Hepatosis is a liver disease with structural changes that are associated with excessive deposition of fat cells and dysfunction of the whole organ. Fatty liver is also called fatty liver, steatosis, fatty degeneration. The following details the causes, symptoms and treatment of fatty liver hepatosis, as well as measures to help avoid such a problem.

Hepatosis is a chronic process that is accompanied by obesity of hepatocytes and excessive accumulation of lipids in them. A change in the structure of cells leads to their damage and changes in the intercellular substance, which further provokes inflammatory-necrotic changes. The chronic course and latent symptoms cause untimely treatment and the appearance of changes in the body that are very difficult to eliminate.

The long course of the pathology leads to the inability of the organ to perform its functions. One of the varieties of live hepatosis is alcoholic hepatosis, which occurs in people who abuse alcohol. The pathogenesis of the disease remains the same - fat cells accumulate in hepatocytes, which change the structure and performance of the organ.

If the degeneration of the liver is not caused by alcohol, the pathology can be observed in a certain part of the organ, while, in general, the process proceeds benignly and does not threaten the life of the patient. Under the influence of adverse factors or excessive alcohol consumption, the pathology begins to progress, which leads to a life-threatening chain: fibrosis-cirrhosis-need for organ transplantation or death.

Forms and stages

In most cases, patients are diagnosed with a form such as non-alcoholic fatty liver disease. This diagnosis has many synonyms - fatty degeneration, steatohepatitis, steatosis and others. Pathological changes begin when the accumulation of fat exceeds 10% of the weight of the cookies. There are 4 degrees of pathology:

• Zero. There are no clinical symptoms, small particles of fat are present in single liver cells.
• First. The size of fatty deposits increases, their number now resembles individual lesions.
• Second. Fat deposits contain about half of hepatocytes, intracellular obesity is diagnosed.
• Third. Accumulated fat continues to be deposited in the intercellular space, forming fatty formations and cysts.

Symptoms

There are usually no specific signs of the disease, and the chronic course of the pathology explains the late diagnosis and complexity of treatment. The disease develops gradually and does not cause discomfort to the patient for many years. At the first and second stages, reversible changes occur and therapy can lead to a positive result. At the third and fourth stages, obesity occurs with the degeneration of the lobular structure of the organ, which is considered a state of precirrhosis.

At the first stage, the patient's symptoms and complaints are absent. Later, non-specific signs of the disease begin to appear:

• nausea
• weakness
• poor appetite
• discomfort under the ribs on the right side

Closer to the third stage may be focal or diffuse. The latter condition is accompanied by a more vivid clinical picture and objective disorders that can be diagnosed by instrumental and laboratory methods. With steatosis, there is:

• liver dystrophy
• accumulation of body fat
• delayed elimination of toxins
• insulin resistance
• circulatory disorder
• increase in free radicals
• cell destruction
• disruption of apoprotein formation

Improper metabolic processes in the liver disrupt the functions of other organs. The pain appears when the liver capsule is stretched due to an increase in its size. Clinical manifestations are not related to the time of eating. Soreness is detected by the doctor during palpation of the abdomen.

The general appearance of the patient resembles an asthenic physique and is complemented by complaints of weakness, drowsiness, and impaired performance. The reason for the appearance of such symptoms is a violation of the most important biochemical processes, which now do not lead to the production of a sufficient amount of energy.

Nausea appears as a result of a violation of bile formation and a slowdown in the elimination of toxins. In the later stages, all biochemical processes that are associated with the functioning of the liver are affected. The level of bilirubin and bile acids rises, which now enter the bloodstream and are carried throughout the body.

So there are additional symptoms of the later stages of hepatosis - jaundice, which is accompanied by itching, vomiting, deterioration in general well-being. In the analyzes, hyperbilirubinemia and a change in the concentration of liver enzymes are diagnosed.

In addition to jaundice and itching, a rash or hemorrhages on the skin may join. The basis for the appearance of such symptoms is the deterioration in the elimination of toxins. Lack of treatment, as well as prolonged action of damaging factors, leads to the fact that steatosis gradually turns into fibrosis - liver cells are replaced by connective tissue that does not have the ability to perform the work of hepatocytes. Fibrosis is followed by cirrhosis.

The reasons

Among the causes of fatty hepatosis, one should know the provoking factors that increase the likelihood of developing the disease, and the causes themselves. The first group includes:

• Overweight. In people with obesity, the liver has an increased load, so the organ is constantly in a state of enhanced performance. Over time, its cells wear out, the accumulation of glycogen in the liver is disrupted and the deposition of lipid cells increases.
• Alcohol abuse. Frequent use of alcoholic beverages leads to the destruction of hepatocytes, their insufficient regeneration and disruption of the organ as a whole. Alcoholism also changes metabolic processes in other organs, worsens the detoxification and enzymatic function of the liver.
• Wrong nutrition. The health of the liver is very dependent on the quality of nutrition. The risk group includes people who love fresh pastries, as well as vegetarians who receive less protein. Fresh pastries are considered heavy food for the pancreas, liver and other organs of the digestive tract. Despite the amazing taste and smell, doctors of various specializations do not recommend its use. Vegetarianism is welcomed by doctors only if the right diet is followed, which will ensure a balanced diet and the intake of all necessary substances in the body. If there is not enough protein, such nutrition will lead to a weakening of the whole organism and disruption of the work of many internal organs.
• Physical inactivity. Insufficient physical activity contributes to the accumulation of excess body weight, which will adversely affect the state of internal organs, in particular the liver.

The main causes of hepatosis are as follows:

• insulin resistance. With a decrease in the sensitivity of tissues to insulin, hyperglycemia occurs and a compensatory mechanism develops, which leads to an increase in insulin production. A large amount of insulin enhances lipolysis, which releases a large amount of fatty acids and increases the accumulation of triglycerides in the liver. The balance of production and utilization of fat cells is disturbed, which leads to the accumulation of very low density lipoproteins. Later, inflammation occurs, the death of hepatocytes and their degeneration into connective tissue.
• Dysbacteriosis. Excessive activity of pathogenic microflora in the intestine leads to the fact that bacteria enter the portal vein and liver. This contributes to the development of the inflammatory process, the activation of the immune response and the subsequent development of fibrous tissue.
• Violation of metabolic processes. Incorrect metabolism is accompanied by hyperlipidemia. This is usually observed with endocrine disruptions (diabetes mellitus and hormonal disorders).

One of the leading places in increasing the likelihood of developing steatosis is assigned to excess body weight. Adult patients should consciously take care of their health, as well as prevent obesity in their children. Thus, fatty hepatosis can act as an independent disease, develop as a complication of endocrine or metabolic disorders, and also be a consequence of exposure to intoxication and other adverse factors.

Obesity

Obesity is a pathological condition in which there is an increase in body weight and the deposition of excess fat in the body. It occurs as a result of overeating, the predominance of refined foods, simple carbohydrates in the diet, a sedentary lifestyle, hereditary predisposition, pathologies of the nervous system. It manifests itself in people who take antidepressants and hormonal drugs.

The disease manifests itself as:

• weight gain
• shortness of breath
• disability
• difficulty defecation
• increase in blood pressure
• pain in the heart and joints
• decreased libido
• psychological disorders: decreased self-esteem

With an external diagnosis of a patient with obesity, the doctor reveals that the liver is slightly enlarged in size. The higher the body weight, the less likely it is to attach other symptoms. To make an accurate diagnosis, the body mass index is calculated, densitometry is performed, the amount of muscle tissue and adipose tissue is measured, as well as the nature of its distribution.

Metabolic diseases

Metabolic disorders are a complex of manifestations that indicate that the process aimed at the synthesis of energy in the body is disturbed. Dysfunction is caused by a deficiency of important micronutrients: selenium, zinc, manganese, chromium, fat-soluble vitamins: A, D, E. Iron deficiency anemia, insufficient intake of folic acid, vitamin B 12 can become a trigger for the development of metabolic disorders.

When carbohydrate metabolism is disturbed, diabetes mellitus develops, and fatty metabolism causes cholesterol to accumulate, provoking dysfunction of the cardiovascular system. An excess of free radicals is fraught with neoplasms. Metabolic disorders lead to the development of:

• fatty hepatosis
• weight gain
• destruction of tooth enamel
• skin color change
• deterioration in the condition of the skin and hair

Intestinal disorders are also possible, which manifest themselves in the form of dyspeptic disorders, constipation, diarrhea.

Hypodynamia

Patients with physical inactivity are prone to rapid weight gain. Adipose tissue gradually replaces liver cells, the patient develops hepatosis. Regular physical activity activates metabolic processes, the functioning of the lymphatic system. The saturation of cells with oxygen is normalized, the processes of purification and regeneration are restored. Patients with hypodynamia are recommended to include daily moderate physical activity, review the diet, and take daily walks in the fresh air.

The lack of motor activity is fraught not only with a violation of the functioning of the liver, but also with dysfunction of the musculoskeletal system, muscle atrophy, and psycho-emotional disorders. In patients, bone mass decreases, and the likelihood of developing osteoporosis increases. The functioning of the gastrointestinal tract and respiratory organs, the endocrine system is disturbed, the level of insulin decreases. The patient complains of a constant feeling of weakness, impaired memory, sleep, and disability. Physical inactivity is not officially recognized as a disease, but it significantly worsens the quality of life.

Binge eating

The main cause of fatty liver are metabolic and endocrine disorders that cause overeating. Eating an excess amount of food is fraught with a violation of carbohydrate and mineral metabolism, an increase in low-density lipoproteins. "Bad" cholesterol accumulates in the walls of blood vessels, adipose tissue gradually replaces hepatocytes.

The predominance of fatty foods, red meat, rich broths, simple carbohydrates, sugar, white flour, refined products, low-quality oils in the diet causes diseases of the cardiovascular system, hepatosis, and endocrine disorders. The higher the body weight, the higher the risk of developing diabetes, vascular complications. The risk group includes people with a poor-quality unbalanced diet, eating disorders, a hereditary predisposition to overweight.

Vegetarianism with impaired carbohydrate metabolism

Carbohydrate metabolism disorders according to the excess type lead to weight fluctuations, changes in physical and emotional state, fluctuations in blood pressure, tremors in the body, sharp jumps in glucose, dry mouth, constant thirst.

An insufficient type of carbohydrate metabolism, which is often observed in people with limited nutrition, can cause:

• constant weakness and drowsiness
• hand tremor
• shortness of breath
• headache, dizziness
• apathy
• progression of ketoacidosis, provoking nausea, vomiting
• blood glucose drops, excellent processes slow down

In case of violations of carbohydrate metabolism, the functioning of the liver is disrupted, the likelihood of developing hepatosis increases. With dietary restrictions, it is important to control and promptly compensate for the violations of vitamins, trace elements, amino acids. Contact a dietitian, nutritionist for the selection of a complete diet enriched with essential nutrients. Courses to take vitamin, mineral complexes, vitamin D, omega-3. To cleanse the liver, use milk thistle, dandelion roots.

Diets for weight loss

An unbalanced diet while following diets for weight loss can provoke metabolic disorders, exacerbations of chronic pathologies. Insufficient intake of vital substances is fraught with a violation of mineral metabolism, hyper- or hypoglycemia, Burke's disease, and liver dysfunction. The risk group includes people with:

• hereditary predisposition to metabolic, endocrine, carbohydrate disorders;
• circulatory disorders
• tumors
• toxic damage to the liver and the body as a whole
• disorders of neurohormonal regulation
• regular psycho-emotional overstrain

If there is a violation of the carbohydrate function of the liver in the anamnesis, the condition and the clinical picture are aggravated. Immediate provision of high-quality medical care, correction of the diet, use of hepatoprotectors, and compliance with the drinking regime are required.

Long-term use of certain drugs

The liver is the first to suffer from prolonged, uncontrolled use of drugs in high doses. A number of processes of pharmacodynamics, splitting and transformation of chemicals take place in the liver. Complications are caused by drugs, which include heavy metals (mercury, mice, aluminum), antibacterial agents. Before using the drug, it is recommended to read the instructions, pay attention to the list of possible contraindications, side effects, age restrictions.

Individuals with a history of liver disease should be especially careful. The use of any medicinal product must be reported to the hepatologist. Carefully study the drug interactions of individual groups of drugs. Try not to use hepatotoxic substances. Otherwise, the risk of developing fatty hepatosis and irreversible conditions increases. To maintain the organ during therapy, Silymarin, milk thistle preparations are used.

Vitamin A overdose

More than 85% of the vitamin is deposited in the liver cells in the form of an ester. In the future, the substance is transformed into the aldehyde form and retinoic acids. Substances are highly soluble in oil and insoluble in water. Excessive deposition of the liver and accumulation in tissues can have a toxic effect not only on the organ, but also on the body as a whole. Prolonged overdose causes liver dysfunction, hair loss, headache, weakness, fatigue. The clinical picture is aggravated in patients with fatty hepatosis.

Diseases of the organs of internal secretion

Diseases of the organs of internal secretion or endocrine disorders are one of the most common causes of fatty hepatosis. Hyperfunction or hypofunction of the glands leads to dysfunction of the thyroid gland, diabetes mellitus. All this provokes non-alcoholic fatty hepatosis in patients of all age groups. At a high concentration of T3 and T4 in free form, there is a violation of the synthesis of proteins caused by liver pathologies. The organ produces thyroxin-binding globulin, which is responsible for the binding of T3 and T4.

Alcohol abuse

The liver is one of the target organs that suffers from excessive consumption of ethanol. Alcohol leads to damage and death of liver cells - hepatocytes. Redox processes are disturbed, acetaldehydes, toxic decomposition products of alcohol, accumulate. The development of an inflammatory process is observed, followed by the replacement of liver cells with connective tissues. The organ increases in size, ceases to function properly, and hepatosis develops.

