severe fatty liver
Introduction
Introduction to severe fatty liver Contains phospholipids, triglycerides, fatty acids, cholesterol and cholesterol esters. If the fat content exceeds 5% for mild fatty liver, more than 10% is moderate fatty liver, and more than 25% is severe fatty liver. The total amount of fat can reach 40% to 50%, and some can reach more than 60%. basic knowledge The proportion of illness: 1.5% Susceptible people: good for middle-aged and older people, more men than women Mode of infection: non-infectious Complications: hepatitis, liver cirrhosis, cirrhosis, ascites
Cause
Severe fatty liver disease
First, nutritional disorders
Nutritional disorders mainly include overnutrition and malnutrition. Long-term consumption of big fish and big meat, fried foods, sweets, etc. are mostly caused by overnutrition. High-fat liver diet, due to excessive intake of fat, increases the burden on the liver. Thereby interfering with the metabolism of fat, fat accumulates in the liver and forms fatty liver. When the sugar is ingested too much, too much sugar will turn into synthetic fatty acids and accumulate in the liver.
Second, the amount of physical activity is small
Lack of physical exercise is an important cause of chronic diseases such as diabetes, obesity, cardiovascular disease, etc. The right amount of exercise helps to lower blood lipids. If the amount of exercise is too small, the fatty liver of the internal body will be converted into energy, excess fat. It is easy to accumulate liver and lead to the formation of fatty liver.
Third, alcohol
One of the most common causes of fatty liver during long-term drinking is that long-term heavy drinking can lead to an increase in liver burden. Alcohol is mainly decomposed in the liver, which causes the liver to break down the catabolism of fat, thus causing accumulation of fat. Severe alcoholism will eventually lead to cirrhosis and liver cancer.
Prevention
Severe fatty liver prevention
Fatty liver patients should be properly rations for three meals a day to achieve a balanced nutritional balance. A sufficient amount of protein can remove intrahepatic fat and should consume 80-100 grams per day. The staple food eaten by fatty liver should not be too fine and too fine. Patients with fatty liver should eat more coarse grains such as oatmeal, corn, sweet potato and soy products. The food contains extremely rich linoleic acid, calcium, selenium, lecithin, vitamin E and more cellulose, which can lower serum cholesterol and triglycerides, and neutralize the excessive consumption of meat and eggs. Excessive acid, maintain the body's acid-base balance, and can excrete excess fat, sugar, and toxins from the intestines to prevent fat and prevent fatty liver.
Fresh fruits are rich in water, vitamins, cellulose and minerals. Regular consumption will undoubtedly be good for health. However, the health effect of fruits is not as good as possible, because fruits contain a certain amount of sugar, and excessive consumption for a long time can lead to blood sugar and blood lipids. Elevated, and even induced obesity, so obesity, diabetes, hyperlipidemia and fatty liver patients should not eat too much fruit.
Complication
Severe fatty liver complications Complications hepatitis cirrhosis cirrhosis ascites
1, often accompanied by other manifestations of alcoholism, such as alcohol dependence, pancreatitis, peripheral neuritis, anemia, glossitis, alcoholic hepatitis, cirrhosis and so on.
2, over-nutrition fatty liver often management other basic diseases occur, 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 coexist with chronic wasting diseases, such as tuberculosis, ulcerative colitis.
4, acute fatty liver in pregnancy often complicated by renal failure, hypoglycemia, pancreatitis, sepsis, disseminated intravascular coagulation (DIC).
5, severe fatty liver patients can have ascites and lower extremity edema, other can also have spider mites, male breast development, testicular atrophy, impotence, women have amenorrhea, infertility and so on.
Symptom
Severe fatty liver symptoms common symptoms ascites liver enlargement edema abdominal pain lower blood potassium
1, with similar symptoms of chronic hepatitis, may have loss of appetite, fatigue, nausea, vomiting, weight loss, liver area or right upper abdomen pain. Mild swelling of the liver may be tender, the texture is slightly tough, the edges are blunt, the surface is smooth, and a small number of patients may have splenomegaly and liver palm.
2, there may be ascites and lower extremity edema, electrolyte imbalance such as low sodium, hypokalemia and so on.
3. When there is too much fat deposition in the liver, the liver capsule can be inflated and the liver ligament can be pulled, causing severe pain or tenderness in the right upper quadrant, fever, leukocytosis, and misdiagnosis as acute abdomen for laparotomy. When the fat vesicles rupture, the fat particles entering the blood can also cause brain and pulmonary blood vessel fat embolism and sudden death.
4. If hepatic cell fat accumulation forces the hepatic sinus or small bile duct, the portal vein blood flow and bile excretion are blocked, and portal hypertension and cholestasis occur.
