, vascular fragility is reduced, cholesterol levels in the blood are normalized, oxygen consumption by cells is stimulated, and the transport and utilization of glucose is regulated.
*Antihypoxic effect* *(improving the utilization of oxygen by the body, increasing the resistance of tissues and organs to oxygen starvation)*	*Antihypoxants*	*The following have antihypoxic effects:* carnitine; trimetazidine; hypoxene; Actovegin.

Diet for hepatosis

Fatty hepatosis differs from other liver diseases by a more favorable course. It is treatable with complete recovery of the liver. Often, recovery is as simple as reconsidering your diet and lifestyle. Therefore, following a diet can become the main treatment for the initial stages of steatohepatosis. With proper nutrition, the body's metabolism is normalized, the amount of fat in the liver is reduced, and the functioning of the gastrointestinal tract improves.

Along with weight loss, the risk of developing diabetes mellitus, hypertension ( high blood pressure) diseases, cardiovascular diseases.

Diet therapy should be selected by a nutritionist individually for each patient, taking into account age, weight, gender and concomitant diseases. An incorrectly selected diet can only cause harm. For diseases of the liver and gall bladder, you should follow a specially designed diet - table No. 5 according to Pevzner and diet No. 8 for obesity. The purpose of the diet is to be gentle on the liver.

When following a diet, it is important to remember that:

Meals should be balanced and contain the required daily protein intake ( 110 – 130 g), fats ( 80 g, 30% – vegetable) and carbohydrates ( 200 – 300 g).
You should drink enough water ( 1.5 – 2 liters excluding tea, compote, soups).
It is necessary to limit the amount of salt consumed ( 6 – 8 g) and sugar ( 30 g).
The number of meals should be up to 6 – 7 times a day ( fractional meals), dinner 3 – 4 hours before bedtime.
Food should not be cold or hot.
Fried foods are completely excluded, and preference is given only to boiled, steamed, baked and stewed foods.
Avoid foods that irritate the gastric mucosa and increase bile secretion - sour foods, pickles, spices and others.
You should avoid overeating and eat small portions.
Alcohol consumption is completely excluded.
Excluded green tea, coffee, cocoa, chicory, hibiscus.

It is a mistake to think that if you have steatosis, you should completely exclude fats from your diet. You just need to reduce the amount of fat you eat. Fats and proteins protect the liver from fatty degeneration and promote speedy recovery. If there is a lack of fat, the body obtains it from carbohydrates, which does not have the best effect on health. A low-fat diet causes the same damage to the body as excess diet. fatty foods. Fats are part of the structure of cells and are necessary for the body to absorb fat-soluble vitamins ( A, D, K, E), participate in the production of certain hormones and bile acids. The main sources of fats should be vegetable oils ( olive, sunflower) and more than half are food of animal origin.

Allowed and prohibited sources of fats for fatty hepatosis

Fats
skim cheese, up to 500 ml of milk per day, kefir, yogurt; lean beef, rabbit, turkey, chicken; steamed cutlets; seafood ( oysters, mussels, squid); lean fish ( tuna, pike perch).	fatty dairy products; salo; fatty meat ( duck, goose, pork, beef); caviar, sushi, fatty fish ( trout, catfish), salted and smoked fish; offal ( liver, tongue); mayonnaise, ketchup, mustard; sausages; canned food

A sufficient amount of proteins of plant and animal origin should be supplied with food. Proteins play an important role in normal functioning liver, so their deficiency will only increase fatty infiltration of the liver.

Allowed and prohibited sources of proteins for fatty hepatosis

Carbohydrates maintain metabolic balance and normal liver function, and fiber reduces cholesterol concentrations ( structural fat-like element of cells) in blood. This leads to a reduced risk of disease of cardio-vascular system, intestinal and stomach tumors. Carbohydrates are simple ( easily digestible) and complex ( difficult to digest). Simple carbohydrates (glucose, fructose) are found in sweets, sugar, and confectionery products. They are instantly broken down, satisfy hunger for a short time and contribute to the storage of fat in reserve. Complex carbohydrates (fiber, starch) are digested by the body for a long time, dulling the feeling of hunger for a long time. They take out harmful substances, cleanse the intestines, promote proper operation digestive organs.

Allowed and prohibited sources of carbohydrates for fatty hepatosis

Carbohydrates

Authorized products include:

boiled and baked vegetables;
raw vegetables in limited quantities;
dried fruits;
mashed compotes;
prunes;
nuts;
porridge ( oatmeal, buckwheat, pearl barley, muesli);
Rye bread, crackers, bread, bran;
honey, marmalade, pastille, lollipops;
weak black tea, rosehip decoction.

Prohibited products include:

bakery;
ice cream;
sugar ( more than 30 g per day);
carbonated and sweet drinks ( Sprite, Coca Cola, fruit juices);
semolina;
products made from premium flour;
pasta;
legume products ( nagut, lentils);
adjika, horseradish;
pickles;
chocolate, confectionery with cream, condensed milk, waffles;
berries and fruits – apples, raspberries, grapes, cranberries, cherries and others;
vegetables – radishes, eggplants, garlic, onions, corn and others;
fresh juices.

An approximate menu for the day should meet dietary requirements and include:

First breakfast– oatmeal water with milk, low-fat cottage cheese, black tea.
Lunch– dried fruits, apples, prunes.
Dinner– vegetable soup with vegetable oils ( corn, olive), buckwheat, compote
Afternoon snack– bread, unsweetened cookies, rosehip decoction.
Dinner– mashed potatoes with steamed fish, beet salad, low-fat kefir.

You need to follow a diet not only for a certain period until recovery. This should become a lifestyle and you need to stick to it constantly. To achieve better results and maintain them, diet must be combined with sports. Heavy physical activity is not recommended. Swimming, yoga, Pilates, and cycling are best.

Is hepatosis treated with folk remedies?

Folk remedies help in the treatment of fatty hepatosis no worse than expensive medications. A positive effect can be expected only in the initial stages of the disease. During this period, the main attention is paid not to drug treatment, but to following a properly selected diet, which can be combined with taking decoctions, herbal teas, and tinctures. But we must remember that self-diagnosis and self-medication can be even more dangerous to health than complete absence treatment. The appearance of symptoms of liver disease indicates the progression of the disease with damage to the liver structure and function. And self-medication with folk remedies will only lead to aggravation of the situation and the impossibility of further recovery. Therefore, before using any products, you should consult your doctor.

The goal of folk remedies is to improve liver function, restore liver cells ( hepatocytes), removal of toxins, reducing the amount of fat in the body, weight loss. Many medications are based on medicinal herbs. Therefore these natural remedies may be an effective treatment. Herbs can be used alone or in combination herbal infusions with a complex therapeutic effect on the liver.

Used for the treatment of steatohepatosis :

Why is liver steatosis dangerous? complications, consequences)?

