Heterogeneous fatty liver
Introduction
Introduction to heterogeneous fatty liver Fatty liver is caused by various causes (obesity comorbidity, alcoholic fat infiltration, trophic apolipoprotein deficiency, diabetes eating too much fat or sugar, chemical apolipoprotein synthesis, tuberculosis, bacterial pneumonia and sepsis) A disease caused by excessive accumulation of fat in liver cells. Fatty liver is divided into two types: uniformity and non-uniformity. The incidence of heterogeneous fatty liver is low. It is also called focal fatty liver or focal fatty infiltration of liver. It is a special type of fatty liver. The diagnosis of lesions provides a means, but because of the special sonogram of such lesions, ultrasonography is often misdiagnosed as hepatic hemangioma and intrahepatic space-occupying lesions. 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: cirrhosis, fatty liver, liver damage
Cause
Heterogeneous fatty liver disease
Fatty liver is caused by various causes (obesity comorbidity, alcoholic fat infiltration, trophic apolipoprotein deficiency, diabetes eating too much fat or sugar, chemical apolipoprotein synthesis, tuberculosis, bacterial pneumonia and sepsis) A disease caused by excessive accumulation of fat in liver cells. The total amount of fat in the liver of a normal person accounts for about 5% of the liver weight. More than 5% of fat is mild fatty liver, and more than 10% is moderate fatty liver. More than 25% are severe fatty liver.
Prevention
Heterogeneous fatty liver prevention
First, you must stop drinking, eat more vegetables, eat more fruits.
Second, control energy intake: For fatty liver patients, energy supply should not be too high. Fatty liver patients who are engaged in mild activities and whose body weight is within the normal range should be supplied with 126-147KJ (30-35kcal) per kilogram per day to prevent weight gain and avoid aggravation of fat accumulation. For obese or overweight, the daily dose should be 84 ~ 105KJ (20 ~ 25kcal) to control or lose weight, to achieve the ideal or appropriate weight. Reasonable diet to prevent fatty liver, eat some coarse grains, do not eat more sweet.
Third, in the diet, you can use the food color to match the liver diet. The daily three meals must be properly formulated to achieve a balanced nutrient balance, and a sufficient amount of protein can remove liver fat.
Fourth, the use of drugs with caution The liver is the chemical plant of the human body, and any drug that enters the body must be detoxified by the liver. So don't take medicine if you don't move. For patients with symptomatic fatty liver, it is necessary to carefully guard against the toxic and side effects of drugs when using drugs. Drugs that are harmful to the liver must not be used to avoid further aggravation of liver damage.
Fifth, control carbohydrates: should eat low-carbohydrate diet, fasting foods rich in monosaccharides and disaccharides, such as high-sugar cakes, ice cream, dried dates and sweets, etc., to promote the elimination of fat in the liver. However, excessive restriction of carbohydrates can reduce the body's sensitivity to insulin. Daily carbohydrates are about 60% of the total energy.
6. Supplementing enough dietary fiber: Dietary fiber can slow down the time of gastric emptying, reduce the intake and absorption of fat and sugar, and have the effect of lowering blood fat and lowering blood sugar.
Seven, add enough vitamins, minerals and trace elements: the liver stores a variety of vitamins.
Complication
Heterogeneous fatty liver complications Complications liver cirrhosis fatty liver and liver injury
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
Heterogeneous fatty liver symptoms Common symptoms Liver palmar liver swelling, jaundice, nausea, abdominal distension, abdominal pain
Fatty liver is a common clinical phenomenon, not an independent disease. Its clinical manifestations are asymptomatic, and the severe cases are fierce. In general, fatty liver is a reversible disease, which can be restored to normal after early diagnosis and timely treatment.
Fatty liver is divided into two types: uniformity and non-uniformity. The former is more common in clinical practice, and the ultrasound image has typical characteristics, which can be clearly diagnosed. The latter has a low incidence rate, also known as focal fatty liver or focal fatty infiltration of the liver. It is a special type of fatty liver. Although ultrasound provides a means for the diagnosis of this lesion, it is especially due to the sonogram of such lesions. Ultrasonography is often misdiagnosed as hepatic hemangioma and intrahepatic space-occupying lesions.
Examine
Heterogeneous fatty liver examination
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, presence or absence of fibrosis, and exclusion of space-occupying lesions that are difficult to identify in non-invasive examinations are also instructive for the choice of treatment options.
Diagnosis
Heterogeneous fatty liver diagnosis and differentiation
The diagnosis of fatty liver mainly depends on medical history, clinical manifestations and laboratory tests, especially B-ultrasound and CT have certain characteristics, and the diagnosis depends on liver biopsy.
1. History: Alcoholic fatty liver has a long history of alcohol abuse, especially white alcohol with high alcohol content. In addition, there are obesity, diabetes, high-energy venous nutrition, use of related drugs and exposure to poisons.
2, clinical manifestations: After the formation of fatty liver, most of the performance of loss of appetite, nausea, vomiting, weight loss, fatigue, abdominal distension, liver discomfort or dull pain.
3, physical examination: can touch the swollen liver (usually within 2-3 cm below the right rib), the surface is smooth, the edge is round and blunt, soft or medium hardness, may have mild tenderness, some patients have slamming pain, Severe patients may have cirrhosis.
4, laboratory and other auxiliary examination: alanine aminotransferase (ALT) increased, a small number of patients may have mild jaundice.