5, due to acute chemical poisoning, drug poisoning or acute gestational fatty liver, its clinical manifestations are mostly acute or subacute hepatic necrosis, easy to be confused with severe hepatitis.
6, acute fatty liver in pregnancy, also known as obstetric acute pseudo-yellow liver atrophy, is a rare and rare disease in the late pregnancy. The disease is rapidly onset, the condition changes rapidly, and the clinical manifestations are similar to those of fulminant hepatitis.
7, in addition, patients with fatty liver often have glossitis, angular cheilitis, skin ecchymosis, limb numbness, limb abnormalities and other changes in peripheral neuritis. A small number of patients may also have gastrointestinal bleeding, bleeding gums, and nasal discharge.
8, severe fatty liver patients, fatty liver performance is diverse, in case of difficult diagnosis, liver biopsy can be diagnosed.
9, obvious fatigue, poor appetite, abdominal distension after meals, nausea, vomiting, liver pain, swelling of the right shoulder and back, dizziness, slow pulse, lower blood pressure, dry mouth, bitter mouth, irregular stool, accompanied by constipation or It is thin, and it can also have symptoms such as ascites and lower extremity edema. Among them, nausea and vomiting are common clinical symptoms of severe fatty liver, and the special discomfort of the upper abdomen is the main symptom of severe fatty liver. If severe fatty liver is accompanied by liver damage, the symptoms may be accompanied by liver symptoms such as nausea, nausea, nausea, and upper abdominal distension.
Examine
Severe fatty liver test
Laboratory inspection
1. Serum enzymatic examination:
(1) ALT, AST: generally mildly elevated, reaching 2 to 3 times the upper limit of normal, AST elevation of alcoholic fatty liver is obvious, AST/ALT>2 has diagnostic significance, ALT is not alcoholic fatty liver /AST>1, ALT>130U, suggesting that liver lobular fat infiltration is obvious, and persistently elevated ALT suggests fatty granuloma.
(2) -GT, ALP: -GT elevation is more common in alcoholic fatty liver, ALP is also seen to increase, up to 2 times the upper limit of normal, -GT can be elevated in patients with nonalcoholic fatty liver.
(3) GST: can reflect stress liver damage, more sensitive than ALT.
(4) glutamate dehydrogenase (GDH), ornithine carbamoyltransferase (DCT), GDH is a mitochondrial enzyme, mainly active in the liver acinar III, DCT is urea synthase, involved in methylation In response to fatty liver, both enzymes are elevated, especially alcoholic fatty liver, with a GDH/OCT > 0.6.
(5) cholinesterase (CHE), lecithin cholesterol acyltransferase (LCAT): 80% fatty liver serum CHE and LCAH increased, but low nutritional status of alcoholic fatty liver is not obvious, CHE identifies obesity Sexual fatty liver has a certain meaning.
2. Plasma protein changes:
(1) -globulin, 1, 2, lipoprotein increased.
(2) Albumin is normal.
(3) In obese fatty liver, LDL-C increased, HDL-C decreased significantly, and Apo B, Apo E, Apo CII and III increased.
3, plasma lipids TG, FA, cholesterol, phospholipids often rise, which cholesterol is significantly increased, often > 13mmol / L.
4, pigment excretion test BSP, ICG excretion decreased, in obesity and alcoholic fatty liver, because fat accumulation in the liver acinar III, and pigment treatment is also in this part, liver fat storage affects hepatocyte excretion The function of the pigment, the degree of excretion reduction is related to the degree of liver fat infiltration.
5, bilirubin severe fatty liver may have elevated blood bilirubin, mild to moderate fatty liver bilirubin more normal.
6, prothrombin time (PT) non-alcoholic fatty liver more normal, part can be extended.
7. The blood insulin level is highly delayed, and the glucose tolerance curve rises at a peak and the decline is delayed.
8, blood urea nitrogen, uric acid occasionally increased.
Auxiliary inspection
1. B-ultrasound: The ultrasound image of diffuse fatty liver is mainly expressed as echo attenuation. According to the degree of attenuation, fatty liver can be divided into three types:
(1) Mild fatty liver: manifested as near-field echo enhancement, far-field echo attenuation is not obvious, and the intrahepatic tubular structure is still visible.
(2) Moderate fatty liver: the front field echo is enhanced, the back field echo is attenuated, and the tubular structure is blurred.
(3) Severe fatty liver: The near-field echo is significantly enhanced, the far-field echo is obviously attenuated, the tubular structure is unclear, and it is unrecognizable. The sensitivity of ultrasound to severe fatty liver is 95%.
