Gastroenterology

Fatty liver disease


Fatty liver disease - causes, symptoms and treatment

The liver takes an active part in the metabolism of fats. Fatty infiltration of the liver occurs in the case of accumulation in the liver of high amounts of triglycerides.

Causes of fatty liverFats from food are broken down in the intestine by enzymes and absorbed into the blood stream. From there they travel to the liver where it is converted to triglycerides, cholesterol, phospholipids and other necessary for our body. Fatty infiltration of the liver occurs in the case of accumulation in the liver of high amounts of triglycerides. In the fatty triglyceride content can reach more than 50% of its mass (normally not more than 5 %). Factors leading to this condition are varied: increased delivery of fatty acids from food, increased production of triglycerides in the liver, impaired transport of triglycerides from the liver to adipose tissue, where the triglycerides in the normal stored as fat. Depending on the nature of the deposits of fat fatty liver is divided into large droplets and small droplets (size of the fat droplets in the liver cells).

Causes of fatty liver

– alcohol is the most common cause of fatty hepatosis. Ethanol and products of its metabolism influence all stages exchanges of fats in the liver. The severity of fatty directly proportional to the amount consumed;
– diabetes mellitus;
– obesity and high intake of fat from food;
– protein malnutrition;
– poisoning hepatotropic poisons (carbon tetrachloride, DDT, yellow phosphorus, etc);
– the use of certain drugs.

Symptoms of fatty liver

Patients with fatty liver complaints usually do not show. The disease blurred, slowly progressive. From time to time there are constant dull pain in the right hypochondrium, there may be nausea, vomiting, disturbances of a chair.

Very rare fatty liver with severe clinical picture: severe abdominal pain, jaundice, weight loss, itchy skin.

Treatment of fatty liver

In the first place should be either eliminated, or to minimize the effect of the factor that led to the deposition of fat in the liver. It is almost always possible against alcohol, if we are not talking about the formation of dependencies that require the assistance of a psychiatrist. Patients with diabetes mellitus and hyperlipidemia should be monitored jointly by the endocrinologist and cardiologist, respectively. All patients need a diet low in fat and adequate daily physical activity.

Obese patients doctors usually see a need to reduce the body weight of the patient. The effect of a decrease of body weight on the course of fatty hepatosis is ambiguous. Quick weight loss naturally leads to increased activity of inflammation and progression of fibrosis. The decrease in weight 11-20 kg/year positively affects the severity of steatosis, inflammation and fibrosis of the liver. The most effective is the weight reduction of not more than 1.6 kg/week, which is achieved when the daily calorie 25 cal/kg/day. and active exercise.

When these measures are insufficient, the doctor may prescribe special drugs that affect the metabolism of fat in the liver. The majority of patients with fatty degeneration of the liver is characterized by a mild, benign course of the disease. Such patients is a therapy that combines anti-oxidant protection, stabilization of membranes of hepatocytes, immune modulation, providing anti-inflammatory activity, and aimed mainly at the relief of manifestations of biliary dyskinesia.

 

Among drugs, improves the functional state of the liver, occupies a leading position Heptral (ademetionine), which is a complex drug consisting of two natural substances – adenosine and methionine. Heptral takes part in the reconstruction of cell membranes, prevents oxidation of fat, stimulates the formation of protein in the liver. Its use is indicated primarily in alcoholic liver disease, not only at the stage of fatty hepatosis, but also hepatitis and even cirrhosis. Additional therapeutic effect of Heptral presents its mild antidepressant properties, helping to overcome alcohol addiction, so that drug was included in the Arsenal is not only gastroenterologists but also psychiatrists.

Another leading drug in the treatment of fatty hepatosis is ursodeoxycholic acid (Ursosan, Ursofalk) at a dose of 10-15 mg/kg/day, possessing cytoprotective, immunomodulatory and antiapoptotic effects, have a positive impact on biochemical parameters and steatosis, improves the rheological properties of bile.

Treatment of fatty liverPatients with hyperlipidemia shows an observation and possible specific received lipid-reducing therapy (statins and/or fibrates). You should take into account that the isolated administration of drugs that reduce blood lipids is not effective, and requires constant supervision.

Insulin resistance plays a principal role in the pathogenesis of fatty hepatosis. This was a prerequisite to the effectiveness of insulin sensitizers (biguanides, glitazone). Extensive experience of use of biguanides in diabetes mellitus insulinrezistentnost that was the basis for using it when fat hepatosis. Thiazolidinedione (glitazone) – a new class of drugs that selectively improves insulin sensitivity (insulin, sensitizer). Glitazones improve insulin sensitivity by activating certain enzymes in the liver, resulting in improved glucose uptake by peripheral tissues, decreased concentrations of glucose, insulin, triglycerides and lipids in the blood.

Most promising is combination therapy with insulin sensitizers of different classes: Metformin (a biguanide) and rosiglitazone (glitazone) for 6-12 months. This positive trend in liver function tests combined with the correction of the main manifestations of the syndrome of insulin resistance: a decrease in the degree of obesity, hypertension, dyslipidemia, hyperuricemia.

Each patient should remember that the prescription of any drug used for the treatment of fatty hepatosis, is a physician, with an individual approach to each patient, with the definition of indications and contraindications of medicines and under strict control of the prescribed treatment!