Steatosis ( accumulation of fat droplets in liver cells with their destruction) is dangerous by progression to fibrosis and cirrhosis of the liver. Steatosis is a completely reversible process. To do this, you need to change your diet and lead a healthy lifestyle. But with prolonged negative influence of many factors on the liver and lack of treatment, the disease progresses to more severe stages of the course. The rate of progression differs for each patient. In case of fatty degeneration with concomitant diabetes mellitus, obesity, alcohol intake, viral hepatitis, the process is significantly accelerated and turns into fibrosis.

Fibrosis is a reversible proliferation of dense connective tissue (cicatricial) in the liver when liver cells – hepatocytes – are damaged. In this way, the inflammatory process is limited to prevent its further spread. It has now been proven that fibrosis is treatable. But despite this, fibrosis often progresses to cirrhosis of the liver.

Cirrhosis is a progressive, irreversible disease in which liver tissue is replaced by scar tissue. At the same time, the number of functioning cells is significantly reduced. In the initial stages of the development of cirrhosis, it is possible to stop and even partially restore damaged structures, but in severe cases the disease is fatal ( patient's death). The only treatment is a liver transplant.

Can pregnancy cause fatty liver disease?

Periodically, pregnancy is complicated by such a pathological condition as fatty liver hepatosis ( cholestatic hepatosis of pregnancy). Hepatosis appears at the beginning of the third trimester ( from 25 – 26 weeks of pregnancy). Diagnosed in 0.1% - 2% of pregnant women. There is no clear answer about the cause of hepatosis during pregnancy. However, most doctors agree that the trigger is a high level of sex hormones - pregnancy hormones, which causes the manifestation of genetic defects in the processes of bile formation and bile excretion. Therefore, the pathology often becomes familial and is inherited through the maternal line. Other reasons besides genetic predisposition may include uncontrolled use vitamin preparations, which the liver cannot cope with fully, an unbalanced diet with excess amounts of fats and carbohydrates, which leads to fatty degeneration of the liver and the development of acute fatty hepatosis. Put correct diagnosis Only a doctor can do this based on laboratory and instrumental examinations.

Symptoms of fatty hepatosis in pregnant women are:

widespread skin itching;
icteric staining of the mucous membranes and skin;
nausea, heartburn, periodic vomiting, loss of appetite;
a feeling of heaviness and moderate pain in the upper abdomen on the right;
stool discoloration;
general weakness, malaise, fatigue.

Cholestatic hepatosis in pregnant women can be dangerous for the mother and fetus, as the risk of oxygen starvation increases ( hypoxia) baby and premature birth. Delivery is very common ( ) at 38 weeks or even earlier, given the severity of the woman’s condition. Fatty liver disease in pregnant women can lead to severe postpartum hemorrhage, since the liver’s production of blood clotting factors is disrupted, which leads to inadequate functioning of the hemostatic system ( a complex biosystem that ensures that blood is maintained in a liquid state under normal conditions, and if the integrity of a blood vessel is damaged, it helps stop bleeding).

Can children get hepatosis?

Hepatosis also occurs in children. Hepatosis is divided into primary ( hereditary, congenital) and secondary ( acquired), as well as pigment ( disruption of the metabolic processes of pigments - substances that give color to tissues) and fat ( violation of fat metabolism with their accumulation in liver cells).

Hereditary hepatosis - liver damage against the background of genetically determined metabolic disorders, manifested by a violation of intrahepatic bilirubin metabolism ( main component of bile). Manifests itself from birth in the form of chronic or recurrent jaundice ( yellowness of the skin and mucous membranes). These hepatoses are usually benign, with almost no effect on the patient’s quality of life, with the exception of Crigler-Nayjar syndrome, accompanied by a high level of bilirubin in the blood with toxic damage to the central nervous system, heart and internal organs.

Secondary hepatosis develops against the background of concomitant diseases and poor lifestyle. Diabetes mellitus type I ( appears in childhood), obesity, congenital hepatitis, toxic effect medications, cholestatic disorders ( bile stagnation), poor nutrition are the main causes of liver disease in children.

Is it possible to cure fatty hepatosis?

Fatty liver disease is a reversible liver disease. This pathology can be successfully treated in the early stages. There is no specific treatment. It all comes down to changing lifestyle, reviewing nutrition, eliminating etiological ( causal) factors. In many cases, it is not possible to exclude the causes contributing to the development of hepatosis. For example, incurable diabetes mellitus, congenital metabolic disorders, many endocrinological diseases. In this case, maintenance therapy is carried out with hepatoprotectors ( medications that help protect and restore liver cells), lipid-lowering drugs ( reducing the concentration of fats in the blood), antihypoxic ( improving the utilization of oxygen by the body, increasing the resistance of tissues and organs to oxygen starvation) and antioxidant ( protecting cells from destruction due to excessive exposure to reactive oxygen species) drugs and others. They also support concomitant diseases in the stage of compensation, that is, the body’s adaptation to the pathological condition with a reduction in negative consequences.

Basically, fatty hepatosis is asymptomatic. It is diagnosed accidentally during routine examinations or diagnostic procedures for other diseases. Therefore, it is rarely possible to detect hepatosis in the early stages. Over time, the situation only gets worse and is complicated by fibrosis ( reversible replacement of normal organ tissue with scar tissue) or cirrhosis ( irreversible chronic replacement of tissue with scar tissue). In this case, it is very difficult or impossible to cure the liver.

What is the difference between hepatosis and liver steatosis?

Steatosis is a type of hepatosis. Hepatosis is a set of liver diseases, which are based on metabolic disorders with disruption of the structure and function of liver cells ( hepatocytes). Steatosis is a pathological ( abnormal) accumulation of fat in body cells due to metabolic disorders. There are pigmentary hepatosis ( violation of the metabolism of pigments - substances that color the skin and tissues) and fatty hepatosis ( synonyms – hepatic steatosis, fatty liver, fatty infiltration of the liver, steatohepatosis, fatty degeneration, “fatty” liver).

Development of fatty hepatosis ( steatosis) patients with type 2 diabetes mellitus are more susceptible ( incidence of the disease from 70% to 90% of patients), obese ( from 30% to 95% of patients), with impaired fat metabolism ( from 20% to 92% of cases).

To diagnose steatosis, laboratory and instrumental methods are used. TO laboratory methods include general and biochemical blood tests. With steatosis, blood tests reveal an increase in transaminase activity ( enzymes in liver cells that speed up chemical reactions) 4 – 5 times, increasing cholesterol concentration ( fat-like structural element of cells), lipoproteins ( complexes of proteins and fats) low density, increased blood sugar, bilirubin ( bile pigment), decrease in protein concentration and others. Instrumental analyzes include ultrasound examination ( Ultrasound), Magnetic resonance imaging ( MRI), CT scan ( CT), elastography ( Fibroscan) and liver biopsy. These examinations reveal an increase in liver size ( hepatomegaly), local or diffuse fatty accumulations in liver cells, cysts ( pathological cavities in tissues), fibrosis ( a reversible process of replacing healthy liver tissue with scar tissue).

