Steatohepatosis: what is it, what are the causes and treatment. Non-alcoholic steatohepatitis: from pathogenesis to therapy Moderate liver steatosis

Excluded:

• Budd-Chiari syndrome (I82.0)

Included:

• hepatic:
  • coma NOS
  • encephalopathy NOS
• hepatitis:
  • fulminant, not elsewhere classified, with liver failure
  • malignant, not elsewhere classified, with liver failure
• necrosis of the liver (cells) with liver failure
• yellow atrophy or liver dystrophy

Excluded:

• alcoholic liver failure (K70.4)
• liver failure complicating:
  • abortion, ectopic or molar pregnancy (O00-O07, O08.8)
• Fetal and newborn jaundice (P55-P59)
• viral hepatitis (B15-B19)
• in combination with toxic liver damage (K71.1)

Excluded: hepatitis (chronic):

• alcoholic (K70.1)
• medicinal (K71.-)
• granulomatous NEC (K75.3)
• reactive nonspecific (K75.2)
• viral (B15-B19)

Excluded:

• alcoholic liver fibrosis (K70.2)
• cardiac sclerosis of the liver (K76.1)
• cirrhosis of the liver):
  • alcoholic (K70.3)
  • congenital (P78.3)
• with toxic liver damage (K71.7)

Excluded:

• alcoholic liver disease (K70.-)
• amyloid liver degeneration (E85.-)
• cystic liver disease (congenital) (Q44.6)
• hepatic vein thrombosis (I82.0)
• hepatomegaly NOS (R16.0)
• portal vein thrombosis (I81)
• toxic liver damage (K71.-)

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

K70-K77 Liver diseases. V. 2016

International Classification of Diseases, 10th Revision (ICD-10)

K70-K77 Liver diseases

K70-K77 Liver diseases

Reye's syndrome (G93.7)

viral hepatitis (B15-B19)

K70 Alcoholic liver disease

K71 Liver toxicity

Budd-Chiari syndrome (I82.0)

“Pure” cholestasis K71.1 Toxic liver damage with hepatic necrosis Liver failure (acute) (chronic), caused by drugs K71.2 Toxic liver damage, occurring as acute hepatitis

yellow atrophy or liver dystrophy

liver failure complicating:

• abortion, ectopic or molar pregnancy (O00-O07, O08.8)
• pregnancy, childbirth and the puerperium (O26.6)

jaundice of the fetus and newborn (P55-P59)

viral hepatitis (B15-B19)

in combination with toxic liver damage (K71.1)

K74 Fibrosis and cirrhosis of the liver

cardiac sclerosis of the liver (K76.1)

cirrhosis of the liver:

• alcoholic (K70.3)
• congenital (P78.3)

with toxic liver damage (K71.7-) K74.0 Liver fibrosis

• acute or subacute
  • NOS (B17.9)
  • not viral (K72.0)
• viral hepatitis (B15-B19)

toxic liver damage (K71.1)

cholangitis without liver abscess (K83.0)

pylephlebitis without liver abscess (K75.1) K75.1 Portal vein phlebitis Pylephlebitis Excluded: pylephlebitic liver abscess (K75.0)

amyloid liver degeneration (E85.-)

cystic liver disease (congenital) (Q44.6)

hepatic vein thrombosis (I82.0)

portal vein thrombosis (I81.-)

toxic liver damage (K71.-)

Focal nodular hyperplasia of the liver

Hepatoptosis K76.9 Liver disease, unspecified

Portal hypertension in schistosomiasis B65.- †)

Liver damage in syphilis (A52.7 †) K77.8* Liver damage in other diseases classified elsewhere Liver granulomas in:

• berylliose (J63.2†)
• sarcoidosis (D86.8 †)

Notes 1. This version corresponds to the 2016 WHO version (ICD-10 Version: 2016), some positions of which may differ from the ICD-10 version approved by the Russian Ministry of Health.

2. The translation into Russian of a number of medical terms in this article may differ from the translation in the ICD-10 approved by the Ministry of Health of Russia. All comments and clarifications on translation, design, etc. are gratefully received by e-mail.

3. NOS - without further clarification.

4. NEC - not classified in other categories.

5. The main codes of the underlying disease that must be used are marked with a cross †.

6. Optional additional codes that relate to the manifestation of a disease in a separate organ or area of ​​the body that represents an independent clinical problem are marked with an asterisk.

Steatohepatitis

Steatohepatitis is an inflammatory liver pathology that develops against the background of replacement of healthy tissues and cells of this organ with connective tissue. The disease can be diagnosed in people regardless of age. A large number of factors can lead to the development of such a disorder, ranging from many years of constant drinking of alcoholic beverages to the presence of obesity in a person.

Each type of disease has specific symptoms, which is why establishing the correct diagnosis is not difficult. The main clinical manifestations are considered to be the sudden appearance of jaundice, severe thirst, nausea and vomiting, as well as stool disturbances.

Establishing the correct diagnosis requires a comprehensive examination of patients. Treatment of steatohepatitis is carried out by conservative methods, among which the main one is diet therapy.

In the international classification of diseases, such a disease has its own meaning. ICD-10 code – K76.0.

Etiology

Since such a disorder is an inflammation in the liver tissue caused by the degeneration of fat cells, clinicians identify several main groups of predisposing factors that determine the development of the disease.

In most cases, the formation of steatohepatitis occurs against the background of excessive drinking of alcoholic beverages. Gastroenterologists have found that every third patient with a similar illness is dependent on alcohol.

Often the reason for the formation of this disease is a disruption of the metabolic process. This could be done by:

• lack of protein or glucose in the body;
• presence of excess body weight;
• prolonged refusal to eat;
• rapid weight loss;
• diabetes;
• dyslipidemia is a disease that leads to disruptions in lipid metabolism;
• complete replacement of the patient’s normal nutrition with parenteral nutrition.

In addition, there are several categories of medications that cause the development of such liver damage. These medications include:

• cytostatics;
• antifungal;
• glucocorticoids;
• antibacterial agents;
• non-steroidal anti-inflammatory drugs, which can be used to relieve pain or reduce fever;
• estrogens and other synthetic hormonal substances;
• calcium channel antagonists.

Among other etiological factors of fatty steatohepatitis, it is worth highlighting:

• a person has previously undergone surgical intervention on the gastrointestinal tract, in particular, partial excision of the small intestine;
• diverticulosis;
• Wilson-Konovalov syndrome, which leads to changes in normal copper metabolism.

In some situations, the causes of such liver disease remain unknown.

The main risk group is women and the elderly.

Classification

Depending on the etiological factor, the classification of such a disease will look like this:

• alcoholic steatohepatitis - as the name suggests, is caused by a long-term addiction to drinking large quantities of alcohol-containing drinks;
• non-alcoholic steatohepatitis - caused by metabolic disorders;
• drug-induced steatohepatitis – formed against the background of uncontrolled or causeless use of medications;
• chronic steatohepatitis - develops in almost every third patient with a similar diagnosis. If not treated in a timely manner, it leads to the development of irreversible processes in the liver.

NAFLD also has its own division depending on changes in the histological picture and the extent of the pathological process. Thus, there are the following degrees of activity of this disease:

• steatohepatitis of minimal activity - characterized by the fact that no more than 33% of liver cells are affected, and foci of the inflammatory process are dispersed throughout the organ. This form is a consequence of a sedentary lifestyle and eating a lot of fatty foods. To eliminate it, you just need to stick to a gentle diet;
• moderate steatohepatitis – involvement of 33 to 66% of hepatocytes in the disease is observed. This condition is a transition from steatosis to the final formation of cirrhosis;
• severe steatohepatitis - adipose tissue is distributed over more than 66% of the liver with a general inflammatory reaction.

It is worth highlighting steatohepatitis during pregnancy. It can occur due to a genetic predisposition or due to pathologies existing before pregnancy.

In addition, steatohepatitis occurs:

• primary – expressed against the background of metabolic disorders;
• secondary - is a consequence of other ailments.

Symptoms

Each type of disease has its own clinical picture, but there are several symptoms of steatohepatitis that are characteristic of any liver damage. Among them:

• almost constant nausea, which quite rarely leads to vomiting;
• slight pain or discomfort in the area under the right ribs;
• slight yellowness of the skin;
• general weakness;
• stool disorders, namely diarrhea;
• an increase in the volume of the affected organ, which can be detected not only during ultrasound, but also during palpation. This sign is one of the main symptoms.

In addition to the above symptoms, chronic steatohepatitis is characterized by:

• intense thirst on a constant basis;
• increased sweating;
• aversion to food, which leads to weight loss;
• nausea and vomiting.

Non-alcoholic steatohepatitis will be accompanied by the following symptoms:

• constant heaviness in the stomach;
• decreased performance, which occurs due to severe weakness;
• constant thirst;
• increased sweating;
• severe pain in the projection of the liver.

Signs of the dosage form of steatohepatitis:

• paroxysmal sharp pain in the area of ​​the right hypochondrium;
• sudden yellowing of the skin and mucous membranes;
• skin rashes;
• severe skin itching.

Diagnostics

Due to the fact that the disease has specific symptoms, establishing the correct diagnosis from a qualified specialist will not be difficult even during the initial examination. However, to confirm the type of disease, a number of laboratory and instrumental examinations will be required.

Primary diagnosis includes:

• a detailed survey of the patient aimed at determining the time of onset and severity of symptoms. This will enable the doctor to determine the severity of NASH or another form of the disease;
• studying the medical history and life history of the patient - in some cases will accurately indicate the etiological factor;
• a thorough physical examination, which must include palpation of the area under the right ribs and assessment of the condition of the skin.

The second diagnostic step is laboratory tests, including:

• clinical blood test - to identify signs of possible anemia and inflammatory process, which is expressed in an increase in ESR and the number of leukocytes;
• blood biochemistry - will show an increase in liver enzymes such as AST and ALT, which accurately indicates liver inflammation;
• general urine analysis.

The basis for making a correct diagnosis is the following instrumental examinations of the patient:

Treatment

Elimination of steatohepatitis of non-alcoholic, medicinal and alcoholic forms is carried out using:

• maintaining a gentle diet;
• taking medications.

Conservative therapy is aimed at:

• ensuring complete rest for the patient;
• weight loss;
• abolition of medications that led to the development of the disease;
• eliminating toxic effects on the liver;
• normalizing fat metabolism;
• restoration of the immune system.

The diet for steatohepatitis is aimed at completely avoiding:

• fresh bread and baked goods;
• fatty meats, fish and poultry;
• mushroom, rich and dairy first courses;
• sorrel and spinach;
• radish and radish;
• green onions and garlic;
• marinades and smoked meats;
• canned food and offal;
• ice cream and chocolate;
• herbs and spices;
• mayonnaise and other sauces;
• confectionery products;
• dairy products with a high fat content;
• carbonated, cold and alcoholic drinks;
• strong coffee, black tea and cocoa.

Despite a large number of restrictions, patients are allowed to eat:

• dried bread and biscuits;
• freshly squeezed berry, vegetable and fruit juices;
• compotes and jelly;
• green and herbal tea, as well as cocoa with milk;
• eggs, but not more than one per day, in the form of a steam omelet or soft-boiled;
• pasta;
• vegetarian broths;
• vegetables and fruits in any form;
• greens and nuts;
• seafood;
• dietary varieties of meat and fish;
• porridge with the addition of a small piece of butter;
• honey and jam.

It is best to eat food in small portions, but five times a day. Dishes should be warm, and foods should be prepared by boiling, steaming, stewing or baking. Dietary table No. 5 is taken as a basis.

In cases of ineffectiveness of diet therapy, treatment of steatohepatitis is carried out using the following medications:

• lipotropic drugs;
• hepatoprotectors;
• substances containing UDQ;
• antibacterial agents.

Possible complications

The formation of consequences against the background of non-alcoholic and other types of steatohepatitis occurs extremely rarely, however, the occurrence of:

• liver damage by cirrhosis;
• liver failure;
• diabetes mellitus

Prevention

To avoid the development of the process of replacing healthy liver cells with adipose tissue, you must adhere to the following rules:

• completely give up addictions;
• control body weight within normal limits;
• use medications only as prescribed by the attending physician and with strict adherence to the daily dosage;
• follow nutritional recommendations;
• undergo regular preventive medical examinations.

Alcoholic hepatitis is a liver pathology that occurs due to alcohol abuse. This liver disease develops quite slowly and may not manifest itself for a long time. In the final stages of hepatitis formation, liver failure and cirrhosis develop in the body.

Hepatitis A is a viral pathology that causes liver damage. Among all types of this disease, it has the most favorable outcome - complete recovery can be achieved, after which immunity to the virus is formed.

Hepatitis B differs from other types of similar liver damage in that it is autoimmune in nature, and for infection a small concentration of the virus in one of the human biological fluids is sufficient.

