Fatty liver in the elderly
Introduction
Introduction to fatty liver in the elderly Due to factors such as diseases or drugs, lipid accumulation in liver cells exceeds 5% of liver wet weight, which is called fatty liver. The lipid content in normal liver accounts for 2% to 4% of liver wet weight, of which 2/3 is phospholipid. In addition, there are cholesterol and neutral fats, mainly membranes that make up cell membranes and other organelles. Most fatty livers are abnormally increased in triglyceride content. According to fat content, fatty liver can be divided into light type (containing 5% to 10% of fat), medium type (containing fat 10% to 25%), and heavy (containing 25% fat). ~50% or >30%) Type III, fatty liver is a common clinical phenomenon, rather than an independent disease, fatty liver is a reversible disease, early diagnosis and timely treatment can often return to normal. basic knowledge The proportion of illness: 0.005% Susceptible people: the elderly Mode of infection: non-infectious Complications: splenomegaly ascites edema upper gastrointestinal bleeding
Cause
Fatty liver disease in the elderly
(1) Causes of the disease
Many diseases can be associated with fatty liver, in order to help clinical diagnosis and treatment, divided into alcoholic fatty liver and non-alcoholic fatty liver.
1. Alcoholic fatty liver long-term heavy drinking has serious harm to human digestion, nerves, circulation and other systems, especially to the liver. The degree of damage is closely related to the amount of alcohol consumed, the time and manner of drinking, some scholars Prospective studies have shown that fatty liver is formed after 10 to 12 days of daily intake of 150-200 g of ethanol. Other statistics show that drinking more than 160g per day, 42% of people suffering from alcoholic fatty liver in 10 years, 32% of people suffering from Alcoholic hepatitis, 14% of people suffer from alcoholic cirrhosis, drinking alcohol stimulates the adrenal gland to secrete catecholamines, causing an increase in peripheral tissue fat mobilization, which is considered to be one of the factors of fatty liver aggravation, while the demand for food by alcoholics is reduced, accompanied by nutrition. The digestive dysfunction can aggravate the poisoning effect of alcohol.
2. Non-alcoholic fatty liver
(1) Obese fatty liver: Obesity is more than 20% to 25% of the standard weight. The incidence of fatty liver in severe obese patients is 61% to 94%. The fat tissue around obese patients is too much, and the unesterified release is released. Increased fatty acids, liver fat storage rate exceeds the rate of decomposition, combined with low protein and high carbohydrate foods in obese patients, protein-heat imbalance, can lead to fatty liver.
(2) malnutrition fatty liver: mainly due to insufficient calorie supply and low protein intake or malabsorption, increased serum free fatty acids during starvation, can lead to fatty liver formation, empty ileal bypass and gastric separation are surgical Methods for controlling obesity, including postoperative complications, include hepatic steatosis.
(3) Diabetic fatty liver: About 50% of diabetic patients are associated with fatty liver. Type I diabetes has lipolysis due to insulin deficiency, plasma lipoprotein clearance is reduced, and fatty liver is formed. Type II diabetes is mainly Caused by obesity caused by excessive intake of sugar.
(4) drugs and toxic fatty liver: drugs that cause fatty liver are found in tetracycline, adrenal cortex hormones and anti-tumor drugs, etc. Common fatty liver poisons are carbon tetrachloride (CCl4), yellow phosphorus, isopropanol, three Chlorinated olefins, arsenic, lead, mercury, etc., the above drugs and poisons can cause different degrees of liver damage.
(5) Others: Primary liver diseases such as viral hepatitis and inflammatory bowel disease.
(two) pathogenesis
Alcoholic fatty liver
Alcohol is oxidized by alcohol dehydrogenase and acetaldehyde dehydrogenase. During this process, a large amount of reduced coenzyme I is produced, which increases the ratio of reduced coenzyme I to coenzyme I, inhibits the mitochondrial tricarboxylic acid cycle, and causes fatty acid metabolism. Obstruction, fat accumulation in the liver cells and fatty degeneration, eventually leading to fatty liver formation, its histological features: hepatocyte balloon degeneration and necrosis; leukocyte infiltration, usually neutrophils, cytoplasm condensation tendency, Mallory The appearance of small bodies is high; fibrosis around the cells; lesions are most prominent in the central area of the lobules, and fat is common, but to varying degrees, depending on the amount of alcohol consumed in the near future.
2. Non-alcoholic fatty liver
Diabetes, obesity, and taking certain drugs have elevated levels of free fatty acid (FFA) in blood and liver cells. FFA has strong cytotoxicity and can damage cell membranes, mitochondria and lysosomal membranes, causing cell damage. It can significantly enhance the toxicity of cytokines, leading to changes in hepatic parenchymal cells such as steatosis, necrosis, inflammatory cell infiltration and fibrosis. Nonalcoholic fatty liver has pathological changes similar to alcoholic liver disease, but no history of alcohol abuse. The diagnostic criteria are:
1 There is moderate or moderate large bubble-like lipid changes with hepatocyte necrosis and inflammation.
2 No alcohol abuse history or weekly drinking is less than 40g, serum HBV and HCV markers are negative.
Prevention
Elderly fatty liver prevention
Alcoholic fatty liver is easy to develop into alcoholic hepatitis, cirrhosis, and liver failure. Non-alcoholic fatty liver is divided into 4 stages: fatty liver, fatty hepatitis, fatty hepatitis with fibrosis, cirrhosis, so fatty liver can be Threatening people's health, prevention can prevent fatty liver.