Metabolic disorders affect not only the liver. Therefore, steatosis is characteristic not only of the liver ( as in the case of hepatosis), but also for the pancreas. The causes of pancreatic steatosis are the same factors as for the liver - excessive alcohol intake, obesity, diabetes, taking certain medications and many others. Therefore, when diagnosing “steatosis,” it is necessary to clarify the pathology of which organ we are talking about.

Is it possible to do tubage for fatty hepatosis?

Fatty hepatosis is not a contraindication for tubage. Tubazh ( from French – tube insertion, intubation) is a medical procedure to cleanse the gallbladder ( digestive organ located under the liver and connected to it by the bile ducts).

The essence of the method is irritation of the gallbladder with choleretic agents ( drugs or substances that stimulate bile production) means followed by enhanced excretion of bile. This procedure is carried out to prevent bile stagnation ( cholestasis) and the formation of gallstones. It is used for diseases of the liver, gall bladder and bile ducts with symptoms of inflammation and impaired bile secretion. Absolute contraindication to tubage is calculous cholecystitis ( inflammation of the gallbladder due to the presence of stones). This can cause a gallstone to pass from the gallbladder into the bile duct, resulting in a blockage of the duct. In this case, only urgent surgical intervention can help.

Tubage can be performed using a duodenal tube or by taking choleretic drugs while simultaneously warming the liver. In the first case, a probe is inserted into the duodenum ( hollow tube) and parenterally ( intravenously) or choleretic substances are administered through the tube. This leads to increased release of bile into the duodenum, from where it is aspirated ( suction with a special device called an aspirator) through a probe. Choleretic substances such as magnesium sulfate solution, sodium chloride solution, 40% glucose solution are taken orally, histamine, atropine and others are taken intravenously.

The second method is probeless tubing ( blind tube). To carry out this procedure, the patient lies on his right side, bending his knees, and drinks a choleretic drug. A warm heating pad is placed under the right side at the level of the liver. Rosehip decoction, magnesium sulfate solution, heated mineral water and others are used as choleretic agents. The patient remains in this position for about 1.5 – 2 hours. The procedure should be carried out once a week for 2 to 3 months.

Which doctor treats hepatic steatosis?

A hepatologist is involved in the diagnosis, prevention and treatment of liver diseases. But since liver steatosis can be caused by various diseases, pathological processes and unhealthy lifestyle, then the treatment and diagnosis of the disease should be dealt with comprehensively. And the hepatologist can prescribe a consultation with doctors of another specialization.

A hepatologist may schedule a consultation with doctors such as:

Life expectancy with fatty hepatosis

It is impossible to unequivocally answer the question about life expectancy with fatty hepatosis. Everything is strictly individual and depends on age, stage of the pathological process, concomitant diseases, complications, treatment effectiveness and the patient’s desire to change his lifestyle. Steatosis does not have a significant effect on life expectancy. Moreover, this disease is easily treatable in the initial stages. The prognosis changes significantly with the transition to fibrosis ( reversible process of scar tissue growth) and cirrhosis ( irreversible process of scar tissue growth). This negatively affects the structure and function of the liver. In severely advanced cases, lack of proper treatment and the presence of provoking factors, the disease progresses rapidly and life expectancy is significantly reduced.

Fibrosis progresses more favorably than cirrhosis. There are five stages of fibrosis. Progression can occur at different rates. For example, it can take several years from stage 0 to stage 2, and stage 3 to 4 in a fairly short period of time. The progression of fibrosis is significantly influenced by diabetes mellitus, obesity, lipid metabolism disorders, age ( progression accelerates significantly after age 50) and others. With diet, a healthy lifestyle and proper treatment, fibrosis can be cured.

Cirrhosis is a severe irreversible disease. Life expectancy with liver cirrhosis directly depends on the severity of the disease. With compensated cirrhosis, the body adapts to the pathology with the least negative consequences. Thus, preserved hepatocytes ( liver cells) perform the functions of dead cells. At this stage, life expectancy is more than seven years in 50% of cases. In the subcompensation stage, the remaining hepatocytes are exhausted and are unable to perform all necessary functions. Life expectancy is reduced to five years. With decompensated cirrhosis, the patient's condition is extremely serious. Life expectancy is up to three years in 10% - 40% of cases.

Does hirudotherapy help? treatment with leeches) with hepatosis?

Hirudotherapy ( treatment with leeches) can help with complex treatment hepatosis. This procedure is used for inflammatory processes in the liver ( For example, chronic hepatitis, toxic hepatitis ), cirrhosis ( irreversible replacement of normal organ tissue or scar tissue).

Contraindications to hirudotherapy are:

pregnancy;
hypotension ( low blood pressure);
anemia ( anemia, manifested by low concentrations of red blood cells and hemoglobin);
hemophilia ( congenital bleeding disorder);
individual intolerance.

The technique of hirudotherapy is very simple. Before therapy, the treatment area is treated with alcohol. Then onto the skin into the area biologically active points leeches are placed. Their bite is practically not felt, as they secrete special painkillers. After about 30 - 45 minutes, the saturated leeches disappear on their own. Apply to wounds sterile dressing. The course of treatment is 12 sessions with a frequency of 1 – 2 times a week.

Massage exercises and yoga help improve liver function. All exercises performed while standing on all fours or lying on the right side minimally load the liver and promote the outflow of bile. Among the exercises for the liver are “scissors” ( while lying on your back, scissor-style leg swings are performed), "bike" ( lying on your back simulates cycling), squats, jumps. Also has a beneficial effect on the liver breathing exercises.

To achieve a therapeutic effect from physical activity, you should follow a diet, do not neglect proper rest, and also completely stop smoking and drinking alcohol.

Fatty liver is a pathology that occurs due to excessive accumulation of fats (lipids) in the cells of the organ. It also has other names - fatty liver And fatty liver disease.

Fat accumulation can be a reaction to various toxic influences and is sometimes associated with certain diseases and pathological conditions the body when a person’s immune system functionality decreases.

As simple fats accumulate in liver cells, under the influence of various factors, they degenerate and form adipose tissue. Gradually, the liver loses its natural ability to neutralize toxins and ceases to function properly.

Causes

The pathological process usually develops due to the influence of dietary factors:

abuse of fatty foods;
systematic consumption of alcoholic beverages;
vegetarianism leading to carbohydrate metabolism disorders;
the predominance of sweet foods in the diet, the components of which are transformed into fats;
regular consumption of cheap food and semi-finished products.

In some patients, hepatosis appears against the background of atherosclerosis, gout, diabetes mellitus, hypertension, drug use or certain medications. Women get sick mainly due to diets that end in sudden overeating.