Chronic hepatitis B is one of the most common types of illness, both viral and of any other origin. The main causes of the development of the disease are considered to be infection with the virus from another person or through contact with the biological fluids of a virus carrier. In addition, the chronic form can be caused by long-term use of medications, alcohol abuse and other predisposing factors.

Autoimmune hepatitis is an inflammatory-necrotic pathology of the liver, which progresses quite quickly and causes deadly consequences. This type of hepatitis differs from others in that the organ is attacked by antibodies produced by the human immune system.

Steatohepatitis: causes, types, symptoms and treatment

According to statistics, liver diseases affecting metabolic disorders, such as non-alcoholic steatohepatitis (NASH), are now being diagnosed more and more often. The disease is especially common among residents of the United States and European countries. You should understand in more detail what steatohepatitis is and why it occurs.

Causes of disorders and development of complications

Among the main causes of the disease are:

1. Impaired metabolism. Provocateurs can be sudden weight loss or weight loss, poor nutrition and lack of proteins or carbohydrates.
2. Overdose of medications. A number of drugs and medications can provoke the development of the disorder in question.
3. Previous operations in the gastrointestinal tract.
4. Hepatocerebral dystrophy.
5. Relationship with lipid metabolism disorders.

Due to disruption of metabolic processes occurring in the internal organs and relating to fats and insufficiently oxidized foods, changes in the structure of the liver occur in the gastrointestinal tract. A particular danger is the fact that disorders are difficult to detect using modern diagnostic techniques, and they do not affect the condition of patients.

Liver steatohepatitis requires a thorough examination and timely diagnosis: this will help take measures for effective treatment. If non-alcoholic steatohepatitis and its other forms are not detected and, accordingly, not treated in time, there is a risk of complications, among which cirrhosis is especially prominent.

NAFLD - non-alcoholic fatty liver disease - develops due to fatty disorders, which provoke a number of possible consequences:

1. Hypertension.
2. Obesity.
3. Chronic hyperglycemia syndrome.
4. Atherosclerosis, etc.

According to the international medical and medical classification ICD-10 (tenth revision), non-alcoholic steatohepatitis has a unique code K75.8. Turning to this document, it is easy to pay attention to the relationship with the concept of “steatosis”. This term reflects a quantitative indicator of the accumulation of fat droplets and inclusions in hepatocytes - the most important liver cells involved in the processes of synthesis and preservation of the structure and substance of liver tissue.

The disease is also considered in connection with the syndrome of cholestasis - stagnation of bile elements in the liver tissues. The following types of cholestasis are distinguished:

1. A functional form in which the content of bile acids inside the liver decreases.
2. A morphological form in which bile accumulates in hepatocytes and ducts.
3. The clinical form of cholestasis, which in one way or another provokes or is a consequence of varying degrees of activity of steatohepatitis.

Types and symptomatic picture of steatohepatitis

There are several possible forms of occurrence:

1. Alcoholic form. It appears predominantly in patients suffering from alcoholism due to the breakdown of alcohol compounds in the liver cells. This causes a decrease in the functional indicators of the organ. Symptoms of steatohepatitis in this form are reduced to pain in the lower chest, dyspepsia and icteric signs. Most patients experience an enlargement and hardening of the liver, and the blood vessels of the esophagus also enlarge, which can lead to internal bleeding. Chronic steatohepatitis can be detected only through targeted examination through tests, ultrasound examination, biopsy, etc.
2. Non-alcoholic steatohepatitis. Often the disease develops as a result of saturation of the liver structures with neutral fats. The result is the development of oxidative and inflammatory processes, structural damage to the integrity of the liver and the occurrence of cirrhosis. Non-alcoholic steatohepatitis is mainly diagnosed in patients with excess weight and pancreatic diseases, with disorders of fat metabolism. Among other causes of development, malnutrition stands out - deficiency of protein compounds, antitrypsin levels, etc. This form, minimally active steatohepatitis, is characterized by the fact that it occurs unnoticed by the patient. The relationship with other ailments discussed earlier most often forces patients to visit their doctor, as a result of which steatohepatitis is discovered.

Dosage form or moderate steatohepatitis occurs due to taking medications that are unfavorable and harmful to the liver. These include antibiotics, estrogens and immunomodulators, immunostimulants, etc. The prognosis of this form is extremely favorable for the patient - if the first signs are detected, the development of LSH can be stopped with minimal therapy.

Regardless of the stage and form of the course, the general symptomatic picture may include:

1. Jaundice.
2. Continuous feeling of heaviness in the abdomen.
3. Malaise.
4. I'm thirsty.
5. Decreased appetite.
6. Weight loss.
7. Obesity.
8. Development of other ailments - diabetes mellitus, hyperlipidemia, etc.

Important! To exclude the development of complications and timely detect steatohepatitis and accompanying disorders, it is recommended to seek qualified help at the first suspicion.

Stages of diagnosis of steatohepatitis. Forecasts

Steatohepatitis with minimal activity and its other forms, regardless of the difficulty of diagnosis, can be detected through a number of measures:

1. Ultrasound examination of the liver to detect enlargement, thickening or other external changes. The ultrasound method is the most productive because it allows you to detect visual criteria for the development of steatohepatitis and take the necessary treatment measures.
2. Submission of laboratory tests. They are designed to reflect the content of cholesterol, bile pigment and other compounds, which will allow the doctor to make a conclusion about the presence of a disorder, if any.
3. Biopsy and other methods. A biopsy involves the intravital collection of cellular material from an organ from the patient’s body for the purpose of a detailed study of the tendency to disorders or their presence.

Important! The prognosis for any category of patients if any form of the disease is detected will depend on individual characteristics and the degree of development of steatohepatitis. Thus, with moderate steatohepatitis in patients aged 30 to 45 years, the prognosis is extremely positive.

In patients older than - years and above, when the alcoholic form is detected and accompanied by other diseases, prediction becomes difficult due to the likelihood of complications and difficulties in prescribing appropriate therapy.

Treatment: folk remedies, medications and diet

Taking into account the detected form and degree of liver damage, the disorder can be treated in several ways:

In the first case, for the treatment of steatohepatitis, predominantly the alcoholic form, the following are prescribed:

1. Hypoglycemics. They are designed to increase the organ's sensitivity to insulin.
2. Stimulating bile movements, designed to protect and preserve liver cells.
3. Hepatoprotectors to eliminate the lack of phospholipids in the patient’s body.

Treatment of non-alcoholic steatohepatitis and other forms in case of contraindications to the use of drugs (for example, with LSG) is carried out by adjusting the diet. Dietary intervention is aimed at selecting an individual diet for the patient, depending on the recommendations given by the doctor.

Diet for steatohepatitis includes:

1. Chicken meat prepared by boiling or stewing. In this case, patients are advised to avoid skin and cartilage.
2. Meat of other birds, rabbits, fish meat is allowed, but you should also be more selective in cooking methods - fried and smoked foods are strictly prohibited.
3. Dairy products, especially kefir, fermented baked milk, cottage cheese and yogurts will only bring benefits. It is important to take into account the mass fraction of fat and try not to consume excessively fatty fermented milk products.
4. Fresh vegetables and fruits.

1. Cereals.
2. Flour products.
3. Sweet products (including sweeteners).
4. Pork.
5. Lamb.
6. Cream (especially vegetable origin).
7. Pickles and smoked meats.

As for folk remedies, their use can hardly be called advisable, however, as a first measure to combat the disease, you can use:

Important! It is recommended to consume all of the healing drinks only with the approval of the specialist you are seeing. Otherwise, there are no guarantees for successful impact. It is also worth making sure that there are no individual intolerances or allergies to the components of healing infusions.

Preventive measures

Having understood what steatohepatitis is and what consequences it can lead to, it is advisable to touch upon an important topic - preventive measures.

In order to prevent the development and occurrence of the disease, it is recommended to follow a number of simple recommendations:

1. A balanced diet is necessary. Getting all the vitamins, compounds and microelements the body needs from food will help strengthen the immune system, improve well-being, and also saturate all organs and systems with the substances required for normal functioning.
2. Regardless of age, gender and health (according to medical statistics, often imaginary), it is advisable to refrain from consuming alcoholic beverages, especially strong cocktails and champagne. Drinking once a month or on occasion of a significant event, on a birthday or New Year is normal, but consuming alcohol in unacceptable quantities provokes the development of various complications and leads to certain consequences, among which liver disease is not the least of the troubles.
3. Refrain from excessive consumption of medications or take them strictly according to the instructions or prescriptions of a medical specialist. When being treated for other ailments, it is not advisable to be zealous in taking pharmaceuticals because of the likelihood of side effects.

Video

Hepatic steatosis as an inducer of inflammation and the formation of liver fibrosis.

Fatty liver degeneration (K76.0)

Version: MedElement Disease Directory

general information

Short description

Fatty liver degeneration is a disease characterized by liver damage with changes similar to changes in alcoholic liver disease (fatty degeneration of hepatocytes hepatocyte - the main cell of the liver: a large cell that performs various metabolic functions, including the synthesis and accumulation of various substances necessary for the body, the neutralization of toxic substances and bile formation (Hepatocyte)

), however, with fatty liver degeneration, patients do not drink alcohol in quantities that can cause liver damage.

Definitions most often used for NAFLD:

1. Non-alcoholic fatty liver (NAFL). The presence of fatty liver without signs of damage to hepatocytes hepatocyte - the main cell of the liver: a large cell that performs various metabolic functions, including the synthesis and accumulation of various substances necessary for the body, the neutralization of toxic substances and the formation of bile (Hepatocyte)

in the form of balloon dystrophy or without signs of fibrosis. The risk of developing cirrhosis and liver failure is minimal.

2. Non-alcoholic steatohepatitis (NASH). The presence of liver steatosis and inflammation with damage to hepatocytes hepatocyte - the main cell of the liver: a large cell that performs various metabolic functions, including the synthesis and accumulation of various substances necessary for the body, the neutralization of toxic substances and the formation of bile (Hepatocyte)

(balloon dystrophy) with or without signs of fibrosis. May progress to cirrhosis, liver failure, and (rarely) liver cancer.

3. Non-alcoholic cirrhosis of the liver (NASH Cirrhosis). Presence of signs of cirrhosis with current or previous histological signs of steatosis or steatohepatitis.

4. Cryptogenic Cirrhosis - cirrhosis without obvious etiological causes. Patients with cryptogenic cirrhosis usually have high risk factors associated with metabolic disorders such as obesity and metabolic syndrome. Increasingly, cryptogenic cirrhosis, upon detailed examination, turns out to be an alcohol-associated disease.

5. Assessment of NAFLD activity (NAS). A set of points calculated from a comprehensive assessment of signs of steatosis, inflammation and balloon dystrophy. Is a useful tool for semi-quantitative measurement of histological changes in liver tissue in patients with NAFLD in clinical trials.

K75.81 - Non-alcoholic steatohepatitis (NASH)

K74.0 - Liver fibrosis

K 74.6 - Other and unspecified cirrhosis of the liver.\

Classification

Types of fatty liver degeneration:

1. Macrovesicular type. The accumulation of fat in hepatocytes is local in nature and the hepatocyte nucleus moves away from the center. With fatty infiltration of the liver of the macrovesicular (large-droplet) type, triglycerides, as a rule, act as accumulated lipids. In this case, the morphological criterion of fatty hepatosis is the content of triglycerides in the liver over 10% of dry weight.

2. Microvesicular type. Fat accumulation occurs evenly and the core remains in place. In microvesicular fatty degeneration, lipids other than triglycerides (eg, free fatty acids) accumulate.

Focal and diffuse hepatic steatosis are also distinguished. The most common is diffuse steatosis, which is zonal in nature (the second and third zones of the lobule).

Etiology and pathogenesis

Primary non-alcoholic fat disease is considered one of the manifestations of metabolic syndrome.

Hyperinsulinism leads to activation of the synthesis of free fatty acids and triglycerides, a decrease in the rate of beta-oxidation of fatty acids in the liver and the secretion of lipids into the bloodstream. As a result, fatty degeneration of hepatocytes develops. The hepatocyte is the main cell of the liver: a large cell that performs various metabolic functions, including the synthesis and accumulation of various substances necessary for the body, the neutralization of toxic substances and the formation of bile (Hepatocyte)

The occurrence of inflammatory processes is predominantly centrilobular in nature and is associated with increased lipid peroxidation.

Increasing the absorption of toxins from the intestines is of some importance.

A sharp decrease in body weight;

Chronic protein-energy deficiency.

Inflammatory bowel diseases;

Celiac disease Celiac disease is a chronic disease caused by a deficiency of enzymes involved in the digestion of gluten.

Diverticulosis of the small intestine;

Microbial contamination Contamination is the entry into a certain environment of any impurity that changes the properties of this environment.

Operations on the gastrointestinal tract.

Diabetes mellitus type II;

Triglyceridemia, etc.

Epidemiology

Sign of prevalence: Common

Sex ratio(m/f): 0.8

The estimated prevalence ranges from 1% to 25% of the general population in various countries. In developed countries the average level is 2-9%. Many findings are discovered incidentally during liver biopsy performed for other indications.