Diseases of the digestive system

The liver is one of the organs involved in the process of digestion. It starts the exchange of vitamin complexes, lipid fractions, carbohydrates. The liver synthesizes albumin, globulin and other blood proteins, takes part in the immunological reaction of the body. All body systems are interconnected and dysfunction of the gastrointestinal tract can affect the state of the liver, urinary system. Treatment involves a holistic approach and the impact on the root cause of the disease. Symptomatic drugs are used optionally.

Diabetes

Numerous studies have confirmed the relationship of diabetes mellitus with various liver pathologies, including fatty liver. The loss of insulin negatively affects the functional state of the liver. Patients with diabetes have elevated levels of liver enzymes. This provokes ALT levels, exacerbates the course of diabetes. Glucose production increases, triglyceride storage anomalies are observed. The liver is one of the insulin-sensitive organs, which can indicate the initial stages of diabetes even before the increase in glucose concentration in laboratory parameters.

gallstones

With fatty hepatosis, gallstones are detected in more than 25% of patients. The disease affects the process of synthesis and promotion of bile. The formation of pigmented calculi is most often due to stagnation of bile in the liver and extrahepatic bile ducts. Stones begin to form in the intrahepatic bile duct in the form of proteinaceous bases, bile pigment and a small amount of lime salt.

Digestive Enzyme Deficiency

Pathologies of the liver (fatty hepatosis) and the biliary system often lead to enzyme deficiency. This is due to the fact that pancreatic enzymes are not sufficiently activated by bile. Foods that are devoid of enzymes lead to an excessive load on the body, and liver pathologies only exacerbate this situation.

Inflammation of the pancreas

Pathologies of the pancreas are accompanied by inflammatory processes, occur under the name "pancreatitis". There is an acute and chronic course of the pathological process. With an exacerbation of pancreatitis, there is a strong edema, the formation of fatty necrosis, painted in white-yellow color. In the absence of timely assistance, the surrounding organs suffer, the liver ceases to function properly. Hemorrhages, suppurations, formation of yellow cysts are possible. The lack of quality assistance is fraught with the development of irreversible processes.

Possible Complications

Steatosis is one of the most severe complications of pregnancy, which, fortunately, is not very common. With the development of steatosis during childbearing, the probability of death in the mother and fetus is quite high. Fatty degeneration of pregnant women develops against the background of existing cholestasis, indomitable vomiting, and late toxicosis. Pathology is rare, but if detected, it requires urgent delivery.

Which doctor to contact

The first complaints of patients are not specific, so they can be addressed to a therapist. The doctor will prescribe the necessary tests, and then refer you to a narrower specialist - a hepatologist.

Diagnostics

The main place in the diagnosis of steatosis is occupied by laboratory tests, in particular, a biochemical blood test. It determines indicators that reflect the work of the body (liver enzymes, bilirubin, bile acids). Elevated concentrations of glucose and cholesterol are also found in the blood.

Instrumental methods - ultrasound, computed and magnetic tomography - help to complete the objective picture. They will clearly show the localization of changes in the structure of the liver and the expansion of its boundaries, however, inflammation in the pictures is not always noticeable.

Treatment

Treatment includes three areas:

• implementation of the treatment regimen prescribed by the doctor;
• compliance with the required diet;
• refusal of alcohol and other provoking factors.

Therapy is often carried out on an outpatient basis with the help of drugs. Medicines of the following groups are prescribed:

• Hepatoprotectors. The main group of medicines for steatosis. Their action is aimed at restoring the structure and functions of hepatocytes, reducing the intoxication of the body, as well as reducing the inflammatory process. Doctors may prescribe herbal or synthetic hepatoprotectors. The best means are preparations containing essential phospholipids - components of hepatocyte membranes, which make cells stronger and increase resistance to adverse factors. Combined agents, which additionally includes glycyrrhizic acid, also have an anti-inflammatory effect and act as antioxidants.
• Choleretic preparations based on ursodeoxycholic acid. They reduce the synthesis of cholesterol and fatty deposits in the liver, stimulate the secretion of bile, improve the detoxification properties of the liver, and contribute to the dissolution of stones.
• Herbal hepatotropic agents. They have a complex effect that normalizes the functions of the organ - they improve the discharge of bile, promote tissue regeneration.
• Vitamins, antihypoxants, antioxidants are necessary to normalize biochemical processes and accelerate the regeneration of hepatocytes.

Diet

Diet is essential for the effectiveness of the main conservative treatment. The main nutritional recommendations are as follows:

• achieving and maintaining the patient's weight within the normal range
• replacement of animal fats with vegetable
• refusal of alcohol, dyes and preservatives
• eating enough vegetables, protein, vitamins
• preference should be given to cooking methods such as boiling and baking in the oven
• fried and fatty foods are recommended to be completely excluded
• eating should occur in small portions, but 6-7 times a day
• it is advisable to eat crushed or liquid foods at a warm temperature

Fatty cottage cheese, spicy sauces, sour cream, smoked meats, fast food, offal, canned food, onions and garlic, all mushrooms, fatty broths are considered harmful for steatosis. Useful for the liver will be lean fish, seasonal vegetables and fruits, low-fat dairy products, steamed meat products, cereals. Confectionery sweets and fresh pastries are recommended to be replaced with marmalade, dried fruits and honey.

Sample menu for the day

• Breakfast. Oatmeal, tea, banana.
• Snack. Low-fat cottage cheese, marmalade.
• Dinner. The first course in vegetable broth with meatballs, buckwheat porridge, cod fillet.
• afternoon tea. Rosehip broth, biscuit cookies, pear.
• Dinner. Vegetable juice, puree, baked fish.
• Late dinner. Low-fat yogurt, not sweet crackers.

Prevention

You can prevent the disease with the help of a healthy lifestyle, a balanced and wholesome diet, and optimal physical activity. Active loads should be present in a person every day, walking and swimming are very useful. Despite the abundance of fast food and store-bought sweets, it is recommended to completely exclude them from your diet and give preference to natural vegetables and fruits, lean meat and cereals.

It is very important to maintain weight within the normal range, since obesity dramatically increases the likelihood of not only liver diseases, but also others. The use of alcoholic beverages in any quantity destroys hepatocytes. Endocrine and hormonal disorders are also considered dangerous. For timely detection of the initial stages of steatosis, it is recommended to undergo preventive examinations and take a blood test at least once a year.

Fatty hepatosis is a dangerous condition that begins imperceptibly and does not manifest itself for a long time. Lack of therapy increases the risk of irreversible changes and death. It is quite easy to prevent pathology, but this requires you to reconsider your lifestyle and diet.

Video: Fatty liver disease - symptoms and treatment

Hepatosis is a collective name liver disease, characterized by a violation of metabolic processes in hepatocytes ( liver cells) and, as a result, damage to the structure of cells and intercellular substance, metabolic disorders and organ function ( dystrophy). According to the type of metabolic disorders, fatty and pigmented ( pigment - a substance that gives color to body tissues) hepatosis.

Steatosis is a pathological deviation from the norm) a condition in which fats accumulate in the cells of the body.

Fatty hepatosis () is the most common reversible chronic process in which hepatocytes ( liver cells) there is an excessive accumulation of lipids ( fat). Gradually, in the liver, an increasing number of cells are replaced by fat cells, which form adipose tissue. As a result, the liver increases in size, its color changes to yellowish or dark red, cells die, fatty cysts form ( pathological cavities in a tissue or organ with contents), organ functions are impaired. Very often fatty infiltration ( accumulation in tissues of substances that are not normally detected) of the liver goes into fibrosis ( reversible process of replacing normal tissue with coarse scar tissue locally or throughout the organ), and then to cirrhosis ( irreversible progressive liver disease in which healthy tissue is replaced by scar tissue).

Fatty liver is a fairly common disease. On average, it affects from 10% to 25% of the population in different countries, among them 75% - 90% are obese and diabetic people. In Russia, every fourth person suffers from fatty hepatosis.

Liver anatomy

The liver is a vital unpaired organ, the largest gland ( an organ that produces specific chemicals) in the human body. It is located on the right in the upper part of the abdominal cavity under the diaphragm. Sometimes there is also a left-sided location of the liver, which must be taken into account during ultrasound ( ultrasound) organ. The liver has an irregular shape, reddish-brown color, weight 1300 - 1800 grams in an adult. It consists of two lobes - the right lobe ( larger in size) and left ( smaller). To facilitate identification of the liver zone during surgical and diagnostic procedures, the liver is divided into 8 segments. A segment is a pyramidal section of the liver adjacent to the hepatic triad, which consists of a branch of the portal vein, a branch of the proper artery of the liver, and a branch of the hepatic duct.

The cells that make up the liver are called hepatocytes. The structural and functional unit of the liver is the hepatic lobule. It has the shape of a prism and consists of liver cells ( hepatocytes), vessels and ducts. In the center of the hepatic lobule is the central vein, and on the periphery of the bile ducts, branches of the hepatic artery and hepatic vein. Hepatocytes produce up to one liter of bile ( fluid consisting of bile acids, water, cholesterol, inorganic compounds and involved in the process of digestion) per day. Bile acids contribute to the breakdown and absorption of fats, stimulating small intestinal motility, as well as the production of gastrointestinal hormones. Small intrahepatic capillaries channels) bile enters the larger bile ducts, and then into the segmental ducts. The segmental ducts merge into the right ( from the right lobe of the liver) and left ( from the left lobe of the liver) bile ducts, which are combined into a common hepatic duct. This duct joins with the duct of the gallbladder and forms the common bile duct, from which bile enters directly into the lumen of the duodenum.

The liver receives nutrients and oxygen from the blood from its own hepatic artery. But, unlike other organs, venous blood, saturated with carbon dioxide and deprived of oxygen, also enters the liver.

There are two systems of veins in the liver:

• Portal. The portal vein system is formed by branches of the portal ( gate) veins. The portal vein is a large vessel into which blood enters from all unpaired organs of the abdominal cavity ( stomach, small intestine, spleen), and from the portal vein to the liver. In the liver, this blood is cleansed of toxins, waste products and other substances harmful to the body. Blood cannot get out of the digestive tract ( gastrointestinal tract) into the general circulation without being "filtered" by the liver.
• Cavalry. It is formed from the totality of all veins that carry blood from the liver. This venous blood is saturated with carbon dioxide and deprived of oxygen due to the gas exchange between the liver cells and blood cells.

The main functions of the liver are:

• Protein exchange. More than half of the proteins main building material of the body), which are produced in the body per day, are synthesized ( formed) in the liver. The main blood proteins are also synthesized - albumins, blood coagulation factors ( act to stop bleeding). The liver stores amino acids ( main structural components of proteins). In case of insufficient intake or loss of protein, the liver begins to produce ( synthesize) proteins from stocks of amino acids.
• lipid metabolism. The liver plays an important role in fat metabolism. She is responsible for the synthesis production) cholesterol ( ) and bile acids ( prevent fat droplets from sticking together, activate substances that break down fats into simpler components). One of the functions is also the storage of fat. Maintains a balance between the metabolism of fats and carbohydrates. With excess sugar main source of energy The liver converts carbohydrates into fats. In case of insufficient intake of glucose ( Sahara) The liver synthesizes it from proteins and fats.
• carbohydrate metabolism. Glucose in the liver sugar) is converted to glycogen and deposited ( is stocking up). In the event of a lack of glucose, glycogen is converted back to glucose and provides the body with the necessary energy.
• pigment exchange ( pigment - a substance that gives color to tissues and skin). When erythrocytes are destroyed red blood cells) and hemoglobin ( iron-containing protein - oxygen carrier) free bilirubin enters the blood ( bile pigment). Free ( indirect) bilirubin is toxic to the body. In the liver, it is converted to bound ( straight) bilirubin, which has no toxic effects on the body. Then direct bilirubin is excreted from the body, and a small part of it enters the blood again.
• Vitamin exchange. The liver is involved in the synthesis ( development) vitamins and absorption of fat-soluble vitamins ( A, D, E, K). With an excess of these vitamins, the liver stores them in reserve or removes them from the body. With a deficiency, the body receives them from the liver reserves.
• barrier function. It is one of the most important functions of the liver. Its purpose is to neutralize, detoxify substances that are formed in the body or come from the environment.
• digestive function. This function consists in the constant production of bile by hepatocytes ( liver cells). Bile enters the gallbladder and is stored there until needed. During meals, bile enters the intestinal lumen, thereby contributing to the digestion process. Bile acids promote emulsification ( mixing with water) fats, thereby ensuring their digestion and absorption.
• enzymatic function. All biochemical reactions are accelerated by special substances - enzymes. These enzymes are found in the liver. And when the body urgently needs any substances ( e.g. glucose) liver enzymes accelerate the processes of their production.
• immune function. The liver is involved in the maturation of immune cells ( Immunity is the sum total of the body's defenses.), as well as in many allergic reactions.
• excretory function. Together with bile, the liver removes metabolic products, which then enter the intestines and are excreted from the body.

Interesting Facts

• The liver ranks second in mass among all organs ( average weight - 1500 g.).
• 70% consists of water.
• In one hour, about 100 liters of blood passes through the liver and, accordingly, more than 2000 liters per day.
• The liver performs more than 500 functions every day.
• The liver could function up to 300 years due to its unique property - the ability to self-repair.
• More than 25% of liver diseases are caused by alcohol consumption.
• About a million chemical reactions take place in liver cells per minute.
• Currently, more than 50 liver diseases are known.
• ).
• More than 11,000 transplants are performed annually ( transplant surgeries) liver.

Forms and stages of hepatosis

To formulate an accurate diagnosis, describe the degree of liver damage and the prevalence of the pathological process, there are classifications of hepatosteatosis according to various criteria. This provides the doctor with a more detailed understanding of the patient's illness, even if the doctor is not familiar with the patient's history ( medical history).