Symptoms

The disease develops in stages. At stage I, it can be generally asymptomatic, but is detected during morphological research organ with taking a biopsy. As fatty liver disease progresses, the patient's well-being worsens. A person complains of such deviations as:

bloating;
feeling of heaviness and pain in the hypochondrium on the right;
various stool disorders;
yellowish coating on the tongue;
occasional nausea;
bitter taste in the mouth.

When stage III is reached, the symptoms of the disease appear as a result of dysfunction of hepatocytes, that is, liver cells. The patient exhibits chronic intoxication, which manifests itself in depression, memory impairment, drowsiness, and irritability. Against the background of cirrhotic changes and impaired blood flow through portal vein syndrome develops portal hypertension. Stage III fatty liver disease is judged by concomitant diseases:

jaundice;
varicose veins of the esophageal veins;
dilation of the veins in the abdomen (the so-called “head of the jellyfish”).

Diagnostics

To confirm the diagnosis of “fatty liver,” the patient is given a referral for an ultrasound scan of the abdominal cavity (during palpation of the abdomen, the doctor can only determine the enlargement of the organ).

The results of a biochemical blood test show elevated levels of liver enzymes. In some cases, a biopsy is taken from the patient and a magnetic resonance or computed tomography scan is offered.

Treatment

Steatosis therapy has several goals:

elimination of factors that provoked organ obesity;
removal of toxins;
metabolism correction;
restoration of liver functions.

Drugs of 3 groups are prescribed as drug therapy:

essential phospholipids – protectors of hepatocytes (Phosphogliv, Berlition, Essentiale Forte);
sulfoamino acids (Taurine, Methionine, Ademethionine);
medicines with herbal ingredients (Karsil, Liv).

Traditional methods of treatment

To remove fats from the organ, it is recommended to drink rosehip decoction. It is prepared by infusing 50 g of berries in a thermos for 12 hours, poured with half a liter of boiling water. Take the infusion 4 r. a glass a day. Corn silk is brewed in a similar way.

You can help the liver restore its normal size by drinking citrus infusion. To prepare it you will need 3 lemons, thoroughly washed and processed in a blender, and half a liter of boiling water. Lemons are crushed together with the peel and the resulting pulp is combined with water. The product is infused overnight, filtered in the morning, and taken between meals for 3 days in a row, no more. Then they take a 4-day break and are treated with infusion again.

To strengthen liver cells, it is useful to eat 1 tsp daily. pine nuts. It is also recommended to add mint leaf or lemon balm to any tea in the morning. Mint herbal infusion is prepared from 20 g of leaves and 125 ml of boiling water. The product is infused all night, and in the morning it is divided into 3 parts and drunk over the next 24 hours.

Prevention

People with this diagnosis are recommended to follow dietary table No. 5. His diet includes increased content protein with limited animal fats. The menu must include dishes from cottage cheese, rice, and cereals - they break down the fats accumulated in the liver.

It is useful to eat pumpkin, cabbage, and carrots as light choleretic agents. Vegetables can be eaten in any form, but not fried. Meat and fish are boiled or stewed. From dairy products you can drink fermented baked milk, kefir, and yogurt. But it is not recommended to drink heavy cream, milk or eat cheese. The following are also prohibited:

For fatty liver disease, it is necessary to consume foods with pangamic acid. It could be brewer's yeast apricot kernels, melons, rice bran, brown rice.

The following measures are indicated as maintenance therapy:

What else is good for the liver, see below:

Forecast

With timely adequate therapy and weight loss, the results of treatment for fatty liver will be noticeable in about 3 weeks. Complete restoration of the organ can be achieved in a few months. To maintain the body in satisfactory condition, the patient must adhere to a diet and give up bad habits. For pregnant women, fatty liver is dangerous due to complications during pregnancy and even death during childbirth.

Negative prognostic factors include the possible degeneration of pathology into fibrosis (proliferation of connective tissue occurs with replacement of liver cells).

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Fatty liver degeneration is a chronic disease of the organ. In this case, degeneration of gland cells is observed. This pathology occurs quite often and requires mandatory treatment. The liver is the most important unpaired organ. The gland performs a large number of different functions. In particular, digestive, protective, cleansing. Up to one hundred liters of blood passes through the liver every day. During this period, it is cleared of heavy metals, toxins, poisons. And all harmful substances settle in the organ and are eliminated after some time. Consequently, the full functioning of the entire organism depends on the health of the organ.

Fatty liver and its causes

In medicine, fatty degeneration can be called steatosis, hepatosis, lipoidosis, steatohepatosis. The disease does not develop due to an inflammatory process. The main change is a large accumulation of adipose tissue in the organ, which becomes overgrown with a capsule. These capsules subsequently develop into cysts. If not treated promptly, cysts can rupture, causing serious complications.

Fatty degeneration, most often, begins to develop at a more mature age of 45-50 years. The main cause of pathology is considered to be metabolic disorders. Violations occur against the background of various factors. Liver hepatosis in most men develops due to excessive alcohol consumption. In this case, alcoholic fatty degeneration is diagnosed. Dangerous and a common complication pathology can be called cirrhosis of the liver.

Liver damage also occurs due to excessive consumption of energy drinks, drugs, and cigarettes. Many people believe that fatty degeneration occurs only in people who are overweight. This opinion is fundamentally wrong. Liver hepatosis is often detected in thin people. This phenomenon is explained by protein deficiency in the human body. In this regard, fatty degeneration is typical for vegetarians. People who are addicted to various diets also suffer from this disease. Extreme sudden weight loss puts a lot of stress on the liver, which begins to accumulate fatty tissue.

Accompanied by the following chronic diseases:

Other factors can also lead to fatty degeneration. Thus, poor nutrition and low amounts of vitamins consumed negatively affect all organs of the digestive system. develops against the background of frequent intoxication, poisoning, and damage to the body by chemicals. Pesticides that enter the body along with vegetables and fruits damage the liver. Even some medications provoke obesity of the gland. These include antibiotics and hormonal agents. Synthetic hormones with high levels of estrogen cause not only dystrophy, but also polycystic gland disease.

Heart and bronchial diseases cause oxygen deficiency. And oxygen deficiency can also serve as a factor in fatty degeneration. Frequent excess of lipids into the gland is considered dangerous. Lipids settle in the liver, fat droplets accumulate and grow. Small amounts of these components are not dangerous. In this case, hepatocytes have time to process and remove them. The progression of an increase in fat cells leads to the next stage of fatty degeneration - inflammatory hepatitis. Next comes liver failure and cirrhosis.

Symptoms of fatty liver disease

The initial stage of fatty liver is asymptomatic. Therefore, it is extremely difficult to recognize the disease in a timely manner. After all, few people regularly undergo routine medical examinations. The disease can be classified according to several criteria. So, the main one is the classification by stages. The first stage of fatty degeneration is characterized by a small number of fat molecules that do not have a significant effect on the liver. But the pathogenic process has already started.