Most often, the disease is detected at older ages, although no age (except for breastfed children) excludes the diagnosis.

The sex ratio is unknown, but a female predominance is expected.

Risk factors and groups

High risk groups include:

more than 30% of cases are associated with the development of liver steatosis Liver steatosis is the most common hepatosis, in which fat accumulation occurs in the liver cells

and in 20-47% with non-alcoholic steatohepatosis.

2. Persons with type 2 diabetes mellitus or impaired glucose tolerance. In 60% of patients, these conditions occur in combination with fatty degeneration, in 15% - with non-alcoholic steatohepatitis. The severity of liver damage is related to the severity of glucose metabolism disorders.

3. Persons with diagnosed hyperlipidemia, which is detected in 20-80% of patients with non-alcoholic steatohepatitis. A characteristic fact is the more frequent combination of non-alcoholic steatohepatitis with hypertriglyceridemia than with hypercholesterolemia.

4. Middle-aged women.

and non-controlling blood pressure. There is a higher prevalence of fatty liver in patients with hypertension without risk factors for fatty liver. The prevalence of the disease is estimated to be almost 3 times higher than in age- and sex-matched control groups that kept blood pressure at the recommended level.

Malabsorption syndrome Malabsorption syndrome (malabsorption) is a combination of hypovitaminosis, anemia and hypoproteinemia, caused by impaired absorption in the small intestine

(as a consequence of the imposition of ileojejunal Ileojejunal - relating to the ileum and jejunum.

anastomosis, extended resection of the small intestine, gastroplasty for obesity, etc.);

and some others.

Clinical picture

Clinical diagnostic criteria

Symptoms, course

Most patients with non-alcoholic fatty liver disease have no complaints.

Minor discomfort in the upper right quadrant of the abdomen (about 50%);

Pain in the upper right quadrant of the abdomen (30%);

Moderate hepatosplenomegaly Hepatosplenomegaly - simultaneous significant enlargement of the liver and spleen

Arterial hypertension AH (arterial hypertension, hypertension) - a persistent increase in blood pressure from 140/90 mm Hg. and higher.

Dyslipidemia Dyslipidemia is a metabolic disorder of cholesterol and other lipids (fats), consisting in a change in their ratio in the blood

Impaired glucose tolerance.

The appearance of telangiectasia Telangiectasia is a local excessive expansion of capillaries and small vessels.

Palmar erythema Erythema - limited hyperemia (increased blood supply) of the skin

Ascites Ascites is an accumulation of transudate in the abdominal cavity

Jaundice, gynecomastia Gynecomastia - enlargement of the mammary glands in men

Signs of liver failure and other signs of fibrosis, cirrhosis, non-infectious hepatitis require coding in the appropriate subheadings.

The identified connection with alcohol, medication, pregnancy and other etiological reasons also requires coding in other subheadings.

Diagnostics

Laboratory diagnostics

are detected in 50-90% of patients, but the absence of these signs does not exclude the presence of non-alcoholic steatohepatitis (NASH).

The level of serum transaminases increased slightly - 2-4 times.

The value of the AST/ALT ratio in NASH:

Less than 1 - observed in the initial stages of the disease (for comparison, in acute alcoholic hepatitis this ratio is usually > 2);

Equal to 1 or more - may be an indicator of more severe liver fibrosis;

More than 2 is considered an unfavorable prognostic sign.

2. In 30-60% of patients, an increase in the activity of alkaline phosphatase (usually no more than twofold) and gamma-glutamyl transpeptidase (may be isolated, not associated with an increase in alkaline phosphatase) is detected. A GGTP level > 96.5 U/L increases the risk of fibrosis.

3. In 12-17% of cases, hyperbilirubinemia occurs within % of the norm.

In clinical practice, insulin resistance is assessed by the ratio of immunoreactive insulin and blood glucose levels. It should be remembered that this is a calculated indicator that is calculated using various methods. The indicator is influenced by the level of triglycerides in the blood and race.

7. 20-80% of patients with NASH have hypertriglyceridemia.

Many patients will have low HDL levels as part of metabolic syndrome.

As the disease progresses, cholesterol levels often decrease.

It should be kept in mind that a low titre positive antinuclear antibody is not uncommon in NASH, and less than 5% of patients may have a positive low titer antismooth muscle antibody.

are more typical for cirrhosis or severe fibrosis.

Unfortunately, this indicator is not specific; if it increases, it is necessary to exclude a number of oncological diseases (bladder, breast, etc.).

11. Complex biochemical tests (BioPredictive, France):

Steato-test - allows you to identify the presence and degree of liver steatosis;

Nash test - allows you to detect NASH in patients with excess body weight, insulin resistance, hyperlipidemia, as well as patients with diabetes).

It is possible to use other tests if non-alcoholic fibrosis or hepatitis is suspected - Fibro-test and Acti-test.

Differential diagnosis

Complications

Fibrosis Fibrosis is the proliferation of fibrous connective tissue, occurring, for example, as a result of inflammation.

Cirrhosis of the liver Cirrhosis of the liver is a chronic progressive disease characterized by degeneration and necrosis of the liver parenchyma, accompanied by its nodular regeneration, diffuse proliferation of connective tissue and deep restructuring of the architectonics of the liver.

In detail (develops especially rapidly in patients with tyrosinemia Tyrosinemia is an increased concentration of tyrosine in the blood. The disease leads to increased urinary excretion of tyrosine compounds, hepatosplenomegaly, nodular cirrhosis of the liver, multiple defects in renal tubular reabsorption and vitamin D-resistant rickets. Tyrosinemia and tyrosyl excretion occur with a number of inherited (p) enzymopathies: deficiency of fumarylacetoacetase (type I), tyrosine aminotransferase (type II), 4-hydroxyphenylpyruvate hydroxylase (type III)

Almost bypassing the stage of “pure” fibrosis);

Liver failure (rarely - in parallel with the rapid formation of cirrhosis).

Treatment

Forecast

Life expectancy for non-alcoholic fatty liver disease is no lower than that of healthy individuals.

Half of the patients develop progressive fibrosis, and 1/6 develop cirrhosis.

Hospitalization

Prevention

1. Normalization of body weight.

2. Patients should be screened for hepatitis viruses. If they do not have viral hepatitis, they should be offered vaccination against hepatitis B and A.

Steatohepatitis

Steatohepatitis is a transitional phase of the disease from steatosis to cirrhosis. This pathology affects the cells of the liver tissue, resulting in an inflammatory process that develops on the basis of fatty degeneration. The only good news is that this process is still reversible (unlike liver cirrhosis).

ICD-10 code

Since the ICD-10 (International Classification of Diseases) code does not have a single designation, today the most common coding is K76.0 - fatty liver degeneration, not classified in other categories.

ICD-10 code

Causes of steatohepatitis

To effectively stop the problem, it is necessary to have an understanding of both the disease itself and the sources that give rise to it.

This pathology is an inflammation in the liver tissue that occurs against the background of degeneration of hepatic fat cells. Doctors divide it into several types, which cause various pathologies. Causes of steatohepatitis.

1. Alcoholic genesis. In almost every third person who abuses alcoholic beverages, the development of this deviation can be observed.
2. Metabolic genesis - pathology based on disturbances in metabolic processes.
   1. Excessively large body weight.
   2. Protein deficiency.
   3. Insulin deficiency in the body, causing diabetes.
   4. Rapid weight loss.
   5. Hunger strike.
   6. Failure in lipid (fat) metabolism - dyslipidemia.
   7. Complete replacement of the patient’s natural nutrition with parenteral administration of food (bypassing the digestive organs). This is mainly the intravenous route.
   8. Prolonged and repeated injection of glucose into a vein.
3. The medicinal trace of the disease. A number of drugs can cause poisoning with chemical compounds (intoxication), as well as fatty infiltration, which is due to increased accumulation of lipid components in liver cells. Such consequences can be observed after taking certain medications:
   1. Cytostatics that block the ability of cells to divide.
   2. Glucocorticoids that directly affect human hormonal levels.
   3. A number of antibiotic drugs.
   4. Nonsteroidal anti-inflammatory drugs (NSAIDs), used as pain relievers, anti-inflammatory and antipyretic agents.
4. This deviation can also be provoked by surgical intervention performed on the organs of the gastrointestinal tract, especially in the case of partial removal of the small intestine.
5. The cause of degeneration can also be diverticulosis - a deviation resulting from the formation of a pouch-like protrusion of the wall of the small intestine. At the same time, there is an increased increase in the colony of pathogenic microorganisms in the intestines.
6. Wilson-Konovalov pathology associated with changes in normal copper metabolism.
7. And a number of other factors. All sources of modern medicine are not yet known for certain.

Symptoms of steatohepatitis

The symptoms of alcoholic or non-alcoholic steatohepatitis are almost identical. Developing against the background of long-term alcohol consumption, which leads to disruptions in metabolic processes (including lipid metabolism), the changes in question primarily affect the liver. After all, it is the “customs” of the body and ethyl alcohol that gets inside is neutralized here. With a regular attack of alcohol, the organ ceases to cope with cleansing the body, and its cells begin to suffer damage. They stop working, and fat gradually begins to accumulate on the surface. Little by little, the accumulation process leads to the emergence of an inflammatory process, and if it is not treated, further progression can lead to a more severe disease - cirrhosis. This is an irreversible process in which the parenchymal liver tissue is degenerated by fibrous connective structures or stroma.

The development of the non-alcoholic form occurs similarly, with only the catalyst of the problem changing.

The main symptoms of steatohepatitis:

• In the area where the liver is located (under the right hypochondrium), aching pain begins to be felt.
• General weakness appears.
• Nausea.
• There is a loss of body weight.
• Signs of diarrhea may appear.
• The skin acquires a yellowish tint.
• But one of the main indicators of pathology, both with alcoholic and non-alcoholic traces of the disease, is an increase in the size of the liver, which is easily determined even by palpation. When pressing on the diseased organ, the patient feels an increase in pain symptoms.

Non-alcoholic steatohepatitis

The name of the type of pathology speaks for itself - non-alcoholic steatohepatitis, that is, the catalyst for deviation from the norm was a source not related to alcoholic beverages. It has another term - metabolic.

This type of disease is most often found in representatives of the fair sex, endowed with curvaceous figures. It is the excess kilograms (obesity) that provoke its onset and progression. Hereditary predisposition can also provoke the disease.

The reason may also be organic: the patient has a history of hypothyroidism, protein metabolism disorders (this may be the result of improper “sitting” on various diets or outright starvation), diabetes mellitus. The patient’s love for fatty foods can also be a source.

The essence of the pathological mechanism is a violation of the metabolic response to endogenous or exogenous insulin (insulin resistance). This disease is fraught with danger not only by a high risk of developing cirrhosis, but also by an increased likelihood of disturbances in the functioning of the cardiovascular system, since the failure of lipid metabolism provokes the accelerated progression of atherosclerosis.

Mostly, a person suffering from fatty liver disease of non-alcoholic origin, with its chronic course, may not even be aware of his problem. In this case, the clinical picture is mild and does not cause the person much discomfort. In this situation, it can only be recognized during a routine examination.

The situation is much more complicated when diagnosing inflammation of the liver structures with small vesicular lipid inclusions. This pathology can cause low blood pressure, pre-fainting and fainting conditions, internal bleeding or the development of cholelithiasis.

Alcoholic steatohepatitis

Pathology of this type is usually diagnosed in every third person who has a special addiction to the “green snake”. At the same time, it is not important for him to drink strong drinks or low-alcohol beer.

Ethyl alcohol is broken down almost completely in the liver. But if there is excess alcohol, the liver cells are not able to process it efficiently. A malfunction occurs, their cellular structure begins to deteriorate, and pain symptoms appear. A person feels a loss of weight, yellowing of the skin appears, belching, loose stool, and heartburn are less common.

In laboratory tests, alcoholic steatohepatitis is manifested by an increase in the number of liver tests, a decrease in hemoglobin levels and the development of leukocytosis is observed.

Primary therapy for this type of disease involves abstinence from alcohol, and then the patient is offered both drug treatment and dietary nutrition.

Fatty steatohepatitis

The pathology in question, in addition to the one given above, has a number of other names: fatty liver or fatty liver, caused by degeneration or degeneration of cellular structures. After the advent of biopsy in the sixties of the last century, this pathology was isolated as a separate disease.

The main characteristic of the pathology under consideration is the appearance of lipid deposits in the cellular or intercellular zone. A morphological parameter is the presence of triglycerides in the organ in question, more than one tenth of the dry mass. Doctors divide this pathology into certain stages of progression: 1.

Increased lipid content of liver cells. At the same time, the structure of hepatocytes and their work remained undisturbed, the mesenchymal (stromal-vascular) cell reaction was not observed. 2.