Steatosis can be:

• Alcoholic- pathological changes in the liver against the background of chronic alcohol intake.
• non-alcoholic(non-alcoholic steatohepatosis - NASH, non-alcoholic fatty disease - NAFLD) - fatty degeneration of the liver, which occurs with the wrong lifestyle, diet, various concomitant diseases.

In fatty hepatosis, there are:

• Stage I - minimal obesity. Droplets of fat accumulate in liver cells without damaging hepatocytes.
• Stage II - moderate obesity. Irreversible processes occur in cells, leading to their destruction and death. Their contents enter the intercellular space. Cysts are formed pathological cavities).
• Stage III - severe obesity. pre-cirrhotic state ( cirrhosis is an irreversible chronic process of replacing liver tissue with scar tissue).

According to the degree of damage to the structure of the liver, there are:

• Focal disseminated - accumulation of small areas of fat in various parts of the liver with an asymptomatic course.
• Expressed disseminated - the accumulation of fatty drops in large quantities in various parts of the liver with the manifestation of symptoms.
• Zonal – location of lipids ( fat) in various parts of the hepatic lobules ( structural and functional units of the liver).
• diffuse - Liver damage, in which the accumulation of fat occurs evenly throughout the entire lobule of the liver with the onset of symptoms.

By etiology(the cause of the disease)steatosis happens:

• Primary- congenital intrauterine metabolic disorder.
• Secondary- a metabolic disorder that appears as a result of concomitant diseases, malnutrition and lifestyle.

According to the microscopic picture of hepatosis, that is, pathological changes at the cellular level, there are:

• Small droplet obesity- simple obesity, in which pathological processes are already occurring, but without damage to the liver cells.
• Large droplet obesity- a more severe course of the disease, in which the structure of hepatocytes ( liver cells) is significantly damaged, which leads to their further death ( necrosis).

Morphologically(structure and shape of cells)allocate:

• 0 degree steatosis- locally in hepatocytes accumulations of fat appear.
• I degree steatosis- accumulations of lipids ( fat) increase in size and merge into foci with damage to liver cells - up to 33% of the affected cells in the field of view.
• II degree steatosis- accumulations of lipids of various sizes, which are distributed over the entire surface of the liver - 33 - 66% of liver cells ( small droplet, large droplet intracellular obesity).
• III degree of steatosis- the accumulation of fat occurs not only in the cells, but also outside them with the formation of a cyst ( pathological cavity in the tissue), destruction and death of cells - more than 66% of the affected liver cells in the field of view.

Causes of liver steatosis

Many factors lead to the development of pathological changes in the liver and disruption of its functions. Liver health is affected by lifestyle, diet, medication, heredity, concomitant diseases, viruses. Often, not one specific cause leads to steatosis, but a combination of several. Therefore, to establish the etiology ( the reasons) of illness, the doctor should ask the patient in detail about his bad habits, diseases, medicines that he has taken or is taking, and so on. A correctly identified cause will not only eliminate the factor itself and its detrimental effect on liver health, but also prescribe an effective treatment. This will significantly increase the patient's chances of recovery.

The causes of steatohepatosis are combined into two large groups:

• causes of alcoholic steatohepatosis;
• causes of non-alcoholic steatohepatosis.

Causes of alcoholic steatohepatosis

Alcohol intake is the only cause of alcoholic steatosis . The accumulation of fat droplets in the liver cells occurs under the action of ethanol ( pure alcohol, the content of which is indicated as a percentage on alcoholic products) in chronic alcoholism or excessive alcohol consumption. Large doses are considered 30 - 60 grams of ethanol per day. Under the influence of alcohol, liver cells die faster than they are renewed. During this period, excess scar tissue forms in the liver. The supply of oxygen to the cells is significantly reduced, as a result of which they shrivel and die. The formation of protein in hepatocytes is reduced, which leads to their swelling ( due to the accumulation of water in the cells) and hepatomegaly ( abnormal enlargement of the liver). Increase the risk of developing alcoholic steatosis heredity, protein deficiency in food, hepatotropic ( peculiar to the liver) viruses, concomitant diseases, obesity and others.

Causes of non-alcoholic steatohepatosis

In addition to alcohol abuse, a number of other factors can lead to steatosis.

Causes of non-alcoholic steatosis

Risk factors are:

• female;
• age over 45;
• body mass index ( BMI is the ratio of weight in kilograms to the square of height in meters) more than 28 kg/m 2 ;
• hypertonic disease ( high blood pressure);
• diabetes ( a disease caused by a lack of insulin, a pancreatic hormone responsible for lowering blood sugar levels);
• ethnicity - Asians are most susceptible to the disease, and African Americans are at a lower risk;
• burdened hereditary history - the presence of a disease in relatives or factors transmitted genetically.

Symptoms of liver hepatosis

Steatohepatosis can be asymptomatic for a long time. It is detected more often by chance during annual medical examinations and diagnostic procedures for other diseases. In the initial stages of hepatosis, the patient does not present any complaints. With the progression and involvement of an increasing area of ​​the liver in the pathological process, the functions and structure of the organ begin to be disturbed. This is what causes the symptoms.

Symptoms of hepatosis

Stage of steatohepatosis	Symptom	Development mechanism	Manifestation
I stage	Asymptomatic	–	–
II stage	Pain syndrome (constellation of symptoms)	The liver has no pain receptors ( proteins that receive information from the stimulus and transmit it to the analyzer center). Pain occurs when the liver increases in size and stretches its capsule ( membrane that covers the liver).	Discomfort, heaviness in the right hypochondrium, appearing regardless of food intake. Feeling of squeezing of organs, pain when probing the liver.
	Weakness	Weakness and malaise are caused by a lack of energy due to a disturbance in nutrient metabolism.	Body aches, constant feeling of fatigue.
	Nausea (persistent or paroxysmal)	It develops due to indigestion associated with a lack of bile-forming liver function. With a lack of bile, the process of digesting fats is disrupted, as a result of which food can stagnate in the digestive tract, which leads to nausea.	Discomfort, discomfort in the stomach and esophagus. Aversion to food, smells. Increased salivation.
	Decreased appetite	Many functions of the liver associated with metabolism are disturbed, which leads to an incorrect assessment of the body's supply of nutrients and the need for them, stagnation of food in the gastrointestinal tract. Also, appetite decreases with nausea.	Lack of hunger, a decrease in the number of meals and its volume.
	Decreased immunity (the body's defenses)	The liver plays an important role in maintaining immunity. Her disease leads to a violation of this function.	Frequent colds, exacerbation of chronic diseases, viral infections, inflammatory processes.
III stage	Jaundice of the skin and visible mucous membranes	An increase in the blood of bilirubin, a yellow pigment, as a result of the inability of the liver to bind it and remove it from the body.	Skin, mucous membranes of the oral cavity, sclera of the eyes ( tough outer shell) acquire a yellow color of varying intensity.
	Itching	With impaired liver function, bile acids are not excreted in the bile, but enter the bloodstream. This leads to irritation of the nerve endings on the skin and the appearance of itching.	Severe burning of the skin. Intense itching, more common at night.
	Skin rashes	The detoxification function of the liver is impaired. Under the influence of toxins and waste products of the body, a rash appears. Impaired hemostasis ( a complex biosystem that maintains blood in a liquid state under normal conditions, and in case of violation of the integrity of the blood vessel, it contributes to stopping bleeding), increased vascular fragility.	Small spots on the skin all over the body. Hemorrhagic rash ( small hemorrhages).
	Manifestations of dyslipidemia (lipid metabolism disorder)	As a result of lipid metabolism disorders,	xanthomas - a disease that appears when there is a violation of fat metabolism and is manifested by focal skin formations consisting of cells with fatty inclusions. xanthelasma - flat xanthomas that appear on the eyelids. Lipoid corneal arch - circular deposition of fat in the outer shell of the eye.

Diagnosis of hepatosis

To determine the type, stage, form of steatosis, it is necessary to conduct a series of examinations. The doctor will select the optimal diagnostic methods individually for each patient.

Diagnosis of the disease includes:

• history taking ( information about the patient's life, medical history and other);
• inspection;
• laboratory examination methods ( complete blood count and biochemical blood test);
• instrumental examination methods ( ultrasound examination, computed tomography, magnetic resonance imaging, liver biopsy, elastography).

Collection of anamnesis

The collection of anamnesis is basic in the diagnosis of the disease. The interview with the patient is the first stage of the examination. The more detailed the history is collected, the easier it will be for the doctor to identify the cause of the disease, choose the treatment, diet and give the right recommendations for lifestyle changes.

At the appointment, the doctor will analyze:

• Patient complaints- complaints of pain, discomfort, heaviness in the right hypochondrium, the presence of vomiting, nausea.
• History of present illness- the time when the first symptoms appeared, how they manifested themselves, how the disease developed.
• Anamnesis of life- what comorbidities the patient has, what lifestyle he leads, what surgical interventions he has undergone, what medications he has taken or is taking and for what period.
• Family history What diseases did the next of kin suffer from?
• Anamnesis of the patient's diet- what foods the patient prefers, how often he eats, what kind of diet he follows, whether there is an allergy to foods, whether alcohol is taken ( threshold - 20 g/day for women and 30 g/day for men).

Inspection

After collecting an anamnesis, the doctor proceeds to examine the patient, during which he tries to identify various signs of liver disease.

During the examination of the patient:

• The skin and visible mucous membranes are carefully examined, the yellowness of the skin, mucous membranes and its intensity, the presence of scratching, rashes are assessed.
• Percussion is performed tapping) and palpation ( probing) abdomen to determine the size and tenderness of the liver.
• Alcohol dependence is also determined - etilism ( chronic alcohol use). With alcoholism, the patient will have a swollen face, tremor ( jitter) hands, untidy appearance, the smell of alcohol.
• The degree of obesity is determined. For this, various formulas for calculating the normal mass of a person are used, depending on gender, age, body type, and the degree of obesity is determined from the tables.

To determine the degree of obesity are used:

• Body mass index ( BMI). This is an objective factor that evaluates the conformity of a person's height and weight. The calculation formula is very simple - BMI \u003d m / h 2, that is, this is the ratio of a person's weight in kilograms and height in m 2. If the index is 25 - 30 kg / m 2 - the patient is overweight ( preobesity), if the BMI is greater than 30, the patient is obese.
• Calculation of ideal body weight ( BMI). This formula also takes into account the gender of the patient and determines his optimal weight, which should be followed. It is calculated according to the formulas - BMI \u003d 50 + 2.3 x ( 0.394 x height in cm - 60) - for men and BMI = 45.5 + 2.3 x ( 0.394 x height in cm - 60) - for women.
• Measuring waist circumference with a measuring tape. Used to predict complications and disease risk. If a woman has a waist circumference of more than 80 centimeters, and a man has more than 94 centimeters, then the risk of diabetes and hypertension increases ( high blood pressure) and grows with every additional centimeter.
• Ratio of waist circumference to hip circumference. For women, the ratio of the waist circumference to the hip circumference is less than 0.85, for men it is less than 1.0. Studies have shown that people with an apple body type ( waist wider than hips) are more prone to various diseases than people with a pear-shaped body type ( hips wider than waist).

General blood analysis

The procedure consists in taking blood from a vein and analyzing it on special laboratory devices.

In order to obtain reliable results, the following rules must be observed :

• blood sampling is carried out in the morning on an empty stomach ( not earlier than 12 hours after eating);
• dinner the day before should be light and early, without coffee and strong tea;
• for 2 - 3 days alcohol, fatty foods, some medications are excluded;
• physical activity, sauna visits are excluded per day;
• tests are given before x-ray examination, massage.

A general blood test can reveal:

• Possible anemia ( anemia). Anemia causes a decrease in the number of red blood cells ( red blood cells) - less than 4.0 x 10 12 /l in men and less than 3.7 x 10 12 /l in women. It also reduces the amount of hemoglobin ( oxygen carrier protein) - less than 130 g/l in men and less than 120 g/l in women.
• Signs of possible inflammation. The number of leukocytes in the blood increases white blood cells) - more than 9.0 x 10 9 /l, ESR increases ( sedimentation rate of erythrocytes) - more than 10 mm/hour in men and more than 15 mm/hour in women.

Blood chemistry

The procedure for taking blood for a biochemical analysis is identical to the procedure for taking blood for a general analysis. Only the lack of dinner the day before is added to the restrictions ( more than 12 hours of fasting), cancellation of lipid-lowering ( blood lipid lowering) drugs two weeks prior to analysis.

A biochemical blood test can reveal:

• Increased activity of transaminases ( ). Aspartate aminotransferase levels rise ACT) more than 31 u/l in women and more than 41 u/l in men and alanine aminotransferase ( ALT) more than 34 u/l in women and more than 45 u/l in men. An increase in their concentration in the blood indicates the process of destruction of liver cells.
• Dyslipidemia ( violation of protein metabolism). An increase in cholesterol levels fat-like component of all cells) more than 5.2 mmol/l. Decreased concentration of HDL lipoproteins - complexes of proteins and high-density fats, "good cholesterol") less than 1.42 mmol/l in women and less than 1.68 mmol/l in men. An increase in the concentration of LDL low density lipoproteins, "bad cholesterol") more than 3.9 mmol / l.
• Violation of carbohydrate metabolism. There is hyperglycemia ( increase in blood sugar) more than 5.5 mmol/l.
• hepatocellular insufficiency ( decreased function). Decreased albumin concentration major blood protein) less than 35 g/l, blood coagulation factors. This indicates the inability of the liver to produce proteins and provide hemostasis ( hemostasis is a complex biosystem that maintains blood in a liquid state under normal conditions, and in case of violation of the integrity of the blood vessel, it helps to stop bleeding).