At the second stage, fatty components almost completely fill the liver cells. There is a risk of developing an inflammatory process. The last third stage is irreversible. The liver cannot perform its functions due to tissue necrosis. In connection with this classification, the signs completely depend on the stage of the disease. The first symptoms begin to appear already in the second stage. The following manifestations are worth noting:

The last stage of the disease manifests itself very clearly. The patient complains of sleep disturbances. There is drowsiness during the day and insomnia at night. Fatigue increases, memory deteriorates, and jaundice appears. Due to the accumulation of free fluid, the abdomen increases in size. The patient becomes irritable and prone to depression. To relieve pain, you need to use more serious drugs, because simple analgesics do not help. Sometimes itching of the skin may occur.

Necrosis in fatty liver is considered very characteristic and typical. Added to all previous symptoms bad smell sweat, mouth, nosebleeds, anorexia, cardiac dysfunction, rapid breathing, increased body temperature. When the very first appear minor signs illness, you must immediately seek help from a specialist. It is strictly forbidden to prescribe therapy yourself. Such actions can lead to complications and death. After all, the disease develops in the shortest possible time.

Treatment methods

Before prescribing treatment, it is necessary to diagnose the abdominal organs. So, the specialist begins collecting anamnesis by interviewing the patient, examining, and palpating the liver. Palpation may reveal an enlarged organ. Next, the patient must pass a series of tests and undergo instrumental examinations. A blood test will show some changes in your blood counts. Ultrasound diagnostics, MRI, CT will allow you to fully assess the condition of the organ and identify the stage of the disease. Only after this the most correct treatment is prescribed.

First of all, the factor that provoked fatty liver degeneration is excluded. So, in the case of alcoholism, a consultation with a narcologist is prescribed. If obesity occurs against the background of diabetes mellitus, the endocrinologist should reconsider the methods of treating the disease. It is very important during and after therapy to follow a diet and daily physical activity.

For patients with increased body weight, it is recommended to reduce it. This will automatically reduce the load on the gland and remove excess fat. But losing weight should be slow and gradual. After all, rapid weight loss provokes inflammation of the organ. In combination, the doctor prescribes some medications that normalize and restore the normal process of fat metabolism in the liver. At mild course diseases, therapy is prescribed aimed at antioxidant protection, restoration of cell membranes and hepatocytes.

Thus, hepatoprotectors are used to normalize liver functions. The following medications are highly effective:

The leading position is occupied by the drug Heptral. This drug is complex. It consists of two natural ingredients- methionine, adenosine. Thus, Heptral takes an active part in restoring liver cell membranes, prevents fat oxidation, and stimulates the production of essential protein in the liver. A very useful remedy for alcohol impairment glands. Its effectiveness is observed not only at the stage of fatty degeneration, but also hepatitis and cirrhosis.

Traditional medicine against fatty hepatosis

Very often representatives traditional medicine recommend seeking help traditional therapy. A large number of herbs and plants have positive effect on the condition of the liver. Everyone knows that most natural preparations for treating the liver are made from milk thistle. In this regard, several herbal preparations have been developed for the treatment of fatty degeneration of the organ.

Milk thistle has a choleretic effect and reduces cell insulin resistance. This prevents the development of fibrosis and cirrhosis. Fatty liver disease can be treated with the following herbal tea:

Plantain leaves;
Milk thistle seeds;
Roots of marsh calamus;
Horsetail;
A series.

All ingredients are taken in the amount of 1 teaspoon. The mixture is poured into a glass of boiling water. It is advisable that it is not just water, but dill infusion. Cover the product with a lid and leave for 40-50 minutes. After this, the preparation is filtered, and a little more dill infusion is added to it, up to 200 ml. Take 50 g of this folk remedy a few minutes before meals. The number of doses per day should be 4-5 times. The course of therapy is quite long - up to 5 months.

Oats have a rich complex of vitamins, which are also often used to treat the liver. For fatty degeneration, it is customary to use a decoction of whole oat grains, oat jelly, and a decoction of oat flour with the addition of honey. This plant promotes the rapid breakdown of fats. Sometimes pumpkin is used in the treatment of hepatosis. This is because the vegetable is rich in minerals and vitamins that restore organ cells.

The following collection is also highly effective: wormwood, sage, string, raspberry leaves, yarrow, chamomile, birch leaves. All components are mixed in equal quantities. The product is poured with boiling water in a ratio of 1:2. After this, the drink is infused for three hours, filtered, and drunk throughout the day, like regular tea.

Diet

It is very important to follow dietary nutrition. The diet should be rich in vitamins and minerals. On initial stage fatty degeneration, simple adherence to a diet is enough for complete. Specialists install table No. 5. In this case, fat consumption is limited, but it is important to consume enough animal protein. So, the following foods are included in the diet:

It is very important to consume a sufficient amount of purified non-carbonated water throughout the day. It is good for the liver to eat carrots, beets, pumpkin, fresh cucumbers, cauliflower, parsley, and zucchini. Healing properties Prunes, bananas, and apples are good for the organ. The dishes must be prepared steamed or baked and boiled. You need to exclude alcohol, large amounts of salt, vinegar, marinades, spices, preserves, fatty meats, coffee, from your diet. meat broths, radishes, garlic, legumes, mushrooms. Proper nutrition combined with an active lifestyle and sports will help to very quickly restore all liver functions and prevent the development of complications of fatty degeneration.

The question of what liver dystrophy is is of interest to many patients who are faced with a similar diagnosis. As doctors explain, this is a comatose state that arose as a result of deep depression of liver functionality. Liver dystrophy (LD) is provoked by various chronic diseases in which the bile-forming gland is damaged.

The liver is a unique organ that plays an important role in lipid metabolism. Triglycerides from food enter the intestines, where they are broken down by enzymes and then enter the bloodstream. Together with the blood, fats enter the liver, where they are converted into various substances necessary for normal operation body.

With excessive accumulation of lipids, fatty degeneration occurs, in which the concentration of fats in the organ increases 10 times. The content of triglycerides can reach more than 50% of the total volume of the gland, and normally this figure does not exceed 5%.

The disease progresses slowly and does not manifest itself characteristic symptoms. It is important to identify signs of pathology in time and consult a doctor who will conduct diagnostics, identify the cause and establish a diagnosis. With absence timely treatment the likelihood of dangerous complications, including death, increases.

Causes of the disease

In most cases, DP occurs due to the fact that the response of hepatocytes (liver cells) to the effects of insulin is reduced. Insulin is a hormone that transports glucose to the body's cells. Due to the fact that hepatocytes do not respond to the action of insulin, a lack of glucose in the liver appears. Glucose is very important for the normal functioning of liver cells, so if there is a deficiency of the substance, they begin to die. The affected cells are eventually replaced by adipose tissue. As a result, liver dysfunction occurs.

DP occurs due to poor nutrition, bad habits, passive lifestyle, etc.

Hepatocytes become resistant to the effects of insulin due to genetic pathologies or metabolic disorders. The lack of a normal response of liver cells may be due to immune aggression towards insulin.