There is an increased lipid content of hepatocytes, the first signs of cellular necrosis appear, and a mesenchymal (stromal-vascular) cell reaction is present. 3.

Pre-cirrhotic stage of development. An irreversible restructuring of the lobular structure of the organ is observed.

Chronic steatohepatitis

The chronic nature of steatohepatitis develops on the basis of constant alcohol intoxication of the body and affects from 20 to 30% of people suffering from alcohol dependence.

Almost completely, through oxidation by special enzymes, ethyl alcohol is metabolized in the liver tissues. Excessive alcohol load on the body causes a malfunction of the organ, as a result of which a sluggish inflammatory process begins, which leads to a deviation from the normal functioning of a number of liver functions.

Such a patient begins to complain of pain in the right hypochondrium, yellowing of the skin and dyspeptic disorders.

If the chronic stage of the disease is not treated in a timely manner, sooner or later its progression can develop into cirrhotic manifestations, which no longer allow restoration of the original integrity and functionality of the liver.

Minimal activity steatohepatitis

Against the backdrop of general automation, modern people are increasingly beginning to suffer from physical inactivity, which develops against the backdrop of a sedentary lifestyle: from floor to floor in the elevator, traveling to work in public transport. Many of our compatriots imagine their vacation only as time lying on the couch in front of the TV. This approach to life cannot but affect the condition of the entire organism and the functioning of internal organs, in particular.

Fatty and high-calorie foods and a sedentary lifestyle, all this adds up to the appearance of additional kilograms. But fat cells begin to “settle” not only in the subcutaneous area, but also on the organs themselves. It is lipid deposits in the cellular and intercellular zone of the renal tissues that give impetus to the progression of the pathology in question.

Moderate steatohepatitis

A mild or moderate degree of development of the disease is observed in 10.6% of cases, the pathology in question especially manifests itself against the background of progressive steatosis, affecting hepatocytes of the perivenular zone and undergoing apoptotic changes.

Conducted research and monitoring of numerous cases of the disease confirms the recent assumptions of doctors about steatohepatitis as a transition bridge from steatosis to cirrhotic transformations.

At this degree of the disease, there are practically no pathological symptoms observed, which prevents early diagnosis. At this stage, the disease can only be detected by chance during a routine examination, so it should not be ignored.

Steatohepatitis during pregnancy

This pathology in a woman who is carrying her baby may be genetic in nature (that is, a hereditary predisposition to this disease), or develop against the background of another liver disease, which the girl may have had even before conception.

Taking a number of medications (vitamin and mineral complexes) can also provoke the problem. A number of multivitamins for pregnant women contain chemical compounds that the female body in a state of increased stress (which is pregnancy) is not able to process.

There are often cases when, due to his incompetence, the doctor himself prescribes increased doses of drugs to a pregnant woman.

We should not forget that, thanks to many incorrect beliefs, some women and their relatives still believe that a pregnant woman should eat for two during this period, which cannot affect the overall weight of the expectant mother. Hence the pathological deposits in the liver tissues and, as a result, the development of the disease discussed in this article in the pregnant woman.

Where does it hurt?

Diagnosis of steatohepatitis

The difficulty in diagnosing the disease in question lies in the fact that, in most cases, it has a fairly low rate of development, and for the time being does not have a clear clinical picture, without manifesting itself in any way.

Mostly, the only sign may be pain on palpation, and for a specialist it is also an increase in the size of the liver and a thickening of its structure. Therefore, it is possible to detect the disease in the early stages only during a visit to the doctor during the next preventive examination, or if a person comes in with another problem.

If the patient already has reasons to worry, then there is no point in postponing an appointment with a specialist.

Diagnosis involves an integrated approach to the problem, since similar symptoms are inherent in not one, but several diseases:

1. Clarification of patient complaints by a specialist:
   • What are the symptoms of discomfort?
   • How long ago did the attacks begin?
   • What events preceded the next attack.
2. Study of anamnesis.
3. What infectious diseases did you suffer from?
4. What medications were used.
5. Is there a hereditary predisposition?
6. And others.
7. External (physical) examination.
   • The presence of yellowed cornea and skin. Hue intensity.
   • The condition of the epidermis is assessed for scratching.
   • Obtaining the patient's weight index, which allows assessing the presence of obesity.
8. Palpation of the pathological area for liver enlargement and pain symptoms.
   • Tapping and palpating the abdomen to determine the size of the spleen and liver.
   • The degree of pain to touch.
9. Due to the fact that alcohol can cause liver changes, the doctor may prescribe a special study, the result of which should be an answer to the question of the presence or absence of a person’s addiction to alcoholic beverages.
10. Ultrasound examination of the liver. Here, the dimensional parameters of the organ, morphological and organic changes affecting its tissues are assessed.
11. Laboratory tests are carried out to evaluate the quantitative components of immunoglobulin A, cholesterol, triglycerides, alkaline phosphatase, bilirubin and other indicators. Based on the degree of deviation from the norm, we can talk about the presence of inflammation in this area.
    • General blood analysis.
    • Blood chemistry.
    • Urine examination.
12. If necessary, a tissue biopsy is performed to assess the level of pathological changes, and, consequently, the duration of the inflammatory process.
13. Under certain circumstances, a CT scan may be ordered.
14. There may be a need for additional consultation with more specialized specialists. For example, a hepatologist, a therapist, a surgeon, and so on.

What needs to be examined?

How to examine?

Who to contact?

Treatment of steatohepatitis

The first step is to determine the source of the change. If the catalyst for the problem is alcohol, then the first thing to do is to give up “bad” drinks.

At the same time, it is worth eliminating the toxic effect on the body, increasing sensitivity to insulin, strengthening immune forces, stabilizing and normalizing lipid and other types of metabolism, and restoring the hepatoprotective capabilities of the body.

With this pathology, the patient must reconsider his diet. Usually the doctor prescribes “Table No. 5” to such a patient. Dietary eating should now become a lifelong habit. When returning to the “old life” (for example, drinking alcohol or illicit food), the disease tends to return and manifest itself with renewed vigor.

Pharmacological therapy is also carried out. To improve insulin sensitivity, biguanides are prescribed: metfogamma, bagomet, siofor, metformin - acri, glucophage, avandamet and others.

The hypoglycemic drug metformin - acri is prescribed purely individually for each patient, but not more than 3 g daily, divided into several doses.

Contraindications to the drug include a person’s history of diabetic ketoacidosis or diabetic precoma, coma, dysfunction of the heart, liver, respiratory organs and kidneys, acute cerebrovascular accident, as well as in case of hypersensitivity to the components of the drug.

To reduce the activity of aminotransferases and protect hepatocytes from destruction, the doctor prescribes medications based on ursocholic acid: ursofalk, ursochol, urdoxa, ursodeoxycholic acid, ursosan. Ursodeoxycholic acid capsules are taken orally in a daily dosage, which is calculated as 10–15 mg per kilogram of the patient’s weight. The drug is swallowed before bedtime, without chewing, with a sufficient amount of water. Contraindications for the use of the drug in question include X-ray positive gallstones, increased intolerance by the human body to one or more components of the drug, atrophy of the gallbladder function and inflammation occurring in it and in the bile ducts, pancreatitis, as well as severe hepatic and/or renal dysfunction.

Hepatotropic drugs, normalizes the content of phospholipids: cholenzyme, allohol, tivortin, enerliv, atoxil, polysorb, phosphogliv, livoline forte, essentiale forte, sirin, ribavirin, hepatomax and others.

Essentiale Forte is prescribed in a starting dosage for adult patients and adolescents over 12 years of age, two capsules three times a day. In this case, maintenance therapy involves administering one capsule three times a day. The medicine is used directly during meals, without chewing, together with a small amount of water. The duration of therapy is at least three months. The drug is not prescribed if hypersensitivity of the body to its components is detected.

Drugs that control the amount of cholesterol in atherosclerosis are statins. This may be: pravastatin, cerivastatin, fluvastatin, atorvastatin, simvastatin, rosuvastatin, lovastatin and others.

Fluvastatin is prescribed in a starting amount of 20 mg once a day (in the evening). If necessary, or if therapeutic effectiveness is not achieved, the doctor may double the dosage.

The administration of the drug is contraindicated during the active phase of liver disease, hypersensitivity to the components of the drug or a persistent increase in the accumulation of serum transaminases of unknown etiology, as well as during lactation and pregnancy.

The basis of therapy is diet, but if it does not bring significant results, the doctor can introduce lipotropic drugs into the treatment protocol to normalize metabolic processes and protect the liver from damage. These are silibinin, karsil, legalon, orgitox, legalon, selgon.

The hepatoprotector Karsil is prescribed before meals along with a sufficient amount of water. The duration of therapy is about three months.

In case of mild to moderate liver damage, the drug is administered in dosages of one to two tablets three times a day, in case of more severe damage - four tablets, which corresponds to 420 mg of the drug, three times a day.

The preventive dose is two to three tablets per day.

Contraindications include increased intolerance to the components of the drug and the acute stage of poisoning of various etiologies.

If necessary, antibiotics are also prescribed to stop the proliferation and further development of pathogenic intestinal microflora.

Cytoprotectors, pharmacological compounds that “put” protection on the body’s cells are also often used. These are sucralfate, misoprostol, Venter, sucrafil, Cytotec, alsukral, sucrama.

Misoprostol is administered orally 0.2 g four times a day, the last dose immediately before going to bed. If necessary, the dosage can be changed, but this decision remains with the attending physician.

Contraindications include individual intolerance by the human body to one or more components of the drug, including other prostaglandins and their analogues.

Standard of medical care for steatohepatitis

What can be said about the measures that should be taken when diagnosing the disease discussed in this article? First of all, family and friends should support the person both morally and physically.

The first thing that is necessary is to adhere to the diet prescribed by the doctor - “Table No. 5”. It will not be superfluous and even welcome if the whole family supports the sufferer in terms of nutrition.

Most often, this disorder in the liver is benign in nature and proceeds rather slowly. But there are cases of degeneration into cirrhosis and liver failure. This cannot be allowed under any circumstances. And the first stage of this path is to stop the inflammatory process progressing in the body.

In this case, it is necessary not only to establish the source of the pathology, but also accompanying diseases that can affect the course of therapy, which consists of three main areas:

• Diet therapy.
• Drug treatment.
• Moderate physical activity – physical therapy.

If possible, in parallel with this pathology, a disease that can slow down the effectiveness of the course of treatment or become a catalyst for its relapse should be stopped.

• That is, the standard of care:
• Examination of the patient.
• Studying his medical history.
• Correct diagnosis and reasons for its occurrence.
• Complex therapy that allows you to stop both the main problem and, if possible, concomitant pathology.
• Strict adherence to dietary recommendations.

Diet for steatohepatitis

It is quite difficult to imagine modern medicine without the use of numerous diets developed by specialists to relieve a particular disease. Modern diet therapy is a fairly tangible lever of influence on pain areas. With the correct use and combination of various food products, it becomes possible to significantly improve the condition of the patient’s body, as well as significantly reduce the duration of treatment and rehabilitation therapy.

In the case of our problem, the doctor prescribes “Diet No. 5”, the main feature of which is the exclusion of various smoked, fried, spicy and fatty foods from the diet. On the contrary, the amount of foods rich in vitamins, beneficial minerals and microelements should increase.

If the patient is overweight, then his daily menu should be calculated in such a way that the body receives a sufficient amount of necessary substances, while gradually getting rid of extra pounds. It is also necessary to ensure that weight is not lost too quickly - this is also unacceptable.

The diet is selected individually, taking into account the severity of the clinical picture, medical history and individual characteristics of the person. Therefore, this appointment is the direct prerogative of a qualified specialist.

The daily diet should be hypocaloric and calculated as 25 mg per kilogram of the patient’s weight.

Products allowed to be included in the diet:

• Low-grade bakery products: cookies, bread with rye or wheat flour.
• Not very cool coffee (preferably with added milk) or tea.
• Green tea.
• Sugar.
• It is allowed to take a small amount of butter (no more than 50 g daily).
• Various vegetable and fruit juices, fresh juices, compotes, cups, fruit drinks.
• Sour cream, hard cheeses and cottage cheese (low fat).
• Vegetable decoctions and soups with vegetables based on them, you can add pasta and various cereals.
• Jams and jams.
• Vegetable oil (no more than 50 g daily).
• Various cereals.
• Milk and dairy products with reduced fat content.
• Sweet fruits and berries, sour fruits should be avoided.
• Lean meat products: rabbit, chicken, turkey, beef and so on. Poultry should be cooked and eaten without skin.
• Herbal teas and tinctures.
• Fresh and cooked vegetables.
• Natural honey.
• Various greens.
• Egg (preferably one white) - no more than one per day.
• River fish.

Dishes should be prepared using boiled, steamed or baked products.