Ultrasound procedure ( ultrasound)

Ultrasound procedure ( ultrasound) – non-invasive ( without penetration into the human body and violation of the integrity of the skin, tissues, blood vessels) research method. The essence of the method is to apply ultrasonic waves to the human body. These waves are reflected from the organs and captured by a special sensor, followed by displaying the picture on the monitor. The denser the structure of an organ or medium, the fewer waves pass through them and more are reflected. On the screen, such tissues and organs appear brighter and lighter. A special gel is applied to the patient on the right in the area of ​​​​the liver to facilitate the sliding of the sensor. Then an image of the liver is obtained on the screen. The doctor conducts a description of the results. This is an absolutely painless and harmless procedure, so there are no contraindications to ultrasound.

Indications for ultrasound of the liver are:

• an increase in the size of the liver when probing;
• tenderness of the liver on palpation probing);
• changes in the biochemical analysis of blood.

Ultrasound of the liver can reveal:

• Hyperechogenicity ( increased reflection of waves from tissues) liver- this indicates the compaction of the tissues of the organ.
• Enlargement of the liver in size ( hepatomegaly) - as a result of inflammatory processes and the accumulation of fatty deposits in the liver.
• fatty infiltration ( accumulation in tissues of substances that are not normally present) more than 30% of the liver- all changes in the liver are detected by ultrasound only with fatty degeneration of more than 30% of the organ area.
• Alternating areas of hyperechoic ( with increased reflection of waves from tissues) and hypoechoic ( with reduced reflection of waves from tissues) - dense areas reflect rays, less dense ones absorb them, which indicates the heterogeneity of liver damage.

CT scan ( CT)

CT scan ( CT) – non-invasive ( without penetration into the human body and violation of the integrity of the skin, tissues and blood vessels) examination method. This method is based on the passage of X-rays through the human body from different points and at different angles, which allows you to create a three-dimensional and layered image of the organs on the monitor.

For the examination, the patient must remove all clothing, jewelry, removable dentures and put on a special gown. Then he is placed on a bed with a scanning system that looks like a circle. This system is placed in the area of ​​the liver, after which the scanning probe rotates, passing x-rays through the patient's body. To improve the quality of imaging, the doctor can do a CT scan with a contrast agent, which will more clearly display the structures of the organ on the screen.

Computed tomography is shown:

• with focal ( local a) liver damage;
• with unsatisfactory results of ultrasound ( ultrasound);
• if necessary, in a more detailed, layered image;
• in the presence of formations, cysts ( pathological cavities in tissue).

Carrying out computed tomography(CT)contraindicated:

• with mental illness;
• with inappropriate behavior of the patient;
• with a patient's body weight of more than 150 kilograms;
• during pregnancy.

With liver steatosis, computed tomography can reveal:

• decrease in the x-ray density of the liver due to the accumulation of fats;
• thickening of the liver vessels in comparison with its tissue;
• focal accumulations of fat.

Magnetic resonance imaging ( MRI)

Magnetic resonance imaging is also a non-invasive method. Its essence is as follows. When a human body is placed in a strong electromagnetic field, hydrogen nuclei in its tissues begin to radiate a special energy. This energy is captured by special sensors and displayed on a computer monitor.

For the procedure, the patient must remove all clothing, jewelry, removable dentures and anything that contains metal. He is placed on a bed that slides into the MRI machine. After the procedure, an image of the organ appears on the monitor, which the doctor can examine in detail in all positions, sections and at different angles.

Indications for magnetic resonance imaging are:

• the need for more detailed visualization of liver structures;
• the presence of cysts, neoplasms;
• greater accuracy in tissue imaging, compared to computed tomography, which is more suitable for studying bone structures.

Contraindications to magnetic resonance imaging are:

• mental illness;
• inadequacy of the patient;
• having a pacemaker apparatus in the heart that helps control the heartbeat);
• the presence of metal implants ( dental or bone implants);
• claustrophobia ( fear of closed, cramped spaces);
• the presence of tattoos containing iron in the paint;
• the patient's weight is more than 160 kilograms.

With fatty infiltration of the liver, MRI can detect:

• hardening of the liver;
• enlargement of the liver in size;
• cysts and neoplasms, determine their size and location;
• heterogeneity of the liver structure;
• focal or diffuse accumulations of fat.

Liver biopsy

Biopsy ( excision of a portion of an organ for further examination under a microscope) liver is an invasive method of examination, that is, with a violation of the integrity of the skin, organs, blood vessels. For the procedure, the patient is placed on the examination table. He undergoes an ultrasound examination of the liver to determine the site from which tissue will be taken for study. After the doctor determines the required area for the biopsy, the procedure itself begins. The skin area in the liver area is treated with an antiseptic ( disinfectant). Necessarily in the puncture area, anesthesia of the skin is carried out. The doctor will explain how you will need to breathe during the procedure. Then a special biopsy needle is inserted into the liver area under ultrasound control ( ultrasound) and excised a small area of ​​tissue of the organ. incised area ( biopsy) are sent to the laboratory for examination under a microscope.

After the biopsy, the patient must be monitored by medical staff for four hours. He is strictly forbidden to get up. A cold compress is applied to the puncture area. For some time, there will be slight discomfort in this place. A day later, repeat the ultrasound ( ultrasound procedure) liver, general and biochemical blood tests.

Indications for a biopsy(excision of a part of the organ for its further study under a microscope)liver are:

• Destruction of hepatocytes ( liver cells) for an unknown reason, detected in a biochemical blood test in patients older than 45 years.
• The need to determine the stage and degree of fatty liver hepatosis.
• Differential Diagnosis ( exclusion of other diseases) steatosis and other associated liver diseases.
• The need for a detailed study of the structure of cells.
• Fibrosis is suspected reversible replacement of normal organ tissue with scar tissue) or cirrhosis ( irreversible replacement of organ tissue with scar tissue).
• Determining the severity of steatohepatosis, fibrosis, cirrhosis, when other methods are less informative.
• Surgery for obesity or removal of the gallbladder.
• Absolute contraindications for computed tomography and magnetic resonance imaging.

Contraindications for liver biopsy are:

• patient refusal;
• the presence of purulent processes in the liver, intra-abdominal cavity;
• skin infections in the area of ​​the biopsy;
• mental illness;
• increased tendency to bleed;
• focal lesions of the liver tumor);
• tense ascites ( accumulation of large amounts of fluid in the abdominal cavity).

A liver biopsy will determine:

• The degree of steatosis ( 0, 1, 2, 3 ) and type of lesion ( large droplet obesity, small droplet obesity).
• The presence of structural changes in the tissue and their stage ( fibrosis, cirrhosis).
• The presence of other liver diseases that accompany steatosis.
• Inflammatory processes that cannot be detected by most non-invasive methods.

Elastography

Elastography ( elastosonography) - a non-invasive method for examining the liver, which is performed using a special apparatus - "Fibroscan". It allows you to assess the degree of fibrosis ( reversible process of replacing normal organ tissue with scar tissue). It is an alternative to the invasive method - liver biopsy.

The principle of its operation is similar to the principle of operation of ultrasound. The doctor presses on the area of ​​the organ being examined with a special sensor and evaluates the elasticity of the tissues in the image before and after compression. Structurally altered sections of tissue shrink in different ways ( due to uneven elasticity) and are displayed in different colors on the screen. Stretch fabric is shown in red and green, while stiffer fabric is shown in blue. Normally, the liver tissue is elastic, but with structural changes ( fibrosis, cirrhosis) its elasticity decreases significantly, the tissue becomes more dense, rigid. The less elastic the tissue, the more pronounced the fibrosis. The procedure is safe and painless, therefore it has no contraindications. It is not performed in pregnant women and patients with ascites due to lack of information.

Indications for liver elastography are:

• diagnosis of liver fibrosis;
• staging of fibrosis.

Elastography reveals:

• structural changes in the liver in the form of fibrosis or cirrhosis;
• fibrosis severity ( F0, F1, F2, F3, F4 on a special scaleMETAVIR);
• severity of steatosis ( minimal, mild, moderate, severe).

Patients with fatty liver should periodically repeat diagnostic procedures. This will allow you to evaluate the effectiveness of the prescribed treatment, therapeutic diet, physical activity. It will also prevent the progression of the disease with a complication in the form of fibrosis ( reversible replacement of healthy tissue with scar tissue) and cirrhosis ( irreversible replacement of tissue with scar tissue with damage to the structure and function of the organ).

Periodic medical control

Indicators	Periodicity
Monitoring weight loss, the effectiveness of treatment, diet and exercise.	Twice a year.
Biochemical analysis ( ALT, AST, cholesterol) and complete blood count.	Twice a year.
Glycemic level ( blood sugar).	Daily for patients with diabetes and every 6 months for others.
ultrasound ( ultrasound procedure) liver.	Twice a year.
Liver elastography ( Fibroscan).	Once a year.
Liver biopsy.	Every 3 to 5 years, depending on results.
Hepatologist consultation.	The first year - every six months, then annually.
Consultation of a nutritionist, cardiologist, endocrinologist.	Annually, and in the presence of heart disease, the endocrine system is much more frequent.
Other methods.	According to the doctor's instructions.

Treatment of hepatosis with medicines

There is no specific treatment for fatty liver disease. Basically, the treatment is aimed at eliminating or reducing the negative impact of the causes that contribute to fatty degeneration of the liver, as well as strengthening the body as a whole, protecting and restoring liver cells ( hepatocytes), maintenance of diseases in a compensated state ( a state when the body adapts to the disease, which leads to a minimal negative impact of the pathological process). The dosage and duration of treatment are selected by the doctor individually for each patient, taking into account weight, concomitant diseases, stage and degree of his disease.

Treatment goals and essential drugs

Therapeutic strategy	Medicine group	Name	Mechanism of therapeutic action
Protection of liver cells from the negative effects of many factors, as well as restoration of the structure and function of hepatocytes (liver cells)	Hepatoprotectors (drugs that protect liver cells from damage)	Essential Phospholipids (phospholipids - components of the cell wall): livenciale; essliver forte; phosphogliv; resolution pro; antraliv.	Phospholipids are the structural element of cell walls. The intake of these drugs contributes to the restoration and preservation of hepatocytes, prevents the replacement of normal liver tissue with scar tissue, that is, the appearance of fibrosis and cirrhosis.
		Preparations of natural (vegetable)origin: allochol; carsil; liv-52; hepabene; legalon; silimar; Maksar.	Provide antioxidant ( protection of cells from the damaging effects of reactive oxygen species) action. They have a choleretic effect, preventing stagnation of bile and increased load on the liver. Stimulate the production of proteins, contributing to reparative processes ( cell functions to correct and restore) hepatocytes.
		Ursodeoxycholic acid preparations (the least aggressive, natural component of bile that does not have a toxic effect on cells): ursofalk; urdox; ursodez; Livodex.	Improve the immunological functions of the liver. Enhance the formation and excretion of bile, preventing the formation of stones in the gallbladder. Prevent cell death from toxic bile acids. Delay the spread of fibrosis ( reversible process of replacing healthy tissue with scar tissue). Reduce cholesterol levels component of cell membranes, the excess of which leads to an increased risk of developing cardiovascular diseases).
		Amino acid derivatives (amino acids - the main structural component of proteins): prohepar; heptor; hepa-merz; lecithin.	Contribute to the improvement of local blood circulation in the liver. Restore damaged structures of cells and areas of the liver. Delay the formation of connective ( cicatricial) tissue in the liver. Accelerate protein metabolism in liver diseases with parenteral ( intravenous) nutrition. Reduce ammonia levels toxic metabolic product) in blood.
		dietary supplement (biologically active additives): oats; chepaguard active.	Contains natural ingredients. Contribute to the acceleration of decay ( breaking down fats into simpler substances) fats, which protects the liver from fatty infiltration ( accumulation in the tissues of substances that are not normally present). Remove toxins, eliminate spasms, have an anti-inflammatory effect.
Increasing the sensitivity of cells to insulin (pancreatic hormone that promotes glucose uptake)	Hypoglycemic (reducing the concentration of sugar in the blood)funds	metformin.	Normalizes, reduces body weight. Reduces the concentration of LDL ( low-density lipoproteins - "bad cholesterol", contributing to the development of diseases of cardiovascular diseases) and fats in the blood. Increases the sensitivity of tissues to insulin, which contributes to better absorption of glucose.
		siofor.	Normalizes lipid metabolism ( fat), reduces the concentration of total cholesterol and LDL ( low density lipoproteins, "bad cholesterol").
Decreased lipid levels (fat)	Hypolipidemic (lowering the concentration of lipids in the blood)funds	Statins: atorvastatin; rosuvastatin.	Reduce the concentration of cholesterol and lipoproteins ( complexes of proteins and fats) in blood. Enhance the uptake and breakdown of LDL low density lipoproteins - "bad cholesterol").
		Fibrates: hemofibrate; clofibrate.	Reduce the amount of lipids ( fat) in the blood, LDL, cholesterol. At the same time, it increases the content of HDL ( high-density lipoproteins - "good cholesterol" that prevent the development of diseases of the heart and blood vessels). They have serious side effects, so they are less commonly used.
Weight loss	Other lipid-lowering agents	orlistat.	Suppresses the breakdown and absorption of fats from the gastrointestinal tract, which leads to weight loss.
		sibutramine.	Accelerates the onset of satiety and maintains this feeling for a long time, which leads to a decrease in the frequency of eating. Increases energy consumption.
Antioxidant action (protection of cells from destruction during oxidative processes, that is, with excessive exposure of cells to reactive oxygen species)	Antioxidants	Antioxidants include: mexidol; vitamins A, E, C.	Stimulates regeneration processes recovery), cell destruction processes are stopped, microcirculation improves, vascular fragility decreases, cholesterol levels in the blood normalize, oxygen consumption by cells is stimulated, transport and utilization of glucose is regulated.
Antihypoxic action (improving the utilization of oxygen by the body, increasing the resistance of tissues and organs to oxygen starvation)	Antihypoxants	Have an antihypoxic effect: carnitine; trimetazidine; hypoxene; actovegin.

