What Is the Relationship Between Fatty Liver and Cirrhosis?

Fatty liver (fatty liver) refers to a disease caused by excessive accumulation of fat in liver cells due to various reasons. It is a common liver pathological change, not an independent disease. Fatty liver disease is seriously threatening the health of people in China, becoming the second largest liver disease after viral hepatitis, with an increasing incidence and a younger age. Normal human liver tissue contains a small amount of fat, such as triglycerides, phospholipids, glycolipids, and cholesterol, and its weight is about 3% to 5% of the weight of the liver. If too much fat is accumulated in the liver, it exceeds 5% of the weight of the liver Or when more than 50% of liver cells have steatosis in histology, it can be called fatty liver. Its clinical manifestations are asymptomatic in mild cases and severe in severe cases. In general, fatty liver is a reversible disease, and early diagnosis and timely treatment often return to normal.

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How to treat fatty liver? 2018-11-13 19:11

Fatty liver is a disease caused by excessive accumulation of fat in liver cells due to various reasons. The most common one is non-alcoholic fatty liver (NAFLD). In the clinical application of insulin sensitizers, lipid-lowering drugs and antioxidants, we can also improve the lifestyle to achieve non-alcoholic fatty liver treatment and prevention. ... more

Basic Information

English name: fatty liver
Visiting department: Internal Medicine, Gastroenterology
Multiple groups: Obese

Common causes: Alcoholism, rapid weight loss, malnutrition, diabetes, certain drugs, etc.
Common symptoms: Fatigue is the most common conscious symptom in patients with fatty liver

Causes of fatty liver

The liver is the central organ for lipid metabolism in the body. The liver fat is mainly derived from food and peripheral adipose tissue. The metabolic mechanism that causes lipid deposition in liver cells is not completely clear. At present, the formation of fatty liver is related to the following factors.

Obesity

The degree of fat accumulation in the liver is directly proportional to body weight. 30% to 50% of obese patients with fatty liver, the rate of fatty liver disease in severely obese patients is as high as 61% to 94%. After the weight of obese people is controlled, their fat infiltration also decreases or disappears.

2. Alcohol

Liver puncture biopsy of long-term alcoholics, 75% to 95% have fat infiltration. It has also been observed that the incidence of alcoholic fatty liver increases by 5 to 25 times when drinking more than 80 to 160 grams per day.

3. Lose weight fast

Fasting, excessive dieting, or other rapid weight loss measures can cause a large increase in lipolysis in the short term, consume liver glutathione (GSH), increase the amount of malondialdehyde and lipid peroxide in the liver, and damage liver cells , Leading to fatty liver.

4. Malnutrition

Malnutrition leading to protein deficiency is an important cause of fatty liver. It is more common due to inadequate feeding or digestive disorders. Apolipoprotein cannot be synthesized, so that triglycerides accumulate in the liver and form fatty liver.

5. Diabetes

Fatty liver can occur in about 50% of diabetic patients, and most of them are adult patients. Because 50% to 80% of adults with diabetes are obese, their plasma insulin levels and plasma fatty acids increase, fatty liver changes are related to both the degree of obesity and eating too much fat or sugar.

6. Drug

Some drugs or chemical poisons cause fatty liver by inhibiting the synthesis of proteins, such as tetracycline, adrenocortical hormone, puromycin, cyclohexanamine, turpentine, and arsenic, lead, silver, mercury, etc. Lipid-lowering drugs can also form fatty liver by interfering with lipoprotein metabolism.

7. Pregnancy

It usually occurs at 34 to 40 weeks of the first pregnancy. The disease is serious and the prognosis is poor. The maternal and infant mortality rates reach 80% and 70%, respectively.

8. Other

Fatty liver can also occur during infections such as tuberculosis, bacterial pneumonia, and septicemia. If patients with viral hepatitis have excessive restrictions on their activities and eat a high-sugar, high-calorie diet, liver cell fat can easily accumulate. After receiving corticosteroids, fatty liver More likely to happen. There are also so-called parenteral hypertrophic fatty liver, toxic fatty liver, fatty liver caused by genetic diseases, and the like.

Clinical manifestations of fatty liver

Fatty liver is generally divided into two categories: alcoholic fatty liver and non-alcoholic fatty liver. According to the extent of fatty degeneration in the liver, it can be divided into three types: light, medium and heavy. Usually, when the fat content exceeds 5% to 10% of the liver weight, it is regarded as mild fatty liver, and more than 10% to 25% is medium. Fatty liver, more than 25% are severe fatty liver.