Products prohibited for inclusion in the diet:

• You should limit or completely remove pastry products. These are pancakes, cakes, pancakes, fried pies and so on.
• Steep broths: meat, mushroom, fish.
• Chocolate, cocoa and coffee.
• Root vegetables that are difficult for the digestive system are radishes and radishes.
• Fatty fish.
• Pickled vegetables.
• Animal and cooking fats.
• From greens: spinach, sorrel, green onions.
• Lard and fatty meat.
• Hot sauces and seasonings.
• Mustard and horseradish.
• Sour varieties of fruits and berries.
• Smoked meats.
• Canned meat and fish.
• Creams.
• Strong tea.
• Eggs (especially the yolk), hard-boiled or scrambled (fried).
• Ice cream, especially those based on palm oil.
• Alcohol and carbonated drinks.
• Very cold and too hot food.

More information about treatment

Prevention of steatohepatitis

No one will argue that it is better to prevent any disease than to then deal with its consequences. Therefore, in organizing your life, you need to follow a number of simple rules and the likelihood of the occurrence and development of the disease in question will significantly decrease, tending to zero.

• It is necessary to monitor your weight, it should be close to normal. Obesity has a negative impact on the functioning of all systems and organs of the human body.
• You should not thoughtlessly go on various diets: fasting or sudden weight loss will also not be beneficial.
• Don't get carried away with drinking alcoholic beverages.
• Take medications with extreme caution, having first carefully read the instructions supplied with them.
• You should be very careful about the products you consume. If the human diet is close, and in the treatment of pathology is fully consistent with dietary “Table No. 5,” then “provocations” from the nutritional side will not be expected. This restriction especially applies to fatty and improperly processed foods.
• Diseases such as diabetes mellitus, viral infections, and correction of dyslipidemic disorders should be treated promptly.
• Regular preventive examination is necessary.

Prognosis of steatohepatitis

It is possible to predict the consequences of a particular disease only by knowing its clinical picture, the severity of its course and the individual characteristics of the victim’s body. If we are talking about the alcoholic type of the problem under consideration, then, in the presence of large vesicular deposits in cellular tissues, we can talk about an increase in the likelihood of degeneration into cirrhosis. While the non-alcoholic process, characterized by a low rate of development, gives a similar result in 15–18% of cases. Moreover, this rebirth is extended over time and can reach up to ten years.

The result of the forecast also depends on the activity of the person himself in organizing and adhering to preventive recommendations.

Steatohepatitis and the army

The disease in question is not grounds for exemption from service in the Armed Forces. But modern doctors know that the cause of hepatitis can be not only an infection, but also a disruption of metabolic processes in the human body, as in the case of a failure in metabolism, fatty degeneration develops and, as a consequence, steatohepatitis.

Therefore, these two diseases quite often go hand in hand, and if a conscript’s history of chronic hepatitis is proven, this is precisely the fact that gives grounds not to attract such young people to serve in the Army.

You can get acquainted with this list in more detail in the “Regulations about the military-medical examination in the Health Forces of Ukraine. Ministry of Defense of Ukraine; Mandate, Regulation, Perelik [. ] dated 08/14/2008 No. 402” by following the link http://zakon4.rada.gov.ua/laws/show/z/page9%20%20

Life is wonderful and some representatives of human society try to make the most of it: rich fatty foods, alcohol, even going to the store in the next house - by car. If you want to relax, then go to a restaurant and lie on the sofa or on a trestle bed on the beach. And then they begin to wonder - steatohepatitis - what it is and where it came from. There is a well-known proverb: “Take care of your honor from a young age.” In light of the problem discussed in this article, it should be renamed: “Take care of your health from a young age.” A proper active lifestyle, a healthy diet, and a balanced combination of physical activity and rest will help protect yourself from many health problems. Regular preventive examinations should not be ignored. This will allow, if the pathology already exists, to recognize it at an early stage. In this case, it will be much easier to stop the problem and without serious consequences.

Medical Expert Editor

Portnov Alexey Alexandrovich

Education: Kyiv National Medical University named after. A.A. Bogomolets, specialty - “General Medicine”

The latest research on the topic Steatohepatitis

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ATTENTION! SELF-MEDICATION CAN BE HARMFUL FOR YOUR HEALTH!

Be sure to consult with a qualified specialist so as not to harm your health!

The problem of fatty liver has been of great interest to scientists for a long time. No one can give a definite answer to the question of why this organ accumulates fat. Some scientific minds claim that it is all to blame for a diet with a large amount of animal fats, which settle in the liver.

The second suggests that the cause of fatty liver is based on a lack of protein in the body. With a lack of vitamins and insufficient synthesis of phospholipids, the liver ceases to cope with the breakdown of fat and its accumulation in hepatocytes occurs. In this article we will look at what fatty liver is, why the disease occurs and standard treatment.

Steatohepatosis - what is it?

Liver steatohepatosis is a condition of the organ in which at least 5% of its volume is adipose tissue.. With excessive accumulation of fat, liver cells simply degenerate into fat cells, which cannot perform the functional duties of hepatocytes (cleanse the blood of toxins, produce bile, synthesize protein and cholesterol).

At the initial stage of development of the disease, liver cells gradually cope with the breakdown of fat, but if the load on the organ does not change, then eventually the cell membranes cannot withstand the amount of fat deposits and simply rupture. The fat that comes out of the cells after they are destroyed forms extracellular fat deposits around the liver.

Thus, an irreversible process of destruction of hepatocytes is launched, which leads to degenerative changes in the liver with the consequences of the development of fibrosis, cirrhosis and liver failure.

Disease code according to ICD 10

In the International Classification of Diseases, 10th revision, steatohepatosis is included in the registry, along with a group of similar diseases, under the general name “fatty liver degeneration” with the assignment code K76.0. The diseases are grouped according to points: metabolic disorders in liver cells, development of organ dystrophy in the absence of inflammatory processes.

Important! In the last few years, there has been an increase in the incidence of fatty liver degeneration, mainly due to obesity and poor diet.

Species and types

Doctors distinguish two types of disease:

• alcoholic steatohepatosis. The body produces an enzyme that can process almost all the alcohol that enters the body. As a result, alcohol is broken down with the release of toxic acetaldehyde, which accumulates in the liver, causing an increase in hepatocytes. Abnormally swollen cells produce large amounts of fatty acids, which settle in the liver and lead to the development of the disease;
• non-alcoholic steatohepatosis. In this case, the disease is in no way related to alcohol, but it goes through the same stages of development as alcoholism, starting from steatosis to steatohepatitis, fibrosis and ending with cirrhosis of the liver.

Reasons for appearance

The main causes of fatty liver not associated with alcohol consumption are:

• poor nutrition, which is based on the abuse of fatty foods, sweets, and frequent snacks in fast foods. This lifestyle leads to the appearance of extra pounds and the subsequent deposition of fat on internal organs, including the liver;
• metabolic disorder, which is caused by diabetes, obesity, sudden weight loss and other health problems;
• decreased physical activity with poor nutrition, which leads to excess calories being stored as fat. This leads to the formation of excess weight and accumulation of fat in liver cells;
• diseases such as pancreatitis, ulcerative colitis can disrupt the process of processing fats and provoke the accumulation of fatty deposits;
• long-term use of toxic medications.

Diet and nutrition

Treatment for fatty liver is based on lifestyle changes and avoidance of fatty junk foods. The transition to a balanced, healthy diet is the basis of any treatment regimen. It is recommended to adhere to diet No. 5, according to which the menu limits the consumption of animal fat, which will bring the patient closer to recovery.

The diagnosis of steatohepatosis requires frequent, regular split meals. Preference is given to food boiled in water, steamed or stewed in its juice. It is advisable that it be taken in liquid or ground form. It is advisable to include more fresh vegetables, fruits, melons in the daily menu; cook all soups and broths with vegetables without using meat and bones; porridge, low-fat dairy products, milk soups, rye crackers and stale bread are recommended.

You should avoid using the following products: mushrooms, all legumes, canned food and pickles, any smoked meats, fatty meats and dairy products, caffeinated drinks, chocolate, baked goods, sweets. But drinking a large amount of compotes, unsweetened teas and clean water is mandatory.

Treatment methods

Steatosis and hepatosis do not differ in the treatment process. In addition to diet and exercise, the doctor prescribes drug therapy. It is recommended to take essential phospholipids with Essliver or Essentiale. They strengthen the membranes of liver cells. Also, drug treatment regimens often include drugs containing sulfoamino acids (Taurine or Heptral).

If fatty liver occurs against the background of metabolic failure as a consequence of diabetes mellitus, then insulin-sensitizing drugs cannot be avoided. Doctors prefer Metformin, Rosiglitazone or Pioglizatone. It is also necessary to take a complex of vitamins during the treatment process.

Help your liver

It is very bad that not every person understands the seriousness of the diagnosis of steatohepatosis. Despite the fact that at an early stage the disease is practically asymptomatic, it is difficult to diagnose. This mainly happens when you accidentally visit a doctor for a completely different reason. We recommend that you pay close attention to your health and, at the first signs of developing fatty liver, consult a hepatologist for advice, or better yet, undergo an examination.

You should never starve yourself to lose weight. When making such a decision, be prepared for the fact that it can make the situation even worse.

The diet must be correct and balanced, this is the only way to lose weight without compromising your health. At an early stage, the disease can be completely cured and liver function can be restored to full extent. But even if the liver is severely damaged, you can try to stop the process of further destruction and significantly improve its condition.

Every person diagnosed with steatohepatosis should constantly go for examinations to a hepatologist in order to monitor their health. This will allow you to see how the liver responds to treatment and whether it responds at all, in order to adjust the prescription if necessary.

To prevent the development of fatty liver, you should make sure that you don’t accumulate extra pounds, exercise as much as you can, lead an active lifestyle, and not take long courses of toxic medications that have a destructive effect on the liver. If you know what causes the problem and start solving it in time, this will help prevent the development of steatohepatosis and maintain liver health.

Non-alcoholic fatty liver disease (NAFLD)

Version: MedElement Disease Directory

Fatty liver degeneration, not elsewhere classified (K76.0)

Gastroenterology

general information

Short description

Fatty liver degeneration is a disease characterized by liver damage with changes similar to those in alcoholic liver disease (fatty degeneration of hepatocytes), however, with fatty liver degeneration, patients do not drink alcohol in quantities that can cause liver damage.

Toxic liver damage - K71.-;

Non-alcoholic steatohepatitis (NASH) - K75.81;

Liver damage during pregnancy, childbirth and the postpartum period - O26.6.

Note 2

Fatty liver degeneration is a form of non-alcoholic fatty liver disease (NAFLD).

Definitions most often used for NAFLD:

1. Non-alcoholic fatty liver (NAFL). Presence of fatty liver without signs of hepatocyte damage hepatocyte - the main cell of the liver: a large cell that performs various metabolic functions, including the synthesis and accumulation of various substances necessary for the body, the neutralization of toxic substances and the formation of bile (Hepatocyte)
in the form of balloon dystrophy or without signs of fibrosis. The risk of developing cirrhosis and liver failure is minimal.

2. Non-alcoholic steatohepatitis (NASH). Presence of liver steatosis and inflammation with damage to hepatocytes hepatocyte - the main cell of the liver: a large cell that performs various metabolic functions, including the synthesis and accumulation of various substances necessary for the body, the neutralization of toxic substances and the formation of bile (Hepatocyte)
(balloon dystrophy) with or without signs of fibrosis. May progress to cirrhosis, liver failure, and (rarely) liver cancer.

3. Non-alcoholic cirrhosis of the liver (NASH Cirrhosis). Presence of signs of cirrhosis with current or previous histological signs of steatosis or steatohepatitis.

4. Cryptogenic Cirrhosis - cirrhosis without obvious etiological causes. Patients with cryptogenic cirrhosis usually have high risk factors associated with metabolic disorders such as obesity and metabolic syndrome. Increasingly, cryptogenic cirrhosis, upon detailed examination, turns out to be an alcohol-associated disease.

5. Assessment of NAFLD activity (NAS). A set of points calculated from a comprehensive assessment of signs of steatosis, inflammation and balloon dystrophy. Is a useful tool for semi-quantitative measurement of histological changes in liver tissue in patients with NAFLD in clinical trials.

To date, the list of ICD-10 diseases does not have a single code reflecting the completeness of the diagnosis of NAFLD, so it is advisable to use one of the following codes:

K 76.0 - Fatty liver degeneration, not elsewhere classified
- K75.81 - Non-alcoholic steatohepatitis (NASH)
- K74.0 - Liver fibrosis
- K 74.6 - Other and unspecified cirrhosis of the liver.\

Classification

Types of fatty liver degeneration:
1. Macrovesicular type. The accumulation of fat in hepatocytes is local in nature and the hepatocyte nucleus moves away from the center. With fatty infiltration of the liver of the macrovesicular (large-droplet) type, triglycerides, as a rule, act as accumulated lipids. In this case, the morphological criterion of fatty hepatosis is the content of triglycerides in the liver over 10% of dry weight.
2. Microvesicular type. Fat accumulation occurs evenly and the core remains in place. In microvesicular fatty degeneration, lipids other than triglycerides (eg, free fatty acids) accumulate.