Diet for hepatitis

Fatty hepatosis differs from other liver diseases in a more favorable course. It is treatable with full recovery of the liver. Often, recovery is as simple as changing your diet and lifestyle. Therefore, dieting can be the main treatment for the initial stages of steatohepatosis. With proper nutrition, metabolism in the body normalizes, the amount of fat in the liver decreases, and the functioning of the organs of the gastrointestinal tract improves.

Along with weight loss, the risk of developing diabetes mellitus, hypertension ( high blood pressure) disease, cardiovascular disease.

Diet therapy should be selected by a nutritionist individually for each patient, taking into account age, weight, gender and concomitant diseases. An improperly selected diet can only do harm. For diseases of the liver and gallbladder, a specially designed diet should be followed - table No. 5 according to Pevzner and diet No. 8 for obesity. The purpose of the diet is gentle nutrition for the liver.

When following a diet, it is important to remember that:

• Nutrition should be balanced and contain the necessary daily protein intake ( 110 - 130 g), fat ( 80 g, 30% vegetable) and carbohydrates ( 200 - 300 g).
• Sufficient amount of water should be consumed 1.5 - 2 liters excluding tea, compote, soups).
• It is necessary to limit the amount of salt consumed ( 6 - 8 g) and sugar ( 30 g).
• The number of meals should be up to 6-7 times a day ( fractional nutrition), dinner 3-4 hours before bedtime.
• Food should not be cold or hot.
• Fried foods are completely excluded, and preference is given only to boiled, steamed, baked and stewed foods.
• Products that irritate the gastric mucosa and increase bile secretion are excluded - acidic foods, pickles, spices and others.
• Avoid overeating and eat small meals.
• The use of alcohol is completely excluded.
• Green tea, coffee, cocoa, chicory, hibiscus are excluded.

It is a mistake to think that with steatosis, fats should be completely excluded from the diet. You just need to reduce the amount of fat you eat. Fats with proteins protect the liver from fatty degeneration and contribute to a speedy recovery. With a lack of fat, the body receives them from carbohydrates, which does not have the best effect on health. A low-fat diet causes the same damage to the body as the abuse of fatty foods. Fats are part of the structure of cells, necessary for the body to assimilate fat-soluble vitamins ( A, D, K, E), are involved in the production of certain hormones, bile acids. The main sources of fats should be vegetable oils ( olive, sunflower) and more than half - food of animal origin.

Allowed and prohibited sources of fat in fatty liver

Fats
fat-free cottage cheese, up to 500 ml of milk per day, kefir, yogurt; lean beef, rabbit meat, turkey, chicken; steam cutlets; seafood ( oysters, mussels, squid); lean fish ( tuna, walleye).	fatty dairy products; salo; fatty meat ( duck, goose, pork, beef); caviar, sushi, oily fish ( trout, catfish), salted and smoked fish; offal ( liver, tongue); mayonnaise, ketchup, mustard; sausages; canned food.

A sufficient amount of proteins of plant and animal origin should be supplied with food. Proteins play an important role in the normal functioning of the liver, so their deficiency will only increase the fatty infiltration of the liver.

Allowed and prohibited protein sources for fatty liver

Carbohydrates maintain the balance of metabolism, the normal functioning of the liver, and fiber reduces the concentration of cholesterol ( structural fat-like element of cells) in blood. This leads to a decrease in the risk of diseases of the cardiovascular system, tumors of the intestines and stomach. Carbohydrates are simple easily digestible) and complex ( difficult to digest). simple carbohydrates ( glucose, fructose) are found in sweets, sugar, confectionery. They instantly break down, satisfy hunger for a short time and contribute to the storage of fat in reserve. Complex carbohydrates ( fiber, starch) are digested by the body for a long time, dulling the feeling of hunger for a long time. They remove harmful substances, cleanse the intestines, and contribute to the proper functioning of the digestive organs.

Allowed and prohibited sources of carbohydrates in fatty liver

Carbohydrates

Allowed products include: boiled and baked vegetables; raw vegetables in limited quantities; dried fruits; mashed compotes; prunes; nuts; porridge ( oatmeal, buckwheat, barley, muesli); rye bread, croutons, crispbread, bran; honey, marmalade, marshmallow, lollipops; weak black tea, rosehip decoction.

Prohibited products include: bakery products; ice cream; sugar ( more than 30 g per day); carbonated and sweet drinks ( Sprite, Coca Cola, fruit juices); semolina; flour products of the highest grade; pasta; bean products ( nagut, lentil); adjika, horseradish; pickles; chocolate, cream confectionery, condensed milk, waffles; berries and fruits – apples, raspberries, grapes, cranberries, cherries and others; vegetables – radish, eggplant, garlic, onion, corn and others; fresh juices.

A sample menu for the day should meet the requirements of the diet and include:

• First breakfast- oatmeal on water with milk, low-fat cottage cheese, black tea.
• Lunch- dried fruits, apple, prunes.
• Dinner- vegetable soup with vegetable oils ( corn, olive), buckwheat porridge, compote.
• afternoon tea- bread, unsweetened cookies, rosehip broth.
• Dinner- mashed potatoes with steamed fish, beetroot salad, low-fat kefir.

You need to follow a diet not only for a certain period until recovery. It should become a lifestyle and you need to stick to it constantly. To achieve the best result and maintain it, the diet must be combined with sports. Heavy physical activity is not recommended. Swimming, yoga, Pilates, cycling are best suited.

Is hepatosis treated with folk remedies?

Folk remedies help in the treatment of fatty hepatosis no worse than expensive medicines. A positive effect can be expected only in the initial stages of the disease. In this period, the focus is not on drug treatment, but on following a properly selected diet, which can be combined with taking decoctions, herbal teas, and tinctures. But we must remember that engaging in self-diagnosis and self-treatment can be even more dangerous for health than a complete lack of treatment. The appearance of symptoms of liver disease indicates the progression of the disease with damage to the structure of the liver and its function. And self-treatment with folk remedies will only lead to an aggravation of the situation and the impossibility of further recovery. Therefore, before using any means, you need to consult a doctor.

The goal of folk remedies is to improve liver function, restore liver cells ( hepatocytes), removing toxins, reducing the amount of fat in the body, weight loss. Many medicines are based on medicinal herbs. Therefore, these natural remedies can be an effective treatment. Herbs can be used separately or in herbal preparations with a complex therapeutic effect on the liver.

Used to treat steatohepatosis :

• Bran. Helps remove excess fat from the body. Bran must be insisted in hot boiled water until it cools completely. After the water has cooled, you should take out the bran and eat two tablespoons. They can also be added to cereals and soups. Should be applied up to three times a day.
• milk thistle seeds. Milk thistle is part of many hepatoprotectors ( hepabene, silimar). Has an antioxidant effect protects the liver from the negative effects of oxidative processes, that is, damage to hepatocytes by an excessive amount of reactive oxygen species). Increases immunity, which helps the body to cope with many negative factors. To prepare the tincture, milk thistle seeds are poured with boiling water ( 200 ml) for an hour. After that, filter and take 1/3 cup 3 times a day half an hour before meals.
• immortelle flowers. Immortelle has a choleretic effect, normalizes metabolism ( metabolism) liver. Flowers immortelle pour 200 ml of water at room temperature and heat for half an hour in a water bath. After that, insist 10 minutes and add warm boiled water to the original volume. Take 1 - 2 tablespoons 3 - 4 times a day 10 minutes before meals.
• Dog-rose fruit. They help to remove toxins from the body, enrich it with trace elements and vitamins. About 50 g of rose hips are infused in 500 ml of boiling water for 12 hours. Take three times a day, 150 ml.
• St. John's wort. Strengthens the walls of blood vessels, has an antibacterial effect. A tablespoon of dried herbs pour 300 ml of boiling water, heat in a water bath for 5 minutes. Strain the resulting composition and add boiled water to the original volume.
• Mint leaves. Mint leaves have a choleretic effect, suitable for the prevention of liver diseases. One tablespoon of dried leaves pour 200 ml of boiling water. Leave for 20 minutes and take morning and evening before meals.
• Calendula flowers. They have anti-inflammatory, disinfectant, choleretic action. Contribute to the acceleration of metabolic processes in the liver. One tablespoon of calendula pour 200 ml of boiling water and insist for 20 minutes. Take 100 ml 3 times a day.
• Chamomile flowers. It has a disinfecting, healing effect. Chamomile flowers should be infused for 20 minutes, then strain and take 30 minutes before meals 2-3 times a day.
• Turmeric. A spice that helps restore damaged liver cells. Can be added in small amounts 1 - 2 pinches) when cooking.
• Pine nuts. Strengthen hepatocytes ( liver cells) to prevent their destruction.

What is dangerous liver steatosis ( complications, consequences)?

Steatosis ( accumulation of fat droplets in liver cells with their destruction) is dangerous by progressing to fibrosis and cirrhosis of the liver. Steatosis is a completely reversible process. To do this, you need to change your diet and lead a healthy lifestyle. But with a prolonged negative effect on the liver of many factors and the absence of treatment, the disease passes into more severe stages of the course. The rate of progression is different for each patient. With fatty degeneration with concomitant diabetes mellitus, obesity, alcohol intake, viral hepatitis, the process is significantly accelerated and passes into fibrosis.

Fibrosis is a reversible growth of dense connective tissue ( cicatricial) in the liver with damage to liver cells - hepatocytes. In this way, the inflammatory process is limited to prevent its further spread. Fibrosis has now been shown to be treatable. But, despite this, fibrosis often turns into cirrhosis of the liver.

Cirrhosis is a progressive, irreversible disease in which liver tissue is replaced by scar tissue. This significantly reduces the number of functioning cells. At the initial stages of the development of cirrhosis, it is possible to suspend and even partially restore damaged structures, but in severe cases, the disease is fatal ( patient death). The only treatment is a liver transplant.

Can pregnancy cause fatty liver?

Periodically, pregnancy is complicated by such a pathological condition as fatty liver hepatosis ( cholestatic hepatosis of pregnancy). Hepatosis appears at the beginning of the third trimester ( from 25 - 26 weeks of pregnancy). It is diagnosed in 0.1% - 2% of pregnant women. There is no definite answer about the cause of hepatosis during pregnancy. However, most doctors agree that the trigger is a high level of sex hormones - pregnancy hormones, which causes the manifestation of genetic defects in the processes of bile formation and bile secretion. Therefore, the pathology often acquires a family character and is inherited through the maternal line. Other reasons, in addition to genetic predisposition, may be the uncontrolled intake of vitamin preparations, which the liver cannot fully cope with, an unbalanced diet with an excess of fats and carbohydrates, which leads to fatty degeneration of the liver and the development of acute fatty hepatosis. Only a doctor can make a correct diagnosis based on laboratory and instrumental examinations.

Symptoms of the manifestation of fatty hepatosis of pregnant women are:

• skin widespread itching;
• icteric staining of the mucous membranes and skin;
• nausea, heartburn, occasional vomiting, loss of appetite;
• feeling of heaviness and moderate pain in the upper abdomen on the right;
• discoloration of feces;
• general weakness, malaise, fatigue.

Cholestatic hepatosis of pregnant women can be dangerous for the mother and fetus, as the risk of oxygen starvation increases ( hypoxia) baby and premature birth . Very common delivery ) at 38 weeks or even earlier, given the severity of the woman's condition. Fatty hepatosis of pregnant women can lead to severe postpartum bleeding, as the production of blood clotting factors by the liver is disrupted, which leads to inadequate functioning of the hemostasis system ( a complex biosystem that maintains blood in a liquid state under normal conditions, and in case of violation of the integrity of the blood vessel, it contributes to stopping bleeding).

Can children get hepatitis?

Hepatosis also occurs in children. Hepatosis is divided into primary ( hereditary, congenital) and secondary ( acquired), as well as pigment ( violation of the metabolic processes of pigments - substances that give color to tissues) and fatty ( violation of fat metabolism with their accumulation in liver cells).

Hereditary hepatosis - liver damage against the background of genetically determined metabolic disorders, manifested by a violation of the intrahepatic metabolism of bilirubin ( main component of bile). Manifested from birth as chronic or intermittent jaundice ( yellowness of the skin and mucous membranes). These hepatoses usually proceed benignly, with almost no effect on the quality of life of the patient, with the exception of Crigler-Najjar syndrome, accompanied by a high level of bilirubin in the blood with toxic damage to the central nervous system, heart and internal organs.

Secondary hepatosis develops against the background of concomitant diseases and an unhealthy lifestyle. Type I diabetes mellitus ( appears in childhood), obesity, congenital hepatitis, drug toxicity, cholestatic disorders ( bile stasis), malnutrition are the main causes of liver disease in children.

Can fatty liver be cured?

Fatty liver disease is a reversible liver disease. This pathology can be successfully treated in the early stages. There is no definite treatment. It all comes down to a change in lifestyle, a review of nutrition, the exclusion of etiological ( causal) factors. In many cases, it is not possible to exclude the causes contributing to the development of hepatosis. For example, incurable diabetes mellitus, congenital metabolic disorders, many endocrinological diseases. In this case, supportive therapy with hepatoprotectors ( drugs that help protect and restore liver cells), lipid-lowering agents ( reducing the concentration of fats in the blood), antihypoxant ( improving the utilization of oxygen by the body, increasing the resistance of tissues and organs to oxygen starvation) and antioxidant ( protecting cells from destruction during excessive exposure to reactive oxygen species) drugs and others. They also support concomitant diseases in the stage of compensation, that is, the adaptation of the body to a pathological condition with a decrease in negative consequences.

Basically, fatty liver is asymptomatic. It is diagnosed by chance during preventive examinations or diagnostic procedures for other diseases. Therefore, it is rarely possible to detect hepatosis in the early stages. Over time, the situation only worsens and is complicated by fibrosis ( reversible replacement of normal organ tissue with scar tissue) or cirrhosis ( irreversible chronic tissue replacement with scar tissue). In this case, it is very difficult or impossible to cure the liver.