Other causes of DP:

Presence of bad habits (alcohol, smoking).
Excessive consumption of fatty foods.
Passive lifestyle.

All these factors negatively affect the condition of the liver, causing irreversible changes.

Symptoms

Symptoms of liver dystrophy are most often mild, and the patient may simply not pay attention to them. As a rule, patients do not complain of any disturbing phenomena. The pathological process develops slowly, and clinical picture not explicit.

As DP develops, a dull pain occurs on the right side under the ribs, nausea, hepatomegaly, etc.

However, over time, the following signs appear:

dull pain on the right under the ribs;
hepatomegaly;
nausea;
eruption of vomit;
bowel disorders.

In rare cases, dystrophic changes in the gland are accompanied by severe abdominal pain, sudden weight loss, itching, and yellow discoloration of the skin and mucous membranes.

Typically, symptoms of DP are divided according to the type of pathology. In toxic liver dystrophy with widespread necrosis (tissue death) of the organ parenchyma, increased growth of hepatocytes is observed, which are located next to portal vein lymph nodes and spleen. DP manifests itself as multiple bleedings in the skin, internal and serous membranes. In addition, necrotic and dystrophic changes are observed in tissues that affect the heart muscle and pancreas.

Toxic DP with a chronic course progresses over time to large-nodular cirrhosis (one that develops as a result of widespread necrosis of the organ parenchyma). If left untreated, the patient's likelihood of death due to hepatorenal syndrome (severe functional acute renal failure) increases.

Liver lipodystrophy

Fatty liver degeneration (fatty hepatosis) occurs due to the replacement of hepatocytes with fat cells. With hepatosis they accumulate body fat, which look like drops on the liver.

The cause of fatty degeneration is pathology of the gallbladder, its duct or intestinal tract. FLD (fatty liver) can cause the following diseases:

Intense obesity.
Diabetes mellitus type 2 malabsorption and maldigestive syndrome.
Excessive consumption of alcoholic beverages.
Taking corticosteroids, tetracyclines, estrogens, NSAIDs.

Lipodystrophy often occurs against the background of chronic hepatitis (especially hepatitis type C).

Macroscopic specimen characteristic of HDP: hepatomegaly, the surface of the liver is smooth, the consistency is dense or flabby, the anterior edge of the organ is round, clayey, yellow or yellow-brown.

Toxic DP

Toxic liver dystrophy (TLD) is manifested by extensive, rapidly developing necrotic processes that affect the structure of the liver. Usually the pathology has an acute course, but sometimes it becomes chronic, causing liver dysfunction.

With TDP, necrotic processes develop

Massive necrosis develops under the influence of toxins found in foods, such as mushrooms. Such poisonings occur under the influence of external factors. Toxic liver dystrophy can occur as a result of endotoxemia. Similar conditions include toxicosis in pregnant women and hyperthyroidism (excess thyroid hormones). Often TDP occurs against the background of hepatitis, then dystrophy is a symptom of its fulminant form.

Toxic liver dystrophy is accompanied by hepatomegaly, flabbiness or density of liver tissue, the organ is painted yellow. If left untreated, the size of the gland decreases and the capsular membrane becomes wrinkled. The organ becomes gray in color and resembles a clay mass in appearance. Over the course of 3 weeks, the iron continues to decrease, its color changes to reddish. Over time, the reticular stroma of the liver begins to become exposed, in which dilated, blood-filled capillaries are visible. Liver cells are preserved only in certain areas of the lobules. This is how red dystrophy manifests itself.

Chronic TDP is a rare occurrence that increases the likelihood of patient death due to rapidly progressing liver dysfunction.

Acute hepatic dystrophy

Acute liver dystrophy (ALD) is most often a complication of hepatitis A, which occurs in an unfavorable form. Separately, pathology develops quite rarely.

The disease has been little studied, so doctors cannot accurately answer how it develops. It is also not clear whether there is a connection with the strength of the virus or whether some other factors influence the pathological progress.

ADP is most often a complication of Botkin's disease

Aggravated parenchymal hepatitis is provoked by the following diseases: brucellosis, tick-borne relapsing fever, syphilis. In addition, the likelihood of complications of the disease during pregnancy or after an abortion increases. These factors have a detrimental effect on liver cells, causing severe dystrophy.

Symptoms of ADP at an early stage resemble those of hepatitis A, so there is a risk of significant deterioration in the patient's condition. The pathological process affects the nervous system and, as a result, is disrupted brain activity. The disease is manifested by delirium, anxiety, convulsions, and vomiting. In this case, the patient must be urgently hospitalized in a psychiatric department.

A reverse reaction of the nervous system is also possible: indifference to everything that is happening, depression, decreased vitality, craving for sleep. Symptoms continue to increase, the patient loses consciousness, and hepatic coma develops.

Alcoholic dystrophy

This type of dystrophy occurs due to excessive consumption of alcoholic beverages for 10–12 years. Ethanol penetrates the body and poisons hepatocytes.

ADP manifests itself against the background of excessive and long-term use alcoholic drinks

Alcoholic liver dystrophy (ALD) can occur against the background of hepatosis, cirrhosis, and alcoholic hepatitis. Most often, it is hepatosis that causes gland dystrophy due to excessive consumption of alcoholic beverages. If the patient gives up strong drinks at the early stage of hepatosis, the condition of the liver improves after 2–4 weeks. In most cases, ADP does not cause significant symptoms.

Signs of ADP:

Enlargement of the parotid salivary glands.
Flexion contracture of the fingers.
Redness of the palms and sometimes feet.

The easiest way to identify the disease is through laboratory tests and biopsy.

To restore liver functionality, the patient must give up alcoholic beverages. In addition, the doctor prescribes corticosteroid drugs and essential phospholipids. At the last stage of ADP, an organ transplant is prescribed.

Diffuse dystrophy

Diffuse dystrophic changes in the liver parenchyma are a very dangerous condition. It occurs as a result of the fact that hepatocytes are not able to neutralize toxins that enter the body. Liver cells cannot cope with large-scale poisoning, as a result, parenchymal tissue begins to die, and fibrous connective tissue grows in damaged areas. Diffuse changes become more and more pronounced, and this threatens liver failure. This is how diffuse DP manifests itself.

With diffuse transformation, the liver parenchyma dies

Degenerative dystrophic changes in the liver most often provoke a similar process in the pancreas. This is due to the fact that these organs are closely related to each other.

Focal dystrophy

Focal liver dystrophy (FLD) is difficult to detect using laboratory tests. This is quite difficult even despite the fact that there are functional disorders of the gland. Symptoms of the disease depend on the causes that provoked it.

With focal transformation, individual areas of the liver are affected

Focal DP, which arose as a result of excessive consumption of alcoholic beverages, is manifested by shortness of breath, decreased appetite, and sometimes there is pain on the right side under the ribs. These signs become more pronounced when the patient moves.