Also distinguished focal and diffuse liver steatosis. The most common is diffuse steatosis, which is zonal in nature (the second and third zones of the lobule).

Etiology and pathogenesis

Primary non-alcoholic fat disease is considered as one of the manifestations of metabolic syndrome.
Hyperinsulinism leads to activation of the synthesis of free fatty acids and triglycerides, a decrease in the rate of beta-oxidation of fatty acids in the liver and the secretion of lipids into the bloodstream. As a result, fatty degeneration of hepatocytes develops hepatocyte - the main cell of the liver: a large cell that performs various metabolic functions, including the synthesis and accumulation of various substances necessary for the body, the neutralization of toxic substances and the formation of bile (Hepatocyte)
.
The occurrence of inflammatory processes is predominantly centrilobular in nature and is associated with increased lipid peroxidation.
Increasing the absorption of toxins from the intestines is of some importance.

Secondary fatty liver disease may be the result of the following factors.

1. Nutritional factors:
- sharp decrease in body weight;
- chronic protein-energy deficiency.

2. Parenteral nutrition (including glucose administration).

3. Gastrointestinal lesions causing nutritional disorders:
- inflammatory bowel diseases;
- celiac disease Celiac disease is a chronic disease caused by a deficiency of enzymes involved in the digestion of gluten.
;
- diverticulosis of the small intestine;
- microbial contamination Contamination is the entry into a certain environment of some impurity that changes the properties of this environment.
small intestine;
- operations on the gastrointestinal tract.

4. Metabolic diseases:
- dyslipidemia;
- diabetes mellitus type II;
- triglyceridemia, etc.

Epidemiology

Age: mostly

Sign of prevalence: Common

Sex ratio(m/f): 0.8

There are no precise data on the prevalence of fatty liver degeneration.
The estimated prevalence ranges from 1% to 25% of the general population in various countries. In developed countries the average level is 2-9%. Many findings are discovered incidentally during liver biopsy performed for other indications.
Most often, the disease is detected at the age of 40-60 years, although no age (except for breastfed children) excludes the diagnosis.
The sex ratio is unknown, but a female predominance is expected.

Risk factors and groups

High risk groups include:

1. Persons with excess body weight, especially so-called “visceral obesity”. BMI Body mass index (BMI) is a value that allows you to assess the degree of correspondence between a person’s weight and his height and, thereby, indirectly assess whether the weight is insufficient, normal or excessive. Body mass index is calculated using the formula: I= m/h², where: m is body weight in kilograms, h is height in meters, and is measured in kg/m²
more than 30 in 95-100% of cases is associated with the development of liver steatosis Liver steatosis is the most common hepatosis, in which fat accumulates in the liver cells
and in 20-47% with non-alcoholic steatohepatosis.

2. Persons with type 2 diabetes mellitus or impaired glucose tolerance. In 60% of patients, these conditions occur in combination with fatty degeneration, in 15% - with non-alcoholic steatohepatitis. The severity of liver damage is related to the severity of glucose metabolism disorders.

3. Persons with diagnosed hyperlipidemia, which is detected in 20-80% of patients with non-alcoholic steatohepatitis. A characteristic fact is the more frequent combination of non-alcoholic steatohepatitis with hypertriglyceridemia than with hypercholesterolemia.

4. Middle-aged women.

5. Persons suffering from arterial hypertension and uncontrolled blood pressure. There is a higher prevalence of fatty liver in patients with hypertension without risk factors for fatty liver. The prevalence of the disease is estimated to be almost 3 times higher than in age- and sex-matched control groups that kept blood pressure at the recommended level.

Low risk factor for the formation of secondary fatty liver disease include:
- malabsorption syndrome Malabsorption syndrome (malabsorption) is a combination of hypovitaminosis, anemia and hypoproteinemia caused by malabsorption in the small intestine
(as a consequence of the imposition of ileojejunal Ileojejunal - relating to the ileum and jejunum.
anastomosis, extended resection of the small intestine, gastroplasty for obesity, etc.);

Fast weight loss;

Long-term parenteral nutrition;

Small intestinal bacterial overload syndrome;
- abetalipoproteinemia;

Lipodystrophy of the limbs;

Weber-Christian disease Weber-Christian disease (syn. Weber-Christian panniculitis) is a rare and little-studied disease that is characterized by repeated inflammation of the subcutaneous tissue (panniculitis), which has a nodular nature. Inflammation leaves behind tissue atrophy, manifested by skin retraction. Inflammation is accompanied by fever and changes in internal organs
;

Konovalov-Wilson disease Konovalov-Wilson disease (syn. hepato-cerebral dystrophy) is a hereditary human disease characterized by a combination of liver cirrhosis and degenerative processes in the brain; caused by impaired protein metabolism (hypoproteinemia) and copper; inherited in an autosomal recessive manner
and some others.

Clinical picture

Clinical diagnostic criteria

Obesity; weakness; hepatomegaly; splenomegaly; discomfort in the right upper abdomen; arterial hypertension

Symptoms, course

Most patients with non-alcoholic fatty liver disease have no complaints.

The following may occur symptoms:
- slight discomfort in the upper right quadrant of the abdomen (about 50%);
- pain in the upper right quadrant of the abdomen (30%);
- weakness (60-70%);
- moderate hepatosplenomegaly Hepatosplenomegaly - simultaneous significant enlargement of the liver and spleen
(50-70%).

Signs of chronic liver disease or portal hypertension Portal hypertension is venous hypertension (increased hydrostatic pressure in the veins) in the portal vein system.
are rarely observed.

Usually detected signs of metabolic syndrome:
- obesity (up to 70%);
- arterial hypertension AH (arterial hypertension, hypertension) - a persistent increase in blood pressure from 140/90 mm Hg. and higher.
;
- dyslipidemia Dyslipidemia is a disorder of the metabolism of cholesterol and other lipids (fats), consisting in a change in their ratio in the blood
;
- diabetes;
- impaired glucose tolerance.

Note
The appearance of telangiectasia Telangiectasia is local excessive expansion of capillaries and small vessels.
, palmar erythema Erythema - limited hyperemia (increased blood supply) of the skin
, ascites Ascites - accumulation of transudate in the abdominal cavity
, jaundice, gynecomastia Gynecomastia - enlargement of the mammary glands in men
, signs of liver failure and other signs of fibrosis, cirrhosis, non-infectious hepatitis requires coding in the appropriate subheadings.
The identified connection with alcohol, medication, pregnancy and other etiological reasons also requires coding in other subheadings.

Diagnostics

General provisions. In practice, suspicion of non-alcoholic steatohepatitis arises if the patient has obesity, hypertriglyceridemia and elevated transaminase levels. The diagnosis is confirmed by laboratory tests and biopsy. Imaging methods are of little use for confirmation in the early stages.

Anamnesis: exclusion of alcohol abuse, drug injuries, family history of liver disease.

When diagnosing non-alcoholic fatty liver disease, the following are used: visualization methods:

1. Ultrasound. Steatosis can be confirmed provided that the increase in the amount of fatty inclusions in the tissue is at least 30%. Ultrasound has a sensitivity of 83% and a specificity of 98%. Increased echogenicity of the liver and increased distal sound attenuation are revealed. Hepatomegaly is possible. Signs of portal hypertension and indirect assessment of the degree of steatosis are also identified. Good results have been obtained using the Fibroscan device, which allows additional detection of fibrosis and assessment of its degree.

2. Computed tomography. Main CT signs:
- decrease in radiological density of the liver by 3-5 HU (normal 50-75 HU);
- X-ray density of the liver is less than X-ray density of the spleen;
- higher density of intrahepatic vessels, portal and inferior vena cava compared to the density of liver tissue.

3. Magnetic resonance imaging. Can semi-quantitatively estimate fat content in liver . Surpasses ultrasound and CT in diagnostic abilities. Areas of decreased signal intensity on T1-weighted images may indicate local fat accumulation in the liver.

4. FEGDS - it is possible to detect varicose veins of the esophagus during transformation into cirrhosis.

5. Histological examination of liver punctate(gold standard for diagnosis):
- large droplet fatty degeneration;
- balloon dystrophy or degeneration of hepatocytes (in the presence/absence of inflammation, Mallory hyaline bodies, fibrosis or cirrhosis).
The degree of steatosis is assessed using a scoring system.

Assessment of liver steatosis in patients with NAFLD(D.E. Kleiner CRN system, 2005)

6. ECG due to the increased risk of coronary artery disease, it is standardly indicated for all patients with excess body weight, dyslipidemia and hyperglycerinemia, and arterial hypertension.

Laboratory diagnostics

1. Transaminases. Laboratory signs of cytolysis Cytolysis is the process of destruction of eukaryotic cells, expressed in the form of their complete or partial dissolution under the action of lysosomal enzymes. It can be either part of normal physiological processes or a pathological condition that occurs when the cell is damaged by external factors, for example, when the cell is exposed to antibodies
are detected in 50-90% of patients, but the absence of these signs does not exclude the presence of non-alcoholic steatohepatitis (NASH).
The level of serum transaminases increased slightly - 2-4 times.
The value of the AST/ALT ratio in NASH:
- less than 1 - observed in the initial stages of the disease (for comparison, in acute alcoholic hepatitis this ratio is usually > 2);
- equal to 1 or more - may be an indicator of more severe liver fibrosis;
- more than 2 - is considered as an unfavorable prognostic sign.

2. In 30-60% of patients, an increase in the activity of alkaline phosphatase (usually no more than twofold) and gamma-glutamyl transpeptidase (may be isolated, not associated with an increase in alkaline phosphatase) is detected. A GGTP level > 96.5 U/L increases the risk of fibrosis.

3. In 12-17% of cases, hyperbilirubinemia occurs within 150-200% of normal.

4. Signs of a decrease in the protein-synthetic function of the liver develop only with the formation of liver cirrhosis. The presence of hypoalbuminemia without progression to cirrhosis is possible in patients with diabetic nephropathy Nephropathy is the general name for certain types of kidney damage.
.

5. In 10-25% of patients, slight hypergammaglobulinemia is detected.

6. 98% of patients have insulin resistance. Its detection is the most important non-invasive diagnostic method.
In clinical practice, insulin resistance is assessed by the ratio of immunoreactive insulin and blood glucose levels. It should be remembered that this is a calculated indicator that is calculated using various methods. The indicator is influenced by the level of triglycerides in the blood and race.
It is recommended to study insulin levels on an empty stomach.

7. 20-80% of patients with NASH have hypertriglyceridemia.
Many patients will have low HDL levels as part of metabolic syndrome.
As the disease progresses, cholesterol levels often decrease.

9. Anemia, thrombocytopenia, increased prothrombin time and INR International normalized ratio (INR) is a laboratory indicator determined to assess the extrinsic pathway of blood coagulation
are more typical for cirrhosis or severe fibrosis.

10. Determination of the level of cytokeratin 18 fragments (TPS-test) is a promising method for studying the activity of the process. The method allows you to distinguish the presence of hepatocyte apoptosis (hepatitis) from fatty infiltration of the liver without the use of a biopsy.
Unfortunately, this indicator is not specific; if it increases, it is necessary to exclude a number of oncological diseases (bladder, breast, etc.).

11. Complex biochemical tests (BioPredictive, France):
- Steato-test - allows you to identify the presence and degree of liver steatosis;
- Nash test - allows you to detect NASH in patients with excess body weight, insulin resistance, hyperlipidemia, as well as patients with diabetes).
It is possible to use other tests if non-alcoholic fibrosis or hepatitis is suspected - Fibro-test and Acti-test.

Differential diagnosis

Non-alcoholic fatty liver disease is differentiated from the following diseases:
- hepatitis of various established etiologies, primarily chronic hepatitis B, C, D, E, autoimmune hepatitis and others;
- alcoholic liver disease;
- secondary fatty liver disease (drug-induced hepatitis, metabolic disorders, for example, Wilson's disease, hemochromatosis or alpha-1-antitrypsin deficiency);
- idiopathic fibrosis, sclerosis, cirrhosis of the liver;
- primary sclerosing cholangitis;
- primary biliary cirrhosis;
- hypothyroidism and hyperthyroidism;
- vitamin A poisoning.

Almost all differential diagnosis is based on laboratory tests specific to the diseases listed above and biopsy studies.

Complications

- fibrosis Fibrosis is the proliferation of fibrous connective tissue, occurring, for example, as a result of inflammation.
;
- cirrhosis of the liver Liver cirrhosis is a chronic progressive disease characterized by degeneration and necrosis of the liver parenchyma, accompanied by its nodular regeneration, diffuse proliferation of connective tissue and deep restructuring of the liver architectonics.
(develops especially rapidly in patients with tyrosinemia Tyrosinemia is an increased concentration of tyrosine in the blood. The disease leads to increased urinary excretion of tyrosine compounds, hepatosplenomegaly, nodular cirrhosis, multiple defects in renal tubular reabsorption and vitamin D-resistant rickets. Tyrosinemia and tyrosyl excretion occur in a number of inherited (p) enzymopathies: deficiency of fumarylacetoacetase (type I), tyrosine aminotransferase (type II), 4-hydroxyphenylpyruvate hydroxylase (type III)
, practically bypassing the stage of “pure” fibrosis);
- liver failure (rarely - in parallel with the rapid formation of cirrhosis).