What is the difference between hepatosis and hepatic steatosis?

Steatosis is a type of hepatosis. Hepatosis is a set of liver diseases, which are based on a violation of metabolic processes with a violation of the structure and function of liver cells ( hepatocytes). Steatosis is a pathological abnormal) accumulation of fat in the cells of the body in case of metabolic disorders. Distinguish pigmentary hepatosis ( violation of the metabolism of pigments - substances that color the skin and tissues) and fatty liver ( synonyms - liver steatosis, fatty degeneration of the liver, fatty liver, steatohepatosis, fatty degeneration, "fatty" liver).

The development of fatty hepatosis ( steatosis) patients with type 2 diabetes are more susceptible ( incidence of disease from 70% to 90% of patients), obese ( 30% to 95% of patients), with impaired fat metabolism ( 20% to 92% of cases).

For the diagnosis of steatosis, laboratory and instrumental methods are used. Laboratory methods include general and biochemical blood tests. With steatosis, blood tests reveal an increase in transaminase activity ( enzymes in liver cells that speed up chemical reactions) by 4–5 times, an increase in the concentration of cholesterol ( fat-like structural element of cells), lipoproteins ( complexes of proteins and fats) low density, increased blood sugar, bilirubin ( bile pigment), a decrease in the concentration of proteins, and others. Instrumental analyzes include ultrasound ( ultrasound), Magnetic resonance imaging ( MRI), CT scan ( CT), elastography ( Fibroscan) and liver biopsy. During these examinations, an increase in the size of the liver is found ( hepatomegaly), local or diffuse fatty accumulations in liver cells, cysts ( pathological cavities in tissues), fibrosis ( reversible process of replacing healthy liver tissue with scar tissue).

Violation of metabolic processes affects not only the liver. Therefore, steatosis is characteristic not only for the liver ( as in case of hepatitis), but also for the pancreas. The causes of pancreatic steatosis are the same factors as for the liver - this is excessive alcohol intake, obesity, diabetes, certain medications, and many others. Therefore, when making a diagnosis of "steatosis", it is necessary to clarify the pathology of which organ is in question.

Is it possible to do tubazh with fatty hepatosis?

Fatty hepatosis is not a contraindication for tubage. Tyubazh ( from French - tube placement, intubation) is a medical manipulation to cleanse the gallbladder ( digestive organ located under the liver and connected to it by the bile ducts).

The essence of the method is the irritation of the gallbladder with choleretic ( drugs or substances that stimulate the production of bile) means followed by increased excretion of bile. This procedure is carried out in order to prevent stagnation of bile ( cholestasis) and the formation of gallstones. It is used for diseases of the liver, gallbladder and bile ducts with symptoms of inflammation and impaired bile secretion. An absolute contraindication to tubage is calculous cholecystitis ( inflammation of the gallbladder due to the presence of stones). This can lead to a stone from the gallbladder entering the bile duct, resulting in blockage of the lumen of the duct. In this case, only urgent surgical intervention can help.

Tubage can be carried out using a duodenal probe or by taking cholagogues with simultaneous heating of the liver. In the first case, a probe is inserted into the duodenum ( hollow tube) and parenterally ( intravenously) or choleretic substances are injected through the tube. This leads to an increased excretion of bile into the duodenum, from where it is aspirated ( aspirate with a special device called an aspirator) through the probe. Inside take such choleretic substances as magnesium sulfate solution, sodium chloride solution, 40% glucose solution, intravenously - histamine, atropine and others.

The second method is probeless tubage ( blind tubage). For this procedure, the patient lies on his right side, bending his knees, and drinks a cholagogue. A warm heating pad is placed under the right side at the level of the liver. Rosehip decoction, magnesium sulfate solution, heated mineral water and others are used as choleretic agents. In this position, the patient is about 1.5 - 2 hours. The procedure should be carried out once a week for 2-3 months.

Which doctor treats hepatic steatosis?

A hepatologist deals with the diagnosis, prevention and treatment of liver diseases. But since the cause of liver steatosis can be various diseases, pathological processes and an unhealthy lifestyle, the treatment and diagnosis of the disease should be dealt with in a complex manner. And the hepatologist can appoint a consultation with doctors of other specializations.

A hepatologist may schedule a consultation with doctors such as:

• Gastroenterologist. This is a doctor who treats the organs of the gastrointestinal tract ( gastrointestinal tract). Chronic diseases of the gastrointestinal tract, as well as surgical interventions on the organs of the gastrointestinal tract and long-term parenteral ( intravenous) nutrition leads to improper processing and absorption of nutrients. This leads to a violation of metabolic processes and liver disease with excessive accumulation of fatty inclusions in it.
• Endocrinologist. A doctor who specializes in diseases of the endocrine glands ( thyroid gland, pancreas). endocrine diseases ( diabetes mellitus, thyroid disease, metabolic syndrome - a combination of metabolic, hormonal and clinical disorders) lead to obesity, disrupt the functions of many organs. All these factors are the cause of steatosis. Therefore, the treatment of this pathology without eliminating or compensating for the original cause has no effect.
• Nutritionist. The nutritionist will help the patient to adjust the diet and lifestyle. Since it is malnutrition that often leads to obesity with all the ensuing consequences ( diseases of the cardiovascular system, endocrinological diseases). He will also determine the lack or excess of vitamins, minerals, proteins, fats and carbohydrates from food, and select a diet individually for each patient.
• Obstetrician-gynecologist. Pregnancy may be complicated by hepatic steatosis. This disease can negatively affect the fetus and mother, even lead to death. In severe cases, they come to an artificial termination of pregnancy. Therefore, the hepatologist and obstetrician-gynecologist select supportive drug treatment or perform delivery ( artificial termination of pregnancy) for severe disease. Taking contraceptives ( contraceptives) changes the hormonal background of a woman, which is also the cause of steatosis. In this situation, the gynecologist should choose another method of contraception that does not adversely affect the liver.
• Cardiologist. Heart and liver diseases are closely related. Impaired liver function can be caused by heart failure, chronic oxygen starvation, circulatory disorders. But also liver diseases can lead to aggravation of already existing heart pathologies. Often this is accompanied by endocrine diseases.
• Expert in narcology. A narcologist deals with the treatment of alcohol dependence, which is the cause of a separate group of steatosis - alcoholic steatohepatosis. In liver diseases, alcohol consumption is absolutely contraindicated, because it can lead to cirrhosis of the liver ( irreversible replacement of normal liver tissue with scar tissue) and subsequently to the death of the patient.

Life expectancy in fatty liver

It is impossible to unequivocally answer the question of life expectancy in fatty hepatosis. Everything is strictly individual and depends on the age, the stage of the pathological process, concomitant diseases, complications, the effectiveness of treatment and the patient's desire to change his lifestyle. Steatosis does not have a significant effect on life expectancy. Moreover, this disease is easily treatable in its early stages. The prognosis changes significantly with the transition to fibrosis ( reversible growth of scar tissue) and cirrhosis ( irreversible growth of scar tissue). This negatively affects the structure and function of the liver. With a severely neglected course, the absence of proper treatment and the presence of provoking factors, the disease progresses rapidly and life expectancy is significantly reduced.

Fibrosis proceeds more favorably than cirrhosis. There are five stages of fibrosis. Progression can proceed at different speeds. For example, it may take several years from stage 0 to stage 2, and stage 3 to 4 in a fairly short period of time. The progression of fibrosis is significantly affected by diabetes mellitus, obesity, lipid metabolism disorders, age ( progression accelerates significantly after age 50) and others. With diet, a healthy lifestyle, and proper treatment, fibrosis can be cured.

Cirrhosis is a severe irreversible disease. Life expectancy with cirrhosis of the liver directly depends on the severity of the disease. With compensated cirrhosis, the body adapts to the pathology with the least negative consequences. Thus, preserved hepatocytes ( hepatic cells) perform the functions of dead cells. At this stage, life expectancy is more than seven years in 50% of cases. In the stage of subcompensation, the remaining hepatocytes are depleted and are unable to perform all the necessary functions. Life expectancy is reduced to five years. With decompensated cirrhosis, the patient's condition is extremely severe. Life expectancy up to three years in 10% - 40% of cases.

Does hirudotherapy help? leech treatment) with hepatitis?

Hirudotherapy ( leech treatment) can help in the complex treatment of hepatosis. This procedure is used in inflammatory processes in the liver ( e.g. chronic hepatitis, toxic hepatitis), cirrhosis ( irreversible replacement of normal organ tissue nor scar tissue).

Contraindications to hirudotherapy are:

• pregnancy;
• hypotension ( low blood pressure);
• anemia ( anemia, manifested by a low concentration of red blood cells and hemoglobin);
• hemophilia ( congenital bleeding disorder);
• individual intolerance.

Hirudotherapy technique is very simple. Before the therapy, the procedure area is treated with alcohol. Then leeches are placed on the skin in the zone of biologically active points. Their bite is almost not felt, as they secrete special painkillers. After about 30 - 45 minutes, satiated leeches themselves fall off. A sterile bandage is applied to the wounds. The course of treatment is 12 sessions with a frequency of 1 - 2 times a week.

Massage gymnastics, yoga help improve liver function. All exercises performed while standing on all fours or lying on the right side, minimally load the liver and contribute to the outflow of bile. Among the exercises for the liver, “scissors” can be distinguished ( in the supine position, leg swings are performed in the style of scissors), "bike" ( in the supine position, cycling is simulated), squats, jumps. Breathing exercises also have a beneficial effect on the liver.

To achieve a therapeutic effect from physical activity, you should follow a diet, diet, do not neglect proper rest, and completely stop smoking and drinking alcohol.

fatty liver disease very widespread. It affects up to 20% of the population. The risk group includes overweight people. Signs of fatty hepatosis of the liver determined by the stage of the disease. There are only 3 of them. In most cases, there are no specific signs. This disease develops gradually and is often asymptomatic.

There are no complaints in the early stages. At stage 2, the following signs are observed:

• pain;
• discomfort in the hypochondrium on the right;
• poor appetite;
• weakness;
• nausea.

Distinguish focal hepatosis and diffuse (total). In the latter case, the symptoms are more pronounced. The clinical picture of steatosis is based on the following disorders:

• organ dystrophy;
• insulin resistance;
• accumulation of lipids in hepatocytes;
• increased peroxidation;
• violation of the formation of apoprotein;
• violation of the blood supply to the body;
• cell destruction;
• retention of toxins.

Metabolic processes are disturbed, and the liver cannot perform its functions normally. All signs of liver hepatosis have their own mechanism. Pain appears due to stretching of the organ capsule. These people have hepatomegaly (enlargement of the liver). Clinical manifestations include discomfort unrelated to eating.

On palpation of the abdomen of a sick person, moderate soreness is detected. Fatty degeneration of the liver characterized by asthenic syndrome. It includes weakness, drowsiness and impaired performance. The reason is lack of energy. This is due to the fact that the most important metabolic processes take place in this organ. If available liver changes, the metabolism is disturbed.

Every experienced doctor knows how it manifests itself toxic hepatosis. He is worried about nausea. The reason is a violation of the process of formation of bile. This leads to dyspepsia. With hepatic dystrophy, hypersalivation, aversion to certain foods, and abdominal discomfort are observed. With this disease, people often suffer from SARS. The reason is a decrease in immune defense.

Late signs of steatosis

Like many other liver diseases, fatty liver leads to jaundice. It is often accompanied by itching. The skin of sick people acquires an icteric color. The reason is hyperbilirubinemia. This is possible with difficulty binding and excretion of the bile pigment by the liver. Itching is caused by irritation of the nerve endings.

It is moderate or intense. Often worried about a burning sensation in a certain area. If a person is not treated, then stage 3 develops. Along with jaundice and itching, a rash appears on the body. This creates small spots. On examination, hemorrhages are detected. The appearance of these signs is associated with a violation of the detoxification function of the organ. fatty degeneration of liver cells accompanied by dyslipidaemia.

This means that the ratio of blood lipoproteins changes. An experienced doctor knows the signs of dyslipidemia. These include xanthelasma in the eyelids, xanthomas and the presence of an arc in the cornea. Under the influence of alcohol increased deposition of adipose tissue. This can lead to impaired stool, vomiting, fainting and hypotension. If therapy is carried out out of time, then diabetes mellitus develops.

Therapeutic tactics for steatosis

Before how to treat fatty liver disease requires examination of the patient. It is necessary to exclude other diseases (viral hepatitis, echinococcosis, tumors, cysts). The following research will be required:

• general blood and urine tests;
• biochemical analysis;
• Ultrasound of the abdominal organs;
• percussion;
• palpation;
• tomography;
• elastography;
• biopsy;
• study of the hormonal background;
• radionuclide scanning.

The human liver becomes loose. Ultrasound diagnostics is of great value. Enhanced echogenicity of the liver tissues, its increase and fatty infiltration are revealed. Often, areas of hyperechogenicity alternate with areas of hypoechogenicity. To cure hepatosis, you must adhere to the following recommendations:

• take medicines prescribed by a doctor;
• follow a strict diet;
• give up alcohol completely.

Therapy is carried out in a hospital or outpatient setting. Most often, conservative treatment is organized. If there are echo signs of steatosis on ultrasound, then the following can be prescribed:

• lipoic acid;
• hepatoprotectors;
• folic acid;
• choleretic;
• hypoglycemic drugs;
• biologically active additives;
• derivatives of amino acids;
• phytopreparations;
• antihypoxants;
• antioxidants.

If the liver is enlarged and insulin resistance is found, biguanides or thiazolidinediones are indicated. At fatty hepatitis drugs are prescribed that increase the resistance of cells. These include drugs such as Heptral, Gepabene, Essliver, Heptor, Livenciale, Rezalyut Pro and Phosphogliv.