The clinical manifestations of fatty liver are diverse. Mild fatty liver is mostly asymptomatic, and more patients are found by accident than during physical examination. Fatigue is the most common conscious symptom in patients with fatty liver, but it is not related to the severity of histological damage. Moderate and severe fatty liver has similar symptoms to chronic hepatitis, and may include loss of appetite, fatigue, nausea, vomiting, and pain in the liver area or right upper quadrant.

When excessive fat deposits in the liver can cause the liver capsule to swell and the liver ligament to stretch, causing severe pain or tenderness in the right upper abdomen, fever, and increased white blood cell counts, misdiagnosed as acute abdomen and performed laparotomy. In addition, patients with fatty liver often have changes in peripheral neuritis such as glossitis, angular cheilitis, skin bruising, numbness of the limbs, and paresthesia of the limbs. A few patients may also have gastrointestinal bleeding, gum bleeding, epistaxis and so on. Patients with severe fatty liver may have peritoneal effusion and lower extremity edema, electrolyte disorders such as hyponatremia, hypokalemia, etc., fatty liver manifestations are diverse, and liver biopsy can be used to confirm diagnosis in case of difficulty in diagnosis.

Fatty liver examination

Physical examination

Most patients with fatty liver have obesity, mild swelling of the liver may cause tenderness, slightly tough texture, blunt edges, smooth surface, and a few patients may have splenomegaly and liver palms. As he progresses to cirrhosis, patients may develop jaundice, edema, flutter-like tremor, and signs of portal hypertension.

2. Laboratory inspection

Mild fatty liver, liver function is basically normal. Moderate and severe fatty liver manifests a mild to moderate increase in alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which is 2 to 5 times the normal on-line. Generally, ALT in obese fatty liver is higher than AST. Conversely, AST in alcoholic fatty liver is higher than ALT. Alkaline phosphatase (ALP) and -glutamyl transpeptidase (GGT) can increase by 2 to 3 times in half of the patients. More than 80% of patients have elevated serum cholinease. Serum bilirubin can be abnormal.

3.B ultrasound

The B-ultrasound is more sensitive to the detection of fatty liver. It is mainly used to grade fatty liver based on the clarity of the liver blood vessels and the degree of ultrasound attenuation. Epidemiological Investigation. However, B-ultrasound cannot determine the degree of impaired liver function, and it is difficult to detect early liver cirrhosis.

4.CT and magnetic resonance

CT plain scan showed that the liver density (CT value) was generally lower than that of the spleen, kidney and intrahepatic blood vessels. The CT value of severe fatty liver could become negative. CT is less sensitive than B-ultrasound in the diagnosis of fatty liver, but its specificity is better than B-ultrasound.

Magnetic resonance imaging is mainly used for those who are difficult to diagnose by ultrasound and CT, especially when it is difficult to distinguish between focal fatty liver and liver tumors.

5. Pathological examination of liver tissue

Can perform clinical pathological typing on non-alcoholic fatty liver disease. It is recommended to perform liver puncture under the guidance of B ultrasound to improve the accuracy of puncture and minimize liver damage. Hepatic cell fat infiltration can be seen under the microscope. Larger fat globules can push the nucleus aside, and the entire liver cell can split into fat cysts. Hepatocyte necrosis and inflammatory response were slight or absent.

Fatty liver diagnosis

It is not difficult to diagnose fatty liver through medical history and auxiliary examination. The severity of fatty liver can be judged comprehensively through liver function, blood lipid, B-ultrasound, clinical symptoms, etc. If it is suspected that the disease has progressed to the stage of cirrhosis, items such as "four items of liver fiber" should also be tested.

1. Diagnosis of non-alcoholic fatty liver

(1) No history of drinking or drinking equivalent to ethanol <140 grams per week for men and <70 grams for women.

(2) Exclude specific diseases that can lead to fatty liver, such as viral hepatitis, drug-induced liver disease, total parenteral nutrition, and hepatolenticular degeneration.

(3) In addition to the clinical manifestations of the primary disease, there are nonspecific symptoms and signs such as fatigue, indigestion, dull pain in the liver area, and hepatosplenomegaly.

(4) Metabolic syndromes such as overweight / visceral obesity, increased fasting blood glucose, dyslipidemia, and hypertension may be present.

(5) Serum transaminase and glutamyl transpeptidase levels can be increased from mild to moderate, usually elevated by alanine aminotransferase.