Treatment abroad

The development of fatty hepatosis is based on a violation of metabolic processes in the human body. As a result of this liver disease, healthy organ tissue is replaced by fatty tissue. At the initial stage of development, fat accumulates in hepatocytes, which over time simply leads to degeneration of the liver cells.

If the disease is not diagnosed at an early stage and appropriate therapy is not carried out, then irreversible inflammatory changes occur in the parenchyma, which lead to the development of tissue necrosis. If fatty hepatosis is not treated, it can develop into cirrhosis, which can no longer be treated. In the article we will look at the reasons for which the disease develops, methods of its treatment and classification according to ICD-10.

Causes of fatty hepatosis and its prevalence

The reasons for the development of the disease have not yet been precisely proven, but factors are known that can confidently provoke the occurrence of this disease. These include:

• completeness;
• diabetes;
• disturbance of metabolic processes (lipid);
• minimal physical activity with a nutritious daily diet high in fat.

Doctors register most cases of the development of fatty hepatosis in developed countries with an above-average standard of living.

Important! The disease affects all age groups, from overweight children to old people with diabetes.

There are a number of other factors associated with hormonal imbalances, such as insulin resistance and blood sugar. The hereditary factor cannot be ignored; it also plays a big role. But still the main reason is poor diet, sedentary lifestyle and excess weight. All the causes have nothing to do with the consumption of alcoholic beverages, which is why fatty hepatosis is often called non-alcoholic. But if we add alcohol dependence to the above reasons, then fatty hepatosis will develop much more rapidly.

In medicine, it is very convenient to use coding of diseases to systematize them. It’s even easier to indicate a diagnosis on a sick leave certificate using a code. All diseases are coded in the International Classification of Diseases, Injuries and Related Health Problems. At this time, the tenth revision option is in effect.

All liver diseases according to the International Classification of the Tenth Revision are encrypted under codes K70-K77. And if we talk about fatty hepatosis, then according to ICD 10, it falls under the code K76.0(fatty liver degeneration).

Treatment of fatty hepatosis

The treatment regimen for non-alcoholic hepatosis is to eliminate possible risk factors. If the patient is obese, then you need to try to optimize it. And start by reducing the total mass by at least 10%. Doctors recommend using minimal physical activity in parallel with dietary nutrition to achieve the goal. Limit the use of fats in your diet as much as possible. It is worth remembering that sudden weight loss will not only not bring benefits, it can, on the contrary, cause harm, aggravating the course of the disease.

Important! Drug therapy consists only of correcting impaired carbohydrate metabolism.

For this purpose, the attending physician may prescribe thiazolidinoids in combination with biguanides, but this line of drugs has not yet been fully studied, for example, for hepatotoxicity. Metformin can help correct the process of metabolic disorders in carbohydrate metabolism.

As a result, we can confidently say that by normalizing the daily diet, reducing body fat mass and giving up bad habits, the patient will feel an improvement. And only in this way can one fight a disease such as non-alcoholic hepatosis.

This may be useful to you:

Excluded:

• alcoholic liver disease (K70.-)
• Budd-Chiari syndrome (I82.0)

Included:

• hepatic:
  • coma NOS
  • encephalopathy NOS
• hepatitis:
  • fulminant, not elsewhere classified, with liver failure
  • malignant, not elsewhere classified, with liver failure
• necrosis of the liver (cells) with liver failure
• yellow atrophy or liver dystrophy

Excluded:

• alcoholic liver failure (K70.4)
• liver failure complicating:
  • abortion, ectopic or molar pregnancy (O00-O07, O08.8)
• Fetal and newborn jaundice (P55-P59)
• viral hepatitis (B15-B19)
• in combination with toxic liver damage (K71.1)

Excluded: hepatitis (chronic):

• alcoholic (K70.1)
• medicinal (K71.-)
• granulomatous NEC (K75.3)
• reactive nonspecific (K75.2)
• viral (B15-B19)

Excluded:

• alcoholic liver fibrosis (K70.2)
• cardiac sclerosis of the liver (K76.1)
• cirrhosis of the liver):
  • alcoholic (K70.3)
  • congenital (P78.3)
• with toxic liver damage (K71.7)

K70-K77 Liver diseases. V. 2016

International Classification of Diseases, 10th Revision (ICD-10)

K70-K77 Liver diseases

K70-K77 Liver diseases

Reye's syndrome (G93.7)

viral hepatitis (B15-B19)

K70 Alcoholic liver disease

K71 Liver toxicity

Budd-Chiari syndrome (I82.0)

“Pure” cholestasis K71.1 Toxic liver damage with hepatic necrosis Liver failure (acute) (chronic), caused by drugs K71.2 Toxic liver damage, occurring as acute hepatitis

yellow atrophy or liver dystrophy

liver failure complicating:

• abortion, ectopic or molar pregnancy (O00-O07, O08.8)
• pregnancy, childbirth and the puerperium (O26.6)

jaundice of the fetus and newborn (P55-P59)

viral hepatitis (B15-B19)

in combination with toxic liver damage (K71.1)

K74 Fibrosis and cirrhosis of the liver

cardiac sclerosis of the liver (K76.1)

cirrhosis of the liver:

• alcoholic (K70.3)
• congenital (P78.3)

with toxic liver damage (K71.7-) K74.0 Liver fibrosis

• acute or subacute
  • NOS (B17.9)
  • not viral (K72.0)
• viral hepatitis (B15-B19)

toxic liver damage (K71.1)

cholangitis without liver abscess (K83.0)

pylephlebitis without liver abscess (K75.1) K75.1 Portal vein phlebitis Pylephlebitis Excluded: pylephlebitic liver abscess (K75.0)

amyloid liver degeneration (E85.-)

cystic liver disease (congenital) (Q44.6)

hepatic vein thrombosis (I82.0)

portal vein thrombosis (I81.-)

toxic liver damage (K71.-)

Focal nodular hyperplasia of the liver

Hepatoptosis K76.9 Liver disease, unspecified

Portal hypertension in schistosomiasis B65.- †)

Liver damage in syphilis (A52.7 †) K77.8* Liver damage in other diseases classified elsewhere Liver granulomas in:

• berylliose (J63.2†)
• sarcoidosis (D86.8 †)

Notes 1. This version corresponds to the 2016 WHO version (ICD-10 Version: 2016), some positions of which may differ from the ICD-10 version approved by the Russian Ministry of Health.

2. The translation into Russian of a number of medical terms in this article may differ from the translation in the ICD-10 approved by the Ministry of Health of Russia. All comments and clarifications on translation, design, etc. are gratefully received by e-mail.

3. NOS - without further clarification.

4. NEC - not classified in other categories.

5. The main codes of the underlying disease that must be used are marked with a cross †.

6. Optional additional codes that relate to the manifestation of a disease in a separate organ or area of ​​the body that represents an independent clinical problem are marked with an asterisk.

Liver steatosis

Liver steatosis is a pathology that is characterized by metabolic disorders in the cells of this organ, resulting in the accumulation of fat. Women often suffer from non-alcoholic fatty liver disease (NAFLD), while men, on the contrary, often have alcoholic steatosis. In the International Classification of Diseases (ICD-10), this disease has the code K70-K77.

There are several causes of the disorder, which are divided depending on its type. Alcoholic liver damage is caused by regular drinking of alcohol. A large number of reasons can contribute to the appearance of the non-alcoholic form. The main symptoms of this disorder are the occurrence of pain, heaviness and discomfort in the area of ​​the right hypochondrium, lack of appetite, severe weakness of the body and the appearance of a yellowish tint on the skin.

Diagnosis of the disease is based on a thorough physical examination of the patient, laboratory tests and instrumental examination techniques, in particular ultrasound and biopsy. The disease can be treated with drug therapy and a diet for liver steatosis. Folk remedies will help eliminate the disease, which can only be used if prescribed by a doctor.

Etiology

There are many causes of liver steatosis or fatty hepatosis. The alcoholic type of the disease occurs against the background of regular consumption of alcohol-containing drinks, which is why it is often found in men. NAFLD occurs against the background of a large number of predisposing factors:

• diabetes mellitus;
• having excessively high body weight;
• disorders of fat and copper metabolism;
• prolonged fasting;
• administering insulin injections;
• poisoning or long-term use of certain drugs, for example, hormonal drugs, cytostatics, antibiotics and non-steroidal anti-inflammatory drugs;
• performing operations on the gastrointestinal tract;
• substance abuse;
• high levels of adrenal hormones in the blood;
• viral hepatitis.

Varieties

There are several classifications of liver steatosis, the most common of which involves the division of the disease as the pathological process spreads:

• focal - in which single fatty accumulations are detected on the liver;
• diffuse steatosis - characterized by damage to the entire organ.

Depending on the addiction to alcoholic beverages, the disease is divided into:

Classification of the disease according to formation factors:

• primary – expressed against the background of abnormal metabolism, often congenital, as it occurs during intrauterine development;
• secondary – is a consequence or complication of other diseases or predisposing factors.

Depending on the cell changes that are detected during microscopic examination, such a disease is characterized by:

• small-scale obesity - the initial degree of the disease, during which pathological processes begin to occur, but upon examination no damage to liver cells is observed;
• large-scale obesity - pronounced damage to cells occurs, and the process of their death is observed.

In addition, there are several degrees of hepatic steatosis:

• initial degree - several fatty patches are observed, but the structure of the liver is not disturbed;
• moderate degree - characterized by the accumulation of fats, but their quantity cannot trigger irreversible destructive processes;
• severe degree - characterized by the formation of many fatty cysts in the liver tissue, which entails severe changes in the cells of the affected organ.

There is also another type of steatosis - focal. Often indicates the presence of a benign neoplasm in the liver.

Regardless of the classification, treatment of liver steatosis is aimed at eliminating the causes of formation and preventing the progression of the destructive process. This can be achieved by taking medications, following a diet and using traditional medicine.

Symptoms

NAFLD and alcoholic liver damage quite often occur without symptoms, but are discovered randomly during ultrasound diagnosis of completely different pathologies. As the disease develops, symptoms such as:

• pain, heaviness and discomfort in the right hypochondrium. Often the pain spreads to the entire abdominal area. The occurrence of pain has no connection with food intake;
• decreased or complete lack of appetite;
• attacks of nausea that end in vomiting. Often, not only food particles are found in the vomit, but also mucus or bile;
• the skin of the body, mucous membranes of the eyes and mouth acquire a yellowish tint;
• a decrease in the immune system, against which the patient is susceptible to frequent colds;
• skin itching.

Upon examination, the patient is found to have an increase in the size of the liver, and slightly less frequently, the spleen. In addition, a change in the color of the liver may be observed. The organ becomes yellow or red. Such internal symptoms indicate the presence of fatty steatosis. Some of the above clinical manifestations can be eliminated using folk remedies.

Complications

If the symptoms of NAFLD or alcoholic steatosis are ignored, as well as in cases of incorrect or incomplete therapy, there is a possibility of developing some complications. These include:

• formation of liver inflammation;
• gradual spread of connective tissue;
• Cirrhosis is a disease in which changes occur in the tissues of the affected organ by replacing normal epithelium with connective tissue.

In addition, independent attempts to eliminate the disease using folk remedies, without the advice of a specialist, can lead to the formation of complications.

Diagnostics

Liver steatosis is diagnosed through laboratory tests and instrumental examinations of the patient. Without fail, the specialist needs to familiarize himself with the patient’s medical history, as well as find out the presence and intensity of symptoms. After this, a thorough physical examination of the patient and palpation of the abdomen and right hypochondrium are performed. In addition, the examination will help determine NAFLD or alcoholic liver damage by the characteristic odor, swelling, and hand trembling.

Laboratory studies consist of a general and biochemical study of blood. This is necessary to detect anemia, as well as to detect a high concentration of liver enzymes, which is especially typical for such a pathology.

• Ultrasound and CT scan of the liver - which will help determine what type of damage to this organ is;
• biopsy - is carried out for those patients in whom the factor causing the disease has not been established. This procedure also helps differentiate this disorder from other liver diseases;
• elastography – makes it possible to determine the elasticity of the liver, as well as exclude fibrosis and cirrhosis.

After studying all the results of diagnostic measures, the doctor prescribes the most effective therapy and prepares a special diet for liver steatosis.