Often, herbal remedies are included in the treatment regimen. This group includes Karsil, Liv-52 and Legalon. They have an antioxidant effect, improve bile flow and promote tissue repair. Often prescribed drugs based on ursodeoxycholic acid. Among them is Ursofalk. They prevent the appearance of stones, increase the formation of bile and improve its excretion.

With fatty liver hepatitis, antioxidants are prescribed (Mexidol, vitamins A and E). To improve the utilization of oxygen by tissues, antihypoxants are used. These include Actovegin. Drug therapy for steatosis is of secondary importance. The basis of therapy is diet and proper lifestyle.

The diet of patients with steatosis

It is necessary to know not only what hepatosis is, but also how to eat with it.. The main aspects of the diet are:

• weight loss;
• limiting the consumption of animal fats;
• refusal of alcoholic beverages;
• enrichment of the diet with protein;
• eating foods rich in vitamins and minerals.

After being placed diagnosis of hepatosis should adhere to proper nutrition. The main goal is to reduce weight. The loss of 10-15% of the initial mass favorably affects the metabolic processes in the liver and body. At chronic hepatosis of the liver you need to lose weight slowly. Weight loss should not exceed 500-700 g per week, otherwise stones form in the lumen of the gallbladder and liver failure develops.

With this pathology, table No. 5 or 8 is assigned. A sick person should eat 100-120 g of proteins, about 60-80 g of fat and 200-300 g of carbohydrates per day. The share of animal lipids should not exceed 25-30% of total fats. You need to drink at least 1.5 liters of water. Patients must adhere to the following rules:

• eat food 6-7 times a day in small portions;
• reduce the intake of salt and granulated sugar;
• refuse fatty and fried foods;
• cook food for a couple, boil or bake in the oven;
• exclude from the use of spices, pickles, acidic foods and marinades;
• give up cocoa, coffee and green tea;
• eat food warm.

Vegetable and olive oils should be the main source of fats. Therapeutic nutrition for steatosis prohibits the use of sour cream, fatty cottage cheese, cream, lard, fatty meat, trout, smoked meats, sausages, mustard, mayonnaise, butter, chips, hamburgers, offal, canned food, mushrooms, fatty broths, legumes, onions, garlic and radish.

With hepatosis, you can eat lean meat and fish, seafood, vegetables, fruits, vegetable oil, cereals, berries, low-fat cottage cheese and milk, steam cutlets and meatballs, casseroles. Therapeutic nutrition for steatosis involves the rejection of chocolate, ice cream, pastries, cream, cherries, grapes, cranberries, fresh juice, semolina and soda. From sweets you can eat marmalade, honey, compotes, dried fruits and marshmallows.

Other treatments

How to treat hepatosis of the liver is not known to everyone. An obligatory component of therapy is an increase in motor activity. The prognosis improves with daily exercise. It can be Nordic walking, long walks, push-ups, pull-ups, gardening and swimming.

If a person is very obese, then running is not recommended. It is better to do yoga and fitness. To the scheme treatment for hepatosis of the liver often include folk remedies. They are used with the permission of the doctor. The diet is supplemented by the use of various herbal infusions, decoctions and tinctures. For steatosis, the following remedies are most effective:

• fruits of spotted milk thistle;
• oat stalks;
• oat flour;
• immortelle flowers;
• bran;
• rose hip;
• calendula;
• chamomile;
• Pine nuts;
• turmeric;
• St. John's wort.

If revealed liver enlargement against the background of hepatosis, then you can take milk thistle. This is an effective remedy that has an antioxidant and protective effect on organ tissues. This plant contains silymarin. Milk thistle prevents the development of liver fibrosis, eliminates inflammation, reduces cell resistance to insulin and has a choleretic effect. It acts on fat cells, reducing the risk of developing cirrhosis.

You need to know not only the causes of liver hepatosis, what it is, but also what fees help well with this disease. A mixture based on milk thistle seeds, plantain leaves, calamus root, horsetail and string is often used. An infusion is prepared from these plants. It is filtered and consumed before meals 4-5 times a day for 3-4 months.

At liver hepatosis cause lies in the effect of toxic substances on the body. It can be chemicals and alcohol. In view of this, it is necessary to give up alcoholic beverages during the time and exclude contact with harmful substances. Therapy is aimed at eliminating the main risk factors. If the cause was endocrine diseases, then it is necessary to normalize the hormonal background. Surgical treatment for hepatosis is not carried out. It may be required in severe liver failure.

The effect of treatment and prevention

The prognosis for steatosis is relatively favorable. When all the doctor's prescriptions are fulfilled, the condition improves. If at fatty liver hepatitis treatment is not carried out, then complications are possible in the form of cirrhosis, cholelithiasis, cholestasis, diabetes mellitus and liver failure. There is no specific prevention of steatosis.

Scheme treatment for fatty liver disease selected by the doctor. Ignoring symptoms can lead to liver failure. Thus, steatosis is a common pathology and for a long time proceeds in a latent form.

Fatty hepatosis or fatty liver, fatty degeneration, is called a reversible chronic process of hepatic degeneration, which occurs as a result of excessive accumulation of lipids (fats) in the liver cells.

Currently, there is a rapid growth of this disease due to systematic eating disorders, as well as an unhealthy lifestyle. It is possible to stop the development of the disease by identifying factors that affect the occurrence of fatty hepatosis. Changes for the better are observed after a month with timely treatment.

Fatty hepatosis: what is it?

Fatty liver is a chronic disease in which functional liver cells (hepatocytes) degenerate into adipose tissue.

With fatty hepatosis, liver cells (hepatocytes) lose their functions, gradually accumulating simple fats in themselves and degenerate into adipose tissue. With steatosis or fatty infiltration, the mass of fat exceeds 5%, its small accumulations are scattered, this is what diffuse fatty hepatosis of the liver looks like. With its content of more than 10% of the total weight of the liver, more than half of the hepatocytes contain fat.

It is almost impossible to recognize fatty hepatosis at first. Unfortunately, the symptoms are especially pronounced at the last stage, when the disease is already progressing. The patient has:

• feeling of heaviness in the liver;
• rashes on the skin and its dull color;
• indigestion, frequent nausea, vomiting is possible;
• deterioration of vision.

One of the symptoms that characterize diffuse changes in the liver by the type of fatty hepatosis is an increase in its size - hepatomegaly. A diseased liver occupies a huge place in the internal cavity of a person, causing discomfort. The reasons for the increase in size are:

• an increase in the number of cells to fight toxic substances;
• tissue augmentation to restore lost functions;
• excess fat cells.

The reasons

Based on what causes led to hepatosis, the disease can be divided into two groups: hereditary and resulting from a violation of metabolic processes in the body.

The main causes of fatty liver include:

• obesity;
• metabolic diseases;
• hypodynamia;
• binge eating;
• vegetarianism with impaired carbohydrate metabolism;
• diets for weight loss;
• long-term use of certain drugs:
• cordarone, diltiazem, expired tetracycline, tamoxifen;
• deficiency in the body of alpha-antitrypsin;
• antiviral treatment for HIV;
• an overdose of vitamin A;
• diseases of the organs of internal secretion;
• systematic alcohol abuse;
• exposure to radiation;
• diseases of the digestive system.

The progression of cell dystrophy leads to an inflammatory process, and this, in turn, leads to tissue death and scarring (cirrhosis). At the same time, concomitant pathologies of the gastrointestinal tract, cardiovascular system, metabolic disorders develop:

• diabetes;
• gallstones;
• deficiency of digestive enzymes;
• bile ducts;
• inflammation of the pancreas;
• hypertonic disease;
• ischemia of the heart.

Patient with fatty hepatosis of the liver hard to bear any infections, injuries and interventions.

There are risk factors for the formation of fatty hepatosis, among them:

• high blood pressure;
• female;
• reduced platelets;
• increased alkaline phosphatase and HTG;
• polymorphism of the PNPLA3/148M gene.

Based on the reasons, we can say that the development of hepatosis can be completely prevented. A change in lifestyle will not only prevent the onset of the disease, but also eliminate it at the initial stage.

Degrees

As fat accumulates, fatty liver is divided into three degrees of development:

1. The first degree is characterized by a small accumulation of cells of simple fats. If these accumulations are noted in the number of several foci and a large distance is diagnosed between them, then this is diffuse fatty hepatosis.
2. The second degree is put in the case when the volume of fat in the liver increases, and also areas of connective tissue appear in the structure of the organ.
3. The most severe third degree the disease is noted when areas of overgrowth of liver cells with connective tissue and large deposits of fat are clearly visible.

Symptoms of fatty liver in adults

Hepatosis of the liver is a silent disease. Often, until the process becomes running, a person develops cirrhosis of the liver, nothing is noticeable. However, this is only an appearance. If you carefully listen to your own body, you can notice something that was not observed before. The first symptoms of fatty liver disease include:

• Soreness in right side.
• Enlarged liver, noticeable on palpation.
• Digestive disorders: vomiting, diarrhea, nausea or constipation.
• Deterioration of the skin and hair.
• Predisposition to colds, poor immunity and allergic reactions.
• Reproductive disorders, impossibility of conception.
• In women, there are deviations of the menstrual cycle, heavy or irregular bleeding.
• Deterioration of blood clotting.

Usually, anxiety symptoms do not appear at once, but increase over time. First, patients complain of soreness and discomfort, then symptoms of intoxication of the body appear, because the affected organ ceases to perform its function.

If treatment is not carried out at the initial stage, symptoms characteristic of different stages of liver failure begin to appear:

If fatty liver disease is not treated, symptoms of liver cirrhosis and liver failure appear:

• behavior change; jaundice;
• monotony of speech;
• weakness;
• aversion to food;
• ascites;
• lack of coordination.

It is important to diagnose fatty liver hepatosis at an early stage - symptoms and treatment are determined and prescribed only by a doctor. Then it is more likely to fully restore its functions. The patient can reduce the healing time if he follows all the instructions. Unfortunately, at an early stage, the symptoms of fatty hepatosis do not appear.

People at risk should be checked periodically to detect diffuse changes and start treatment.

Complications

Fatty hepatosis leads to liver dysfunction, which is deadly for the patient. Gradual intoxication of the body negatively affects the functioning of the heart, kidneys and even lungs, causing irreversible damage. Most often, hepatosis develops into cirrhosis, and this disease is not subject to treatment at all.

Consequences for the body:

• Stagnation appears in the gallbladder, which leads to cholecystitis, pancreatitis, and the formation of stones. As a result, food ceases to be completely digested, it overloads the intestines and provokes dysbacteriosis.
• Inadequate working capacity of the liver leads to a deficiency of vital trace elements. As a result, cardiac activity and the condition of the blood arteries worsen, hypertension, varicose veins occur, and visual acuity decreases.
• In addition, there is a decrease in immunity, which leads to frequent, infectious and fungal diseases.

Diagnostics

On examination and palpation by a doctor, the liver was not enlarged, without features. Only when a large amount of fat accumulates, the liver can become enlarged with soft, rounded edges, painful to the touch. In the early stages of fatty hepatosis, pronounced symptoms are usually not detected. In patients due to hepatosis.

The list of necessary measures for an accurate diagnosis includes:

• Ultrasound of the liver. Traditionally, an ultrasound examination of the liver helps to detect its enlargement, and this almost always indicates problems with the organ.
• Tomographic study. MRI allows you to evaluate the structure of the liver. If fat is deposited in the organ, this will be visible on an MRI.
• Blood chemistry. The indicators of ALT and AST are evaluated. With their increase, we are talking about liver disease.
• Biopsy. It doesn't happen that often. Allows you to find out if there is fat in the structure of the body.

How to treat fatty liver disease?

How to treat fatty liver disease? The main treatment of fatty hepatosis is aimed at eliminating the factors that caused the disease, improving the regenerative abilities of the liver, improving metabolism, detoxification. With fatty hepatosis, it is necessary not only to take medications, but also to adjust the lifestyle and diet. Medications are used in combination - you need an effective means of membrane-stabilizing properties and antioxidants.

Drug therapy for fatty liver includes taking drugs to improve the function of the liver and its cells:

• essential phospholipids (essliver, essentiale forte, berlition),
• a group of sulfamic acids (taurine or methionine),
• herbal preparations-hepatoprotectors (karsil, LIV-52, artichoke extract),
• taking antioxidant vitamins - tocopherol or retinol,
• taking selenium supplements
• group B drugs intramuscularly or in tablets.

Application Features:

• Berlition is prescribed at a dose of up to 300 mg (1 tab.) twice a day for up to 2 months. With severe dynamics, Berlition is administered intravenously up to 600 mg for two weeks, followed by a transition to taking 300-600 mg per day in tablets.
• Essentiale is prescribed up to 2 capsules (600 mg) 3 times a day. The duration of treatment is up to 3 months. Gradually reduce the dosage to 1 capsule 3 times a day.
• An effective membrane-stabilizing drug is the artichoke - Hofitol. Assign before meals (3 times a day) three tablets a course of 3 weeks.

Before use, consult your doctor, because. there are contraindications.

The patient at home must:

1. Follow a diet that excludes fats, but rich in protein;
2. Lead an active lifestyle, which will contribute to weight loss if necessary, as well as speed up the metabolism;
3. Take medications prescribed by your doctor, including folic acid, vitamin B12, etc. to improve digestion;
4. visit a doctor;
5. Eat boiled and steamed food, finely chopped or mashed if possible.

Diet

A person diagnosed with fatty liver needs to completely reconsider their lifestyle and diet, in which it is necessary to exclude the consumption of animal fats. At the same time, food should include foods that help dissolve fats deposited in the liver. You need to eat 5 times a day, in small portions, in order to reduce the load on the liver.