(6) The imaging findings of the liver meet the imaging diagnostic criteria of diffuse fatty liver.

(7) Histological changes of liver biopsy meet the pathological diagnostic criteria of fatty liver disease.

Those who have any of the above items 1 to 5 and 6 or 7 can be diagnosed as fatty liver.

2. Diagnosis of alcoholic fatty liver

Long-term heavy drinking is a necessary condition for the diagnosis of alcoholic fatty liver. The general drinking history is more than 5 years, the male equivalent is equal to or greater than 40g / d, the female is equal to or greater than 20g / d, or there is a large amount of alcohol history within 2 weeks, equivalent to the alcohol equivalent> 80g / d. Diagnosis can be made based on the patient's clinical symptoms, laboratory test results, liver B-mode or CT examinations with typical manifestations.

Fatty liver complications

Fatty liver can be an independent disease or a concurrent manifestation of certain systemic diseases:

1. Other concurrent manifestations of alcoholism

Such as alcohol dependence, pancreatitis, peripheral neuritis, anemia glossitis, alcoholic hepatitis, cirrhosis and so on.

2. Diseases that can be complicated by excess nutritional fatty liver

Such as obesity, diabetes, hyperlipidemia, hypertension, coronary atherosclerotic heart disease (referred to as coronary heart disease), gout, cholelithiasis and so on.

3. Malnutrition fatty liver often coexists with chronic wasting diseases

Such as tuberculosis, ulcerative colitis and so on.

4. Acute fatty liver of pregnancy

It is often complicated by renal failure, hypoglycemia, pancreatitis, sepsis, and diffuse intravascular coagulation (DIC).

5. Severe fatty liver patients can progress to cirrhosis

There can be peritoneal effusion and lower extremity edema, others can also have spider moles; male breast development, testicular atrophy, impotence; women have amenorrhea, infertility, etc.

Fatty liver treatment

General treatment

(1) Find out the cause and take measures. Such as long-term heavy drinkers should quit drinking. Those with excess nutrition and obesity should strictly control their diet to bring their weight back to normal. Diabetics with fatty liver should actively and effectively control blood sugar. Patients with malnutrition fatty liver should appropriately increase nutrition, especially protein and vitamin intake. In short, removing the cause is conducive to curing fatty liver.

(2) Adjust diet structure Promote high protein, high vitamin, low sugar, low fat diet. Do not eat or eat less animal fats and sweets (including sugary drinks). Eat more vegetables, fruits and foods rich in cellulose, as well as high-protein lean meat, river fish, soy products, etc., do not eat snacks, do not eat before bedtime.

(3) Properly increase exercise to promote body fat consumption. Aerobic exercise should be selected, such as jogging, brisk walking, cycling, going up and down stairs, playing badminton, skipping rope, and swimming. The pulse during exercise is 100 to 160 times / minute for 20 to 30 minutes. The fatigue after exercise is 20 It should disappear within minutes.

(4) Proper selenium supplementation can make the activity of glutathione peroxidase in the liver reach normal levels, and play a good role in nourishing and protecting the liver.

2. Drug treatment

So far, there are no effective drugs for the prevention and treatment of fatty liver. Western medicine often chooses to protect liver cells, lipid-lowering drugs and antioxidants, such as vitamins B, C, and E, lecithin, ursodeoxycholic acid, silymarin, inosine, coenzyme A, reduced glutathione, and taurine. , Carnitine orotate, and some lipid-lowering drugs. It can also be treated with traditional Chinese medicines such as Danshen, Hawthorn, Caucasus, Zexie, Chaihu Decoction, Wuling Powder.

Fatty liver prevention

Reasonable diet

Three meals a day should be adjusted reasonably, so that the thickness and nutrition balance, a sufficient amount of protein can clear liver fat. Avoid alcohol and smoking, eat less greasy foods, control fat intake, and especially avoid animal fat intake.

2. Proper exercise

Persist in physical exercise every day, depending on your physical fitness, choose appropriate sports, such as jogging, table tennis, badminton and other sports. Start from a small amount of exercise in order to gradually reach the appropriate amount of exercise in order to strengthen the body's fat consumption.

3. Use drugs with caution

Any drug that enters the body must be detoxified by the liver. Be careful when choosing a drug. Beware of the toxic side effects of the drug. Drugs that damage the liver must not be used to avoid further aggravating liver damage.

4. Keep your mood cheerful

It is also very important not to be angry, less angry, and to pay attention to the combination of work and rest.