Fatty liver What we need to know

Fatty liver is a condition in which fat accumulates in liver cells - hepatocytes, causing cell dysfunction, degeneration and death.

Types of fatty liver

1. Non-alcoholic fatty liver - the most common causes are obesity and diabetes. Its subtypes are:

Simple fatty liver - Lipids accumulate in hepatocytes, but there is no inflammatory process in the cells.

Non-alcoholic steatohepatitis - during which an inflammatory process takes place in hepatocytes. Its solution is fibrotic degeneration of liver cells and cirrhosis, eventually forming liver cancer. This condition leads to liver failure and sometimes requires a liver transplant.

2. Alcoholic fatty liver – associated with excessive alcohol consumption. The progression of the disease is followed by:

• Enlargement of the liver - sometimes there are no symptoms, but pain or discomfort in the right lower quadrant is common
• Alcoholic hepatitis - the inflammatory process in the liver causes fever, nausea-vomiting, abdominal pain, jaundice.
• Alcoholic cirrhosis – connective tissue degeneration of liver tissue. Symptoms of alcoholic hepatitis develop along with:
• Ascites - accumulation of fluid in the abdominal cavity
• Hypertension of the portal vein of the liver
• Bleeding
• Cognitive and behavioral disorders
• Spleen enlargement
• Liver failure

Alcoholic fatty liver develops first and then alcoholic hepatitis. Over time, it turns into alcoholic cirrhosis.

Symptoms of fatty liver

Fatty liver (both alcoholic and non-alcoholic) is not accompanied by symptoms at the beginning. Sometimes there may be severe fatigue/weakness and pain in the right armpit.

Non-alcoholic steatohepatitis Appears during:

• An increase in the size of the abdomen
• Expansion of the subcutaneous capillary network
• Swelling of mammary glands in men
• hyperemia (redness) of the palms
• Jaundice of the skin and sclera
• Nausea-vomiting, weight loss, loss of appetite
• Weakness or altered consciousness

Fatty liver risk factors

Excessive alcohol consumption is the reason for the development of alcoholic fatty liver disease. Risk factors contribute to the development of the disease:

• Obesity
• insufficient nutrition
• Presence of chronic viral hepatitis (especially hepatitis C).
• old age

Some patients with nonalcoholic fatty liver disease have only simple fatty liver disease, while others develop nonalcoholic steatohepatitis. The exact reason for this is unknown. The probability of developing steatohepatitis is high if a person has:

• Overweight or obesity
• Insulin resistance and/or type 2 diabetes
• Hyperlipidemia – i.e. high level of "bad" lipids (LDL, VLDL) in the blood
• Polycystic ovary syndrome
• old age
• Hypothyroidism
• Hypopituitarism (insufficient functional activity of the pituitary gland)
• insufficient nutrition
• Rapid weight loss
• Exposure to chemicals or other poisons
• Metabolic syndrome (high blood sugar and lipid levels, arterial hypertension, abdominal obesity)
• Taking medications of some groups: corticosteroids, methotrexate, synthetic estrogens, tamoxifen and others.

Fatty liver in children

Non-alcoholic fatty liver may develop even in children. It is more common:

• In adolescence (rather than in young adults)
• In children of African and Asian-American descent
• It is more common in boys than in girls.

Fatty liver in children usually does not cause complications and only requires periodic monitoring of sleep, proper nutrition and healthy lifestyle.

Diagnosis

Since the disease is sometimes not accompanied by obvious symptoms, people often do not even know about their diagnostics. The diagnostics process is complex and requires the collection and interpretation of clinical-anamnesis and instrumental-laboratory data.

Medical history and physical examination

Diagnosis of the disease begins with the collection of anamnestic data: alcohol consumption, medications - which the patient takes, their dosage and duration - are important data for the differential diagnostics of the disease.

Physical examination can determine: increase in the size of the liver, pain on palpation, weight, mass index, skin color, subcutaneous vascular network and others are also evaluated.

Laboratory diagnostics

Liver function tests Used to detect and monitor liver damage. Liver cells are cells containing enzymes, when they are damaged, these enzymes enter the blood stream where the liver is evaluated. When the liver is damaged, the level of liver enzymes in the blood is much higher than normal.

Tests to evaluate liver fibrosis It evaluates the degree of liver fibrosis or replacement (scarring) with connective tissue.

lipid profile – Determines the level of cholesterol and triglycerides in the blood.

glycated hemoglobin – It is a study that evaluates the level of glucose in the blood during the last 3-4 months

If necessary, tests for hepatitis C, other viral hepatitis, Wilson's disease and other tests are performed.

visualization

Ultrasound, computed tomography, magnetic resonance tomography. Imaging studies can visualize the structure of the liver.

Elastography  It is a study that reveals the degree of elasticity of the liver during fibrosis.

Liver biopsy It is necessary to carry out such complications as cirrhosis of the liver. Morphological study of liver tissue provides detection of the type of damage.

Treatment

During viral hepatitis, the course of virus elimination begins.

In the course of treatment, it is necessary to correct the diet and lose weight. It helps to reduce the degree of inflammation and fibrotic degeneration in the liver. Losing 3-5% of body weight often significantly reduces fatty liver.

To reduce liver damage, it is necessary to stop drinking alcohol.

In case of non-alcoholic steatohepatitis, which is complicated by cirrhosis, liver transplantation becomes necessary.

Aids

Alternative means of treatment often play an important role in the treatment of fatty liver:

Vitamin E - It reduces the inflammatory process, although the effect of its action depends on such factors as the dose, the patient's age, overweight and others. Vitamin overdose may cause intoxication.

caffeine – Caffeine has a positive effect on reducing fatty liver, although the exact mechanism is unknown. Caffeine is believed to activate liver enzymes that help detoxify the liver and reduce inflammation.

Reversible fatty liver

The process of fatty liver may be reversible if the effects of pathogenic factors such as: alcohol intake, excessive caloric diet and others are stopped in time. The liver is one of the human organs that has the ability to renew and replace damaged cells. However, for this it is necessary to exclude harmful factors.

Lifestyle change – Weight loss, physical activity, a diet rich in useful substances, control of diabetes, hypercholesterolemia and other diseases are essential factors for reducing fatty liver.

Complications

To reduce the inflammatory process, the liver tissue begins to undergo fibrotic (connective tissue) degeneration. Cirrhosis is the final stage of the fibrotic degeneration and inflammatory process. This condition is accompanied by:

• Ascites - accumulation of fluid in the abdominal cavity
• Varicose veins of the esophagus and bleeding
• Spleen enlargement
• Liver cancer
• Liver failure

Liver cirrhosis affects the length and quality of a person's life.

"Synevo" offers laboratory tests for diagnosing and monitoring fatty liver:

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