The most effective methods for detecting pathology are magnetic resonance and computed tomography.

Granular dystrophy

This is the most common type of protein DP. Granular liver dystrophy (GLD) is characterized by a violation of the colloidal properties of the cell cytoplasm, in which a grain-like protein appears.

With PDD, the organ becomes flabby and its blood supply is disrupted.

ZDP is provoked by the following factors:

Inadequate feeding of the newborn.
Intoxication.
Infectious diseases.
Poor blood and lymph circulation.
Reasons that provoke oxygen starvation of tissues.

Over time, with PDD, protein metabolism in cells changes, the cytoplasm becomes cloudy and swells. Due to damage to the liver tissue, the bile-forming gland becomes flabby and its blood supply is disrupted.

It is important to distinguish the signs of PVD from natural processes synthesis of proteins in cells, in which granularity appears in the protein.

This pathology is reversible, but it has a severe course. Therefore, there is a possibility of degeneration of PDA during intracellular hyalinosis, hydrocele or necrosis.

Protein DP

Protein liver dystrophy (PDL) develops as a result of disorders of protein metabolism and occurs against the background of amyloidosis, hyaline or granular dystrophy.

BDP manifests itself as a result of protein metabolism disorders

With amyloidosis, amyloid (protein-polysaccharide complex) is formed and deposited in tissues.

Hyalinosis is a type of BDP that complicates atherosclerosis. As a rule, the disease manifests itself locally, for example, in the vascular wall during the formation of a blood clot (thrombosis). The pathology is characterized by the formation of translucent protein structures that resemble cartilage.

With BPD, the liver acquires a granular structure, as drop-shaped and granular formations appear in the protoplasm of the cells. They combine and fill the intracellular space. The protein structures become denser, the functioning of the gland cells is disrupted, and as a result, the liver tissues die.

Hydropic liver dystrophy (HDL, vacuolar dystrophy) is accompanied by the appearance of vacuoles (cavities in the cell cytoplasm), which are filled with cytoplasmic fluid. With pathology, the parenchyma cells of the organ increase, which is accompanied by shrinkage or vacuolization of the nucleus.

With HDP, vacuoles filled with cytoplasmic fluid form in the liver

As the disease progresses, the liver becomes filled with fluid, and its ultrastructures undergo decomposition. The affected cells look like containers filled with water and are a solid cavity with a bubble-shaped core. This is how GDP manifests itself.

Changes can only be detected using a microscope, since the liver does not change externally.

The prognosis for vacuolar dystrophy is unfavorable, as intense disorders of the functionality of the gland appear. If left untreated, the disease ends in focal or total cell death.

Yellow liver dystrophy

VDP is often a complication of pregnancy. The pathology occurs as a result of acute poisoning of the body against the background of infectious diseases. Jaundice in an expectant mother can be caused by DP, inflammation of the gallbladder, or stones in the liver. In addition, the disease can occur independently due to autointoxication of the body (toxicosis).

VSD often appears during pregnancy

ZhDP is a severe degree of toxicosis in expectant mothers. Pathology occurs due to severe poisoning with metabolites. The disease is manifested by staining of the skin and mucous membranes yellow, profuse vomiting, clouding of consciousness, delirium and increased excitability. In addition, there is a possibility of hemorrhagic rash (bleeding under the skin), the volume of urine decreases, it contains cyrosine and lecithin, and liver dullness decreases. If left untreated, the patient dies within a few days.

Diagnosis of the disease

Diagnosis of DP is difficult, since traditional laboratory tests are ineffective, despite disorders of the functionality of the gland.

CT and MRI are the main methods for detecting liver dystrophy

The disease is usually asymptomatic; the only sign of pathology is hepatomegaly. The echogenicity of the liver during ultrasound remains within normal limits, and sometimes even increases, so it is quite difficult to distinguish DP from cirrhosis or fibrosis. Ultrasound examination allows you to identify areas with increased echogenicity. Areas of low echogenicity can be identified using CT. Computed tomography and magnetic resonance imaging are the most informative methods DP recognition. With their help, it is possible to determine focal hepatosis of the liver.

A biopsy is performed to identify pathology. During a pathological examination of tissues, the doctor will determine excess accumulation of fat.

Treatment methods

Many patients wonder how to treat DP. Treatment consists of observing the following rules:

Diet.
Treatment of concomitant diseases.
Restoration of the liver structure.
Consolidation of results.

Complex therapy consists of following a diet and taking medications prescribed by the doctor.

If the pathology is caused by diabetes mellitus, then you should consult an endocrinologist, in case of illness digestive tract contact a gastroenterologist or therapist; if you have alcoholism, contact a narcologist.

Typically, doctors prescribe the following medications:

hepatoprotectors,
synthetic antioxidants,
statins.

Hepatoprotectors stabilize cell membranes and restore their integrity. They improve the metabolism of bilirubin, fatty acids, and proteins. For this purpose, Karsil, LIV-52, Hofitol, Essentiale, etc. are used.

Choleretic agents improve the secretion of bile, normalize its composition, and reduce congestion. For DP, Allochol and Holosas are prescribed.

Statins correct the blood lipid profile. With their help, the penetration of fats into the bloodstream is reduced, and excess cholesterol is removed from the body.

If hepatic encephalopathy is observed during DP, the patient is urgently hospitalized. The patient is administered drugs parenterally, and the amount of proteins is limited. In addition, medications are prescribed that correct the acid-base state. Acidosis often occurs with DP; sodium bicarbonate is administered to prevent it. Antibacterial agents suppress intestinal microflora.

At functional disorders liver is prescribed extracorporeal enterosorption. To support metabolism, glucocorticoids are used.

To reduce the load on the liver and speed up recovery, it is necessary to review the menu. The diet should include foods containing vitamins, fiber, pectins, and carbohydrates. Daily norm fat – 70 g. It is important to exclude foods that contain cholesterol and limit salt intake.

When treating DP, it is forbidden to drink coffee, tea, soda and alcohol.

Patients are allowed to eat soups with vegetables, cereals or skim milk. It is recommended to eat fresh, boiled, baked or steamed vegetables. Occasionally you can enjoy low-fat ham, hard cheese (not spicy), egg white omelet or boiled eggs (no more than 1 egg per day). You can also include buckwheat, oatmeal, semolina and rice in your diet. In addition, fermented milk products with a low fat content are not prohibited.

Preventive measures and prognosis for DP

To prevent the disease, you should avoid the factors that provoke it. It is important to give up bad habits: alcohol, smoking, excessive consumption of food (especially fatty foods), and a passive lifestyle.

To prevent DP, it is recommended to lead a healthy lifestyle

To keep it high vitality and to prevent the development of pathological processes, you should eat right, limit the consumption of hot, fried foods, smoked, canned products. In addition, the patient should constantly monitor his weight and maintain it within normal limits.

In order for the liver to function normally, you should exercise daily: race walking, jogging, swimming, etc.