Diet for fatty liver disease
Allowed products:	Exclude from the diet:
fresh boiled and steamed vegetables; vegetarian soups and borscht (without meat); milk soups; low-fat and mild cheese; boiled eggs (1 per day); steamed omelet; oatmeal, buckwheat, semolina and rice porridge; milk; low-fat or fat-free cottage cheese; kefir, low-fat yogurt. Replace cocoa and coffee with unsweetened tea.	meat broths, fatty meat and fish fresh onions and garlic beans and beans, tomatoes, mushrooms, radish, canned food, salted and smoked foods, fat cottage cheese and sour cream.

Patients with hepatosis should also eat the following foods in any quantities:

• artichoke to stabilize the processes occurring in the liver;
• pine nuts, which help restore tissue cells;
• sorrel, which acts as a stabilizing component and eliminates fatty formations in the affected organ;
• cinnamon, which also breaks down body fat;
• turmeric, which neutralizes sugar and free radicals that are formed in the blood during hepatosis and negatively affect the functioning of the liver.

Menu for the day with hepatosis

A sample menu for the day should meet the requirements of the diet and include:

• The first breakfast is oatmeal in water with milk, low-fat cottage cheese, black tea.
• Second breakfast - dried fruits, apple, prunes.
• Lunch - vegetable soup with vegetable oils (corn, olive), buckwheat porridge, compote.
• Snack - bread, unsweetened cookies, rosehip broth.
• Dinner - mashed potatoes with steamed fish, beetroot salad, low-fat kefir.

Folk remedies for hepatosis

Before using folk remedies, be sure to consult a gastroenterologist.

1. Relieve nausea and heaviness tea with mint and lemon balm, which is brewed and drunk symptomatically, i.e. when the symptoms are directly disturbing.
2. milk thistle(or milk thistle). It is designed to improve the outflow of bile, normalize the work of not only the liver, but also the gallbladder. It also has a membrane-forming function, promotes the restoration of liver cells and helps to synthesize protein.
3. Often with hepatosis, an infusion based on peppermint helps. One tablespoon of such a dried plant (usually chopped mint leaves) is poured with 100 grams of boiling water and left overnight. In the morning, the infusion is filtered, after which it must be divided into three equal portions. Each serving is drunk before meals throughout the day.
4. Dog-rose fruit . They help to remove toxins from the body, enrich it with trace elements and vitamins. About 50 g of rose hips are infused in 500 ml of boiling water for 12 hours. Take three times a day, 150 ml.
5. Liver collection is designed for treatment within 2 months. Ingredients: St. John's wort, plantain, agrimony, marshmallow (3 parts each), immortelle, eleutherococcus (2 parts), chamomile (1 part). 1 st. l. collection, pour a glass of boiling water, after 30 minutes - strain. Drink before meals 30 ml, without sweetening, three times a day.

Prevention

If you want to avoid the occurrence of this disease, it is very important to follow preventive measures. What will be relevant in this case?

• Proper nutrition.
• Maintaining normal weight.
• You need to lead an active lifestyle. Walking in the fresh air, as well as moderate physical activity on the body, are very important.
• You need to drink at least two liters of water per day.
• You also need to give up bad habits. Especially from alcohol.
• It is important to monitor your blood sugar levels.

Fatty liver disease is a reversible liver disease. This pathology can be successfully treated in the early stages. There is no definite treatment. It all comes down to a change in lifestyle, revision of nutrition, exclusion of etiological (causal) factors.

This is all about fatty liver hepatosis: what are the causes and symptoms of the disease, treatment features. Be healthy!

Bad habits negatively affect human health. And besides, they can cause many different serious diseases. In this article, I want to tell you what is

About the disease

At the very beginning, you need to understand what this disease is. So, this is the most common form of alcoholic damage to the human liver. When should we talk about fatty hepatosis? If the fatty mass of the liver is 10% or more higher than its wet mass. These fatty deposits most often have a rather large size, are localized mainly in the 2nd and 3rd hepatic lobules.

Pathogenesis

Separately, I also want to talk about how fatty hepatosis of the liver occurs, and what happens to this organ during its defeat by this disease. So, the disease occurs due to excessive intake of fats in the liver, as well as a violation of their removal from this organ. The number of important elements that are involved in the processing of fats is reduced. As a result, less and less phospholipids, lecithin and beta-lipoproteins are formed from fats, and the fats themselves are gradually deposited in the liver.

Severity

If the patient has diffuse liver changes, hepatosis is a possible consequence of this problem. So, it is worth saying that this disease has four stages of severity:

1. Initial. Droplets of fat accumulate only in individual cells of the liver.
2. 1 degree. Liver obesity is moderate, a large accumulation of fat can only be inside individual sections of cells.
3. 2 degree. There can be various degrees of obesity - from small-drop to large-drop.
4. 3 degree. This is massive obesity. Also, this degree of the disease is characterized by extracellular accumulation of fat, the formation of cysts filled with fat in the liver.

General symptoms

If the patient has a disease such as hepatosis of the liver, symptoms are most often absent. However, it should be said that the disease is more often observed in people with increased body weight. Also, often patients may complain of heaviness in the abdomen and epigastric region, intolerance to fatty foods and bloating. But we must remember that these symptoms can also be witnesses of completely different diseases.

The initial degree of the disease

We further consider such a disease as hepatosis of the liver. Symptoms of the initial degree of the disease - now I want to talk about this. So, you can determine the diagnosis by the level of hepatic transamines, i.e. special enzymes. Their number in patients with hepatosis increases significantly. If the patient is obese, then a sluggish inflammatory process may also occur. In some situations (with incorrect or completely absent treatment), it can lead to a disease such as cirrhosis or even cancer.

The second degree of the disease

Hepatosis of the liver, symptoms that may be inherent in the patient in the second stage of the disease:

1. Discomfort, discomfort (most often observed in the right side of the abdomen).
2. Feeling of heaviness, which is localized in the right hypochondrium.
3. The results will be provided by ultrasound. Changes in the density of the liver will be visible, there will also be increased echogenicity.
4. The liver is slightly enlarged. It can protrude about 3-5 cm beyond the ribs.
5. If you examine the vessels of the liver, it will be seen that the blood flow in this organ is changed, or rather, reduced.

The third degree of the disease

If a patient has third-degree hepatosis of the liver, the symptoms may be as follows:

1. Constipation.
2. Strong flatulence.
3. Frequent nausea.
4. Stretching in the right side.
5. Violation of the digestive processes.
6. Pain sensations. They will be localized in the region of the right hypochondrium and stomach. The pain will be aching, dull.

These symptoms may indicate that the disease is progressing and has passed into its last stage.

The reasons

Why can a disease such as hepatosis of the liver occur? The reasons lie in malnutrition and the influence of nutritional factors on the body:

1. Systematic intake of alcohol.
2. Fatty food intake.
3. Excessive intake of sweets, which are transformed into fats.
4. Overweight.
5. Vegetarianism can cause hepatosis of the liver. The thing is that this condition can be caused by the absence of animal protein, as well as a disorder of carbohydrate metabolism (which often happens to those who refuse to eat animal food).

Also, scientists identify many different factors that contribute to the occurrence of a disease such as hepatosis:

1. Sedentary lifestyle.
2. Eating semi-finished products, fast food.
3. Diets with a sharp exit and subsequent overeating.
4. The impact of drugs.
5. Exposure to toxins or drugs.
6. Certain diseases can also lead to hepatosis (for example, diabetes mellitus, atherosclerosis or gout).

Diagnostics

Only a doctor can tell you how to treat hepatosis of the liver. Self-medication in this case can be dangerous to the health of the patient. After all, only a doctor can make the correct diagnosis and prescribe adequate treatment (depending on the degree of development of the disease). What procedures will the patient have to undergo to make a diagnosis?

1. Examination by a doctor (gastroenterologist). So, a simple probing of the liver by a specialist is important.
2. Ultrasound (or ultrasound diagnostics).
3. Angiography of the liver.
4. MRI, i.e. Magnetic resonance imaging.
5. Examination of liver enzymes.

It is also very important for this disease to completely exclude the presence of viral hepatitis (this can be done using serological studies).

Principles of treatment

If the patient is diagnosed with hepatosis of the liver, treatment is what you need to pay special attention to. After all, if the disease is not treated, you can bring the body to a deplorable state. What would be important in this case? So, at the very beginning it should be noted that there is simply no specific treatment for this disease. The strategy for getting rid of hepatosis will be reduced to the following points:

1. Elimination of factors that can cause liver dystrophy.
2. Improved liver regeneration.
3. Metabolism correction.
4. Liver detoxification.

An important point: along with drug treatment, it is also important for patients to follow the right diet.

Drug groups

Very important is the drug treatment of fatty liver hepatosis. After all, this is the only way to cope with the disease and restore the normal functioning of this organ. There are three main groups of drugs that effectively fight this disease:

1. Preparations that contain essential phospholipids. These can be drugs such as Phosphogliv, Essentiale, Essliver Forte.
2. Drugs that belong to sulfoamino acids. These are medicines such as Heptral, Dibicor.
3. Herbal preparations. These can be medicines such as Karsil, Liv.52.

Medicines

What else is important to know for patients who have fatty liver hepatosis? Medicines must be taken correctly. It is also important to correctly select the dosage (which is why the treatment should be prescribed by a qualified doctor):

1. The drug "Berlition". It is prescribed to patients two tablets (300 mg) per day for 1-2 months. If the disease is in a neglected state, this drug can be administered intravenously (600 mg) for two weeks.
2. At the beginning of the course of treatment, patients may be given intravenous Heptral. Further, it is taken in tablets.
3. The drug "Essentiale" is prescribed to patients three times a day, two capsules. The duration of treatment in this mode is three weeks. Further, the drug is taken in a maintenance mode - one capsule per day for another couple of months.
4. The drug "Hofitol" is an excellent membrane-forming agent (the base is the leaves of the field artichoke). Three tablets are taken daily before meals. The course of admission is three weeks.
5. We consider further the drug treatment of fatty hepatosis of the liver. With this disease, it is also important to take drugs based on taurine (these are medications such as Taufon or Dibikor). This drug has several mechanisms of action: it increases hepatic blood flow, has a membrane-forming property, and acts as an antioxidant.
6. Herbal preparation "Holosas". If you need to simultaneously reduce the density of bile and establish its outflow, you can take this medicine. Taken half an hour before meals, 1 teaspoon. Also, the drug helps to cope with the feeling of fullness in the abdomen.
7. Vitamin E. It is prescribed as an antioxidant. Alternative: vitamin C and selenium.
8. Vitamins. For liver detoxification, niacin (vitamin PP and nicotinic acid) and riboflavin (vitamin B 2) will be very useful.

Healing herbs

If the patient has liver hepatosis, treatment can also be supplemented with herbs and seasonings.

1. Cinnamon. Fights the accumulation of fat in the liver cells. It also reduces appetite and lowers the level of glucose and cholesterol in the blood (important for diabetes).
2. Turmeric. It has antioxidant properties, promotes the outflow of bile, reduces sugar levels. This seasoning is the basis of such a drug as Cholagol.
3. Milk thistle (or milk thistle). It is designed to improve the outflow of bile, normalize the work of not only the liver, but also the gallbladder. It also has a membrane-forming function, promotes the restoration of liver cells and helps to synthesize protein.
4. Curly sorrel. In addition to helping the gallbladder in its work, it also helps to combat the deposition of fat in the liver.
5. Artichokes. Great for helping the liver. They are the basis of such a drug as "Hofitol".

Food

As mentioned above, the main cause of the disease is malnutrition. Therefore, a well-chosen menu is important. With fatty liver hepatosis, all food should be balanced. But some foods will have to be abandoned.

1. Squirrels. It is very important to get enough protein. So, the daily dose remains the same. Half of the proteins need to be obtained from plant foods, half from animals. Foods that are important to consume: fish, eggs, buckwheat, poultry, animal meat (rabbit, beef, veal), soy flour and oatmeal.
2. Fats. The daily fat quota should be reduced to 70 g per day. However, it is impossible to completely abandon their consumption (hormonal changes may occur, and the body cannot function normally without fats). It is necessary to limit as much as possible in the consumption of fat, smoked meats, duck meat, goose, hard margarine, fatty dairy products. The following products remain preferred: marine fish fat, poultry, seafood. A third of all fats should come from plant foods. In this case, you can eat olives, as well as vegetable oils.
3. Carbohydrates. If the patient has diffuse hepatosis of the liver, carbohydrate intake should be limited. At the same time, you need to abandon the consumption of the following products: semolina, rice, muffins, first-class bakery products, ice cream and sweets. Enrich the diet should be food that is rich in complex carbohydrates. These are legumes, vegetables, berries, nuts, fruits, sea kale, bran.

Nutrition principles

It is very important not only to eat the right food, but also to know when and how much to eat. If the patient has a liver disease (like hepatosis), the nutritionist will definitely advise you to reduce your daily calorie intake. At the same time, you also need to remember that you need to eat in small portions about 4-5 times a day. You can't overeat. It is necessary to completely abandon the consumption of alcohol and foods harmful to the body.

Prevention and lifestyle

If you want to avoid the occurrence of this disease, it is very important to follow preventive measures. What will be relevant in this case?

1. Proper nutrition.
2. Maintaining normal weight.
3. You need to lead an active lifestyle. Walking in the fresh air, as well as moderate physical activity on the body, are very important.
4. You need to drink at least two liters of water per day.
5. You also need to give up bad habits. Especially from alcohol.
6. It is important to monitor your blood sugar levels.

At the first symptoms, you need to seek medical help. After all, to cope with the disease at first can be quite easy and without much effort.

Forecast

What can you say to people who have been diagnosed with fatty liver disease by doctors? Do not despair, this disease is curable. If a diagnosis was made in a timely manner and adequate treatment was prescribed, the disease can be completely dealt with in a short time, and the results of treatment will be noticeable already during the first few weeks. If hepatosis has passed into the third stage, the treatment will be quite long. However, it is possible to cope with this disease with the right treatment.