2, CT examination: fatty liver CT image and real-time ultrasound (US) image performance is different, CT diagnosis accuracy is better than B-ultrasound, mainly for liver density or locality, or even lower than the spleen and intrahepatic vascular density, In contrast, echo in the portal vein is enhanced, and the density is reduced in accordance with the severity of fatification. Dynamic CT changes can reflect the increase and decrease of intrahepatic fat infiltration. Diffuse fatty liver is generally lower in liver density on CT. Spleen and intrahepatic vascular density, severe fatty liver, liver CT value can be reduced to about 10Hu (normal liver density is 6 ~ 12Hu higher than the spleen), enhanced CT scan, fatty liver liver vascular shadow is very clear, Its shape, no abnormality in the direction, sometimes the blood vessels can be fine and narrow, but there is no change, the phenomenon of wrapping, help to identify the focal non-affected area of liver cancer and fatty liver (normal "liver island").
3, MRI examination: its value is generally considered to be smaller than US and CT, magnetic resonance (MRI) of fatty liver manifests as whole liver, one leaf or focal fat infiltration, spin echo (SE) sequence and reverse recovery (IR) The T1 weighted signal of the pulsating sequence is normal. The short IR sequence and the T2-weighted image signal of SE can be slightly higher, but only the proton image of fat, the high signal of fat infiltration area, the normal position of blood vessels in the liver, and the MRI measurement in recent years. Liver tissue fat content.
4, liver biopsy: is an important method for the diagnosis of fatty liver, especially for localized fatty liver, under the guidance of B-ultrasound aspiration of liver tissue biopsy is far more accurate than the past blind liver puncture method, safety, the significance of biopsy is to determine the presence of liver Fat infiltration, with or without fibrosis and exclusion of space-occupying lesions that are difficult to identify in non-invasive examinations, also have guiding value for the choice of treatment options, indications for fatty liver biopsy:
(1) Focal fatty liver or diffuse fatty liver with normal liver island is difficult to distinguish from malignant tumors, and liver biopsy should be performed under the guidance of B-ultrasound.
(2) to identify the causes of some rare fatty liver diseases, such as cholesterol ester storage disease, glycogen accumulation disease, Wilson disease and so on.
(3) Asymptomatic suspicious nonalcoholic steatohepatitis, liver biopsy is the only means of diagnosis.
(4) Alcohol-absorptive and alcoholic liver disease or alcoholic liver disease have unexplained clinical or biochemical abnormalities, and alcoholic hepatitis requires liver biopsy to exclude active infection before corticosteroid treatment.
(5) After obesity-induced fatty liver patients reduce their original body weight by 10%, liver function enzymes continue to be abnormal, requiring liver biopsy to find other causes.
(6) Suspected of severe hepatitis caused by fatty liver, requiring liver biopsy to clearly diagnose and understand the cause.
(7) To evaluate the reliability of certain serological indicators, B-ultrasound, CT and other imaging examinations for the diagnosis of fatty liver and fibrosis, liver biopsy changes should be used as the gold standard, and objectively evaluate a certain treatment plan for fatty liver. The exact effect of fibrosis treatment.
(8) Anyone who is suspected to be not a simple hepatocyte steatosis or suspected of multiple causes of fatty liver or liver dysfunction needs to be identified by liver biopsy to determine its specific cause or cause of illness.
Diagnosis
Diagnosis and diagnosis of severe fatty liver
First, simple fatty liver: liver lesions only show fatty degeneration of liver cells. According to the range of hepatic cell lipid changes, fatty liver is divided into diffuse fatty liver, focal fatty liver, and diffuse fatty liver with normal liver island.
Second, steatohepatitis: refers to hepatocyte inflammation that occurs on the basis of hepatic steatosis. According to statistics, long-term heavy alcohol abuse, about 40% of this will occur, while non-alcoholic fatty liver is rarely rickety.
Third, fatty liver fibrosis: refers to the occurrence of fibrotic changes around the liver cells, the degree of fibrosis and the persistence of pathogenic factors and the severity of fatty liver. Alcoholic liver fibrosis can occur on the basis of simple fatty liver, while non-alcoholicity occurs on the basis of steatohepatitis. Liver fibrosis continues to develop and the lesion is fatty cirrhosis.
Fatty cirrhosis: Fatty cirrhosis is the result of the progressive development of fatty liver disease to the advanced stage. In recent years, with the increase of alcoholic liver disease and non-alcoholic liver disease, fatty cirrhosis has accounted for the second cause of cirrhosis in China (the first is viral hepatitis and cirrhosis). The incidence of cirrhosis in alcoholic hepatitis is more than 50%, and a small proportion of non-alcoholic fatty liver can also develop into cirrhosis.