If DP is not accompanied by other diseases, then the prognosis is favorable. With dystrophy with pronounced complications, immunity decreases and the body becomes vulnerable to infectious diseases. Pathogenic microbes enter the body, as a result, the patient tolerates anesthesia and surgical procedures worse and takes longer to recover from them.

If the patient leads an incorrect lifestyle and does not engage in treatment, then the pathology progresses. Then the likelihood of small-nodular cirrhosis and non-alcoholic steatohepatitis increases.

If during treatment for DP the patient abstains from alcohol and follows the diet and doctor’s recommendations, then most likely he will be able to maintain working capacity and improve his general condition.

Based on all of the above, liver dystrophy is a dangerous disease with a chronic course, which occurs as a result of profound inhibition of the functionality of the gland. To prevent dangerous complications, you must be attentive to your health and, if suspicious symptoms occur, contact a hepatologist or gastroenetrologist. If necessary, the doctor will prescribe an ultrasound, MRI or CT scan, as well as a biopsy. The patient must strictly follow the recommendations of doctors and lead a healthy lifestyle.

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Fatty liver disease (or liver lipidosis, fatty hepatosis, steatosis, steatohepatosis, fatty liver disease) is a chronic, non-inflammatory, degenerative liver disease in which there is an accumulation of fatty inclusions in the liver, degeneration of hepatocytes due to impaired fat metabolism in the liver. Most often this diagnosis is made at the age of 45 years. Women suffer from this pathology 1.5-2 times more often than men. In the absence of correct treatment, fatty hepatosis can develop into more serious conditions, which often end in death.

Causes

The main causes of fatty liver degeneration:

The main mechanism for the development of liver lipidosis is quite simple. Fats in the gastrointestinal tract are broken down into fatty acid and triglycerides. In the case when these substances enter the liver in large quantities and under the influence of predisposing factors, a reverse reaction occurs - fat synthesis (esterification). Another mechanism for the formation of fat in tissues is its increased growth under the influence of a large amount of fast carbohydrates. The liver cannot cope with such an amount of free fat and lipids accumulate inside hepatocytes. Under a microscope, it appears as different sized droplets of fat throughout the liver.

It is necessary to distinguish fatty hepatosis from fatty liver. In the first case, fat accumulates inside hepatocytes, and in the second - in the intercellular space, in the connective tissue between cells.

Classification

There is a classification of fatty degeneration based on morphological changes (when examining a liver biopsy under a microscope):

Disseminated focal degeneration - fatty inclusions are single, rare, chaotically located in the liver. Clinical manifestations No;
Disseminated widespread dystrophy - fatty inclusions are located much more densely in the liver. The patient feels a general deterioration in health, periodic discomfort in the right hypochondrium;
Zonal dystrophy - fatty inclusions are located locally, in certain areas of the liver. The clinic is quite pronounced;
Diffuse dystrophy - fatty inclusions occupy the entire liver or one of its lobules. All symptoms are pronounced and cause severe discomfort to the patient.

There is also a classification according to the stages of development of the pathological process:

Stage 1 – hepatocytes contain small fatty inclusions, which practically do not affect the function of the cells, but the processes of destruction have already begun;
Stage 2 – fatty inclusions completely fill the hepatocyte, they are destroyed, and small areas of inflammation may develop around the affected cells;
Stage 3 – processes in the liver are irreversible nature, areas of necrosis (liver cirrhosis) develop.

Symptoms of fatty liver

Symptoms of fatty liver disease depend on the stage of development of the process. The first stage of the process is completely asymptomatic, the patient is not yet bothered by anything. This period of the disease can only be detected by chance, during the diagnosis of another disease, during microscopy of a biopsy specimen.

Symptoms of stage 2 fatty liver:

Pain in the right hypochondrium is nagging, aching, of medium intensity, intensified by eating fatty, fried or spicy foods, or alcohol. Periodically they intensify to cramping;
Nausea, which most often occurs simultaneously with pain in the hypochondrium;
Flatulence (bloating);
The tongue is covered with a white-yellow coating;
Abnormal stool (constipation, diarrhea, or alternation of both).

Symptoms of stage 3 steatohepatosis are more serious complaints:

Increased irritability;
Sleep disturbance (drowsiness during the day and insomnia at night);
Memory impairment;
Tendency to depression;
“Jellyfish head” (expansion of the venous network on the anterior abdominal wall);
Varicose veins in the esophagus;
Increased pain in the right hypochondrium;
Severe nausea after eating;
Rarely – itchy skin.

In the terminal stage, when liver cirrhosis and liver failure are pronounced, additional symptoms join the previous symptoms:

Liver odor from the mouth;
Increased body temperature;
Nosebleeds;
Deterioration or complete loss of appetite;
Dyspnea.

Diagnostics

To diagnose fatty liver, after examining the patient by a doctor, laboratory and instrumental diagnostic methods are prescribed:

Treatment of fatty liver

Drug treatment of fatty hepatosis

Essential phospholipids – Phosphogliv, Essliver, Essentiale;
Amino acids – Heptral, Methionine, Glutargin;
Herbal hepatoprotectors – Karsil, Gepabene, Chofitol;
Vitamins – vitamins E, C, PP and B2;
Ursodeoxycholic acid preparations – Ursofalk, Ursosan.

All drugs are prescribed in individual courses, depending on the degree of liver damage and vary from minimum to maximum dosages.

Diet that eases the course of the disease

Treatment of any stage of fatty liver should begin with proper nutrition:

Increase in protein foods (dairy products, meat, eggs, fish roe, etc.);
Minimizing or even completely eliminating the intake of “fast” carbohydrates (wheat products, sugar, white rice, potatoes). Porridges, products made from rye, whole grain wheat, corn and other types of flour, vegetables and fruits (except bananas and grapes) are allowed;
Some reduction in fat in the diet (eating less fatty varieties meat and fish, reduction of creamy and vegetable oils etc.);
Drinking a sufficient amount of clean water (at least 1.5 liters per day);
Refusal from fried, spicy, over-salted foods for the entire period of treatment.

Also, such people should gradually reduce body weight (no more than 2-3 kg per month), increasing the load, reducing the amount of food consumed at one time, increasing the frequency of meals and reducing the caloric content of food consumed.

Complications

The main complications of fatty liver:

Liver failure;
Development of chronic hepatitis;
Death.

Prevention

Methods for preventing the development of fatty hepatosis include a number of rules and lifestyle modifications:

Increasing the amount of protein in the diet, a slight reduction in fat and an almost complete rejection of “fast” carbohydrates (potatoes, white rice, sugar, wheat products);
Reduce to a minimum or completely abstain from alcoholic beverages;
Increased physical activity;
Strict control over the intake of medications, especially those with hepatotoxic properties;
Treatment of concomitant diseases that increase the risk of developing steatosis (diabetes mellitus, hormonal disorders, obesity, etc.).