Primary prevention: avoid long-term heavy drinking, reasonable diet, weight control, with or without corticosteroids, tetracycline and other drugs to avoid exposure to yellow phosphorus, carbon tetrachloride and so on.
Secondary prevention: blood biochemistry and liver B-ultrasound examination are performed in high-risk groups.
Tertiary prevention: bed rest in patients with steatohepatitis or alcoholic hepatitis, active liver protection, to avoid the development of cirrhosis, severe hepatitis, hepatic encephalopathy and hepatorenal syndrome.
Risk factors and interventions: If nausea, vomiting, fever, jaundice, ascites ALT and AST are found to be elevated, hepatitis is present, diarrhea immediately rests in bed, remove the cause, give liver protection drugs, pay attention to sugar, protein and calorie vitamins Supplementation, prevention of liver failure, mental disorders, lethargy, and hepatic encephalopathy, anti-hepatic coma treatment based on the above treatment.
Complication
Fatty liver complications in the elderly Complications, splenomegaly, ascites, upper gastrointestinal bleeding
A small number of patients may have splenomegaly, and may have portal hypertension (such as ascites, edema, upper gastrointestinal bleeding) and acute encephalopathy.
Symptom
Fatty liver symptoms in the elderly Common symptoms Liver pain beer belly liver large and hard fatigue dyspepsia liver function abnormal nausea bloating nose bleeding hepatic steatosis
Symptom
There are no obvious specific symptoms of fatty liver. The following conditions may indicate the possibility of fatty liver. There are symptoms similar to chronic hepatitis and can exclude the diagnosis of chronic hepatitis, including: liver pain or discomfort, anorexia, nausea, vomiting, bloating, diarrhea. , impotence, nosebleeds, spider mites and male breast enlargement, etc., may have obesity, drinking and medication history.
2. Signs
It may have a large liver, a blunt edge, smooth, soft or tough, but the spleen is not large, with weight loss or systemic lipidation and weight gain.
Because simple fatty liver has no specific clinical symptoms, or its symptoms are often similar to other liver diseases, especially chronic liver diseases, it must be confirmed by laboratory, imaging and histopathological examination. The complete diagnosis should include etiology, pathology and points. Type and so on.
Examine
Elderly fatty liver examination
Laboratory examination: plasma globulin is often increased, bilirubin increased only in fatty liver with cholestasis, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), cholinesterase, alkaline phosphatase slightly increased, The increase of AST in alcoholic liver disease is more obvious than ALT. It is considered to be a specific indicator for the diagnosis of alcoholic liver disease. It may have elevated blood lipids, mainly cholesterol, and prolonged prothrombin time in some patients.
1. Imaging examination
(1) B-show:
1 "bright" liver with a strong echo of the liver.
2 Deep echo waves are attenuated and liver shape changes are less.
3 liver and kidney contrast enhancement.
4 lumen structure is unclear.
(2) The accuracy of CT is better than that of B-ultrasound. The main manifestation is that the density of liver parenchyma is generally or limited, and the echo in the portal vein is enhanced.
(3) MRI (Magnetic Resonance) The proton spectroscopic imaging system can clearly distinguish the difference between water and fat signals, and has a great application prospect, but it is expensive.
(4) 99mTc radionuclide scanning helps to differentiate between localized fatty liver and intrahepatic space-occupying lesions.
2. Liver puncture examination
It is an important method for the diagnosis of fatty liver, especially for localized fatty liver. Under the guidance of B-ultrasound, aspiration biopsy of liver tissue is accurate and safe.
Diagnosis
Diagnosis and diagnosis of fatty liver in the elderly
diagnosis
Obese people who do not have hepatitis, blood transfusion, use drugs that cause liver damage, or have an obesity tendency and can be ruled out by other diseases, and lipids in plasma should be evaluated by B-ultrasound to determine whether there is obesity or fatty liver. , a large number of drinkers, mild fatigue, liver and soft texture, indigestion, elevated transaminase, should consider pregnancy with severe hepatitis or acute fatty liver in pregnancy, a history of drug and toxic exposure or infantile acute encephalopathy with liver Those with abnormal function should consider the fatty liver caused by the corresponding cause.
Differential diagnosis
In most patients with fatty liver, intrahepatic steatosis is diffusely distributed, often need to be differentiated from viral hepatitis, a small number of steatosis distribution is uneven, showing a limited fatty liver changes, often easy to diagnose with liver cancer, hepatic hemangioma, liver abscess, Hepatic cysts and other confusion, viral hepatitis can be used for pathogenic detection, liver cancer can be used for alpha-fetoprotein and CT examination, and percutaneous femoral artery cannulation for selective hepatic angiography can show tumor vascular and hemangioma well, under the guidance of B-ultrasound Liver biopsy is an effective method for the diagnosis of various intrahepatic space-occupying lesions.