Treatment

The main goal of disease therapy is to eliminate the causes of the disease, since very often this disorder is reversible. That is why drug treatment of liver steatosis is prescribed individually for each patient. But in absolutely all cases, medications are prescribed to improve lipid metabolism, antibiotics and hepatoprotectors, as well as other substances aimed at eliminating symptoms. Patients are strongly recommended to:

• playing sports or swimming, especially in people with obesity or diabetes;
• completely stop drinking alcohol, only after this can you begin drug therapy;
• limiting the intake of those drugs that caused NAFLD.

This disease can be treated with proper nutrition. A diet for liver steatosis involves avoiding fatty, fried and spicy foods, as well as reducing the intake of animal fats. In addition, folk medicine can eliminate some of the symptoms of the disease.

Prevention

Preventive measures against liver steatosis involve the timely elimination of diseases that led to the formation of the underlying disease. In addition, prevention consists of:

• maintaining a healthy lifestyle;
• control of normal body weight;
• correction of metabolic disorders;
• complete refusal of drugs that caused such a disease.

The prognosis of the disease depends entirely on the stage of NAFLD and alcoholic liver damage. In the first stage, it is possible to achieve complete recovery and restoration of the tissues of the affected organ. In the second stage, complex therapy gives good results. At the third stage of steatosis, the formation of irreversible processes is observed. Therapy is based on preventing further liver breakdown.

What is steatohepatosis and how to treat it

In the modern world, people are increasingly faced with liver diseases. Everything happens due to poor nutrition, drinking alcohol and a sedentary lifestyle. One of the most common diseases is liver steatohepatosis. Steatohepatosis, what is it, how to treat it, what symptoms and signs accompany it, what pills should you take for steatohepatosis? What is the difference between non-alcoholic and alcoholic steatohepatosis?

What kind of disease is this?

So, what kind of disease is this, if you take the word (steatohepatosis) apart, hepatosis is any disease or change in the liver associated with its structure. And steatosis, or it is also called steatohepatitis, is (fat) or its accumulation in the liver, which subsequently leads to diffuse changes in the organ, then to dysfunction and destruction of the cells of this organ. All this ultimately leads to cirrhosis or liver failure.

There is a single regulatory document - the International Classification of Diseases (ICD-10), where each disease has a unique code. Liver disease code in ICD 10 from K-70-K-77. According to the international classification of liver diseases, steatohepatosis has code K76.0.

There are two types of steatohepatosis:

1. Alcohol - as everyone knows, the liver is the main filter in the body. With its help, all harmful substances entering the body are filtered. Alcohol goes through certain stages in the digestive tract and releases toxic substances that accumulate in the liver. An allergy occurs, and then healthy cells are replaced by fat cells, subsequently developing alcoholic steatohepatosis of the liver.
2. Non-alcoholic - the main difference from the previous one is that steatohepatosis does not develop due to alcohol consumption. Fatty hepatosis and chronic hepatitis lead to this disease. They gradually reduce the normal functioning of the liver, and fatty, salty, smoked foods and antibacterial drugs accelerate the development of the disease. This disease occurs more often in women with excess body weight, as well as high levels of sugar and cholesterol in the blood. The nature of non-alcoholic steatohepatosis has not been precisely studied; it is assumed that this occurs due to the accumulation of free fatty acids, which degenerate into toxic substances, which in turn lead to the accumulation of fatty inclusions. Non-alcoholic steatohepatosis is usually favorable; it does not develop into cirrhosis and patients do not develop liver failure.

Causes of the disease

There are many reasons for the occurrence of non-alcoholic steatosis:

1. Wrong diet: excessive consumption of fatty, smoked, spicy, salty, sweet, baked foods leads to excess weight gain, and then to such serious consequences.
2. Sedentary lifestyle: If a person eats right, but completely ignores exercise, even walking, this leads to a reserve of calories, which will later cause damage to your liver.
3. Slow metabolism and precursor diseases: obesity, diabetes, pancreatitis and other problems leading to excess weight gain.

Improper weight loss or long-term abstinence from food: a sudden loss of extra pounds puts the body in a stressful state, which leads to disruption of the functioning of many internal organs.

Manifestation of the disease

Unfortunately, in the initial stages, diffuse steatosis does not have any pronounced symptoms or manifests itself in symptoms familiar to us:

• weakness;
• dizziness;
• heaviness in the right side;
• change in stool (more often diarrhea than constipation);
• less often nausea, vomiting;
• lack of appetite;
• weight loss;
• allergic rashes on the body;
• A yellow tint to the face is not always noticeable.

All these symptoms are characteristic not only of this disease, but also of many others. In order to make sure of this, you need to immediately go to the hospital.

Diagnostics

To avoid it being too late, you need to undergo a medical examination every year and monitor your body.

If you are observed in a hospital, it is unlikely that you will be diagnosed with non-alcoholic or alcoholic steatohepatosis of the last stage. If necessary, the therapist you are seeing will prescribe all the necessary tests and procedures. Usually this:

• Ultrasound of the liver or all digestive organs;
• computer and magnetic resonance imaging, which will allow you to view the organ in more detail (determine the stage of the disease);
• biopsy - this diagnostic method will help study liver cells.

The non-alcoholic type of the disease does not appear quickly; such steatohepatosis develops very slowly and subsequently becomes chronic.

Healing procedures

Treatment should include a set of procedures aimed at:

• elimination of sources of fatty liver;
• fight against alcoholism, if necessary for the patient;
• renewal of organ cells;
• restoration of normal functioning;
• eliminating or at least slowing down destructive processes in the organ;
• normalization of all organs of the digestive tract;
• healing of the body.

To all of the above, dietary nutrition and moderate physical activity are added, as well as medications (anabolic steroids, B12 vitamins, antibacterial agents and others) and, if necessary, physiotherapeutic measures (trips to pressure chambers, ozone therapy and ultrasound exposure).

The disease is treatable in the first two stages. At the last stage, the disease is curable only if the patient is transplanted with a healthy liver and it survives successfully. The sooner treatment begins, the faster a person recovers.

Proper nutrition for fatty degeneration

If the disease is acquired due to excessive alcohol consumption, therefore, you need to avoid alcoholic beverages completely. If it’s due to an unhealthy diet, then you should forget about junk food.

A diet for diffuse steatosis involves limiting the consumption of foods that contain large amounts of fat and increasing dairy and fermented milk products. This will reduce the load on the liver and help remove toxic substances from the body. The main task is for the liver to normalize its functions.

You need to eat in small portions 4-5 times a day.

Products to forget about:

• alcoholic and carbonated drinks;
• legumes;
• mushrooms;
• spicy (garlic, horseradish, pepper);
• coffee;
• sour vegetables and juices (tomato, apples);
• sweets (ice cream, cakes, waffles, cookies, candies);
• animal fats, butter;
• mayonnaise, ketchup and other sauces;
• fried, smoked, salted fish and meat.

Products to be consumed daily:

• steamed lean meat and fish;
• dairy products;
• vegetables and fruits;
• wholemeal or grain bread.

During such a diet, food must be steamed or baked in the oven. Salt consumption should also be reduced to a minimum.

Alternative medicine

Treatment with folk remedies is very popular, but still you should not get carried away with these methods. Before using the products, you should consult a specialist. You should not self-medicate, as this can lead to adverse consequences.

A few recipes to help you rehabilitate after illness:

1. A decoction of rose hips helps cleanse the liver of fat. Two tablespoons of rose hips are poured into two glasses of boiled water and left for 8-12 hours. The resulting product should be drunk throughout the day. The course of treatment is 3 days.
2. A decoction of St. John's wort flowers and leaves copes well with liver disease.
3. Three large lemons are crushed through a meat grinder or blender and pour half a liter of boiled water and leave for 8-10 hours. Drink the strained decoction throughout the day. You should not drink the decoction for more than 3 days, as lemon will have an adverse effect on the gastric mucosa.

In order to prevent the development of non-alcoholic steatohepatosis, you should monitor your body weight, what you eat and drink, lead a healthy lifestyle, play sports, do not abuse alcoholic beverages and medications, and do not forget about visits to doctors. Look after not only your health, but also the health of your loved ones.

Liver steatosis (fatty degeneration)

Hepatic steatosis is a pathological condition associated with excess lipids. In this case, fatty transformation of hepatocytes develops and the normal functioning of the organ is disrupted.

Steatosis can develop at any age. Non-alcoholic lesions occur in postmenopausal women over 50 years of age who are obese. The alcoholic type develops in men over 45 years of age who abuse alcohol. In the modern world, cases of liver disease in young people and children have become more frequent.

Fatty liver degeneration manifests itself not only as an independent disease, but also as a consequence of metabolic disorders.

In ICD 10 it is located in the section on liver diseases (K70 - K77). The code for fatty liver degeneration is K76.

Etiology

In the human body, the liver is the largest gland that performs many important functions. She is susceptible to pathological processes, as throughout her life she encounters harmful and toxic substances.

The main reasons for the development of steatosis are:

• abuse of alcohol and its substitutes;
• chronic diseases of the digestive system;
• thyroid hypothyroidism;
• intestinal dysbiosis due to long-term use of antibiotics;
• long-term use of hepatotoxic drugs (cytostatics, hormonal drugs);
• drug use;
• unhealthy diet (constant overeating and hunger, predominance of fat in food);
• obesity;
• diabetes mellitus type 2;
• failure of fat metabolism in the body;
• chronic diseases of the respiratory system and heart;
• hormonal imbalance or change during postmenopause in women.

Clinical picture of liver steatosis

At first, the disease is asymptomatic. At later stages there are:

• fatigue and general weakness;
• nausea and sometimes vomiting (with bile);
• belching with an unpleasant odor and bitterness in the mouth;
• heaviness and pain in the right hypochondrium due to liver enlargement;
• loss of appetite;
• yellowness of the skin, mucous membranes and sclera of the eyes;
• skin itching;
• frequent colds and viral diseases;
• irritability;
• sleep problems.

If you suspect a disease, you should seek help from a specialist. Timely medical assistance will help avoid serious consequences.

Liver steatosis: types and stages

The following types are distinguished:

1. Steatosis of the liver and pancreas. With pancreatic steatosis, severe dyspeptic disorders occur due to changes in healthy cells, fill with fat and cease to function normally. Endocrine cells stop producing the necessary enzymes for the normal functioning of the digestive system. The patient is worried about diarrhea, increased gas formation, belching and heartburn. When the process is advanced, pain appears in the left side with radiation to the back.
2. Diffuse steatosis is established if fatty transformation has occupied more than 10% of the entire liver parenchyma. It is believed that the largest fat deposits are in the second and third lobes. Fat deposits are located evenly and diffusely.

At initial manifestations, liver function is not impaired. If the process progresses, the cells of the organ change, which leads to disruption of the normal functioning of the entire body.

Gross specimen in pathological anatomy:

The liver is large and yellow. Its surface is smooth, its structure is dense. The section shows an accumulation of fat on the entire surface. Fatty lesions range from 1 mm to 2 cm in diameter.

Micropreparation for fatty liver:

Fat cells push hepatocytes to the periphery, and liver cells become signet ring-shaped. Infiltration can involve both single cells and groups of cells. In this case, large fatty cysts are formed. Over time, hepatocytes die and connective tissue forms in their place.

Diagnosis of liver steatosis

The diagnosis is made on the basis of anamnesis and examination of the patient: it is important to pay attention to the presence of hereditary diseases, alcoholism, diabetes and the appearance of the patient. Laboratory methods are not informative for steatohepatosis. Blood biochemistry reveals a slight increase in liver enzymes or cholesterol. This is not enough to establish hepatomegaly.

• Ultrasound examination of the abdominal organs (determining the size of the liver, spleen, pancreas).
• Computed tomography (look at the size and structure of the parenchyma).
• Chest X-ray (enlargement of the borders of the heart).
• Liver biopsy (if malignancy is suspected).

If you suspect an enlarged liver, you must urgently seek help from specialists, primarily from your local physician. He will examine and prescribe all examinations. After identifying the pathological process, they are referred for consultation to a hepatologist or gastroenterologist.

To confirm the diagnosis, a liver biopsy is taken (a small piece of organ tissue to study the cellular structure).

There are degrees of steatosis:

• 1st degree – cells with accumulation of fat, but not damaged;
• 2nd degree - cells are subject to irreversible changes, with a huge content of fatty inclusions;
• Moderate steatosis is a small amount of lipids in cells that does not disrupt its structure and function.

Treatment

First, you need to contact a specialist to identify the localization and advanced stage of the disease. After this, the appropriate medical tactics are selected. Clinical symptoms and treatment of fatty liver are closely related.

Before starting drug treatment, you must:

• stop drinking any alcohol (to recover from alcoholism);
• eat right to lose weight;
• maintain a sleep and rest schedule;
• reduce physical stress on the body.

Before starting treatment for the disease, you need to ease the load on the liver.

The diet for liver damage is as follows:

• be sure to exclude spicy and highly salty foods;
• in the diet there is a predominance of foods high in fiber and protein, microelements and vitamins;
• Cook food only by steaming or baking in the oven;
• eat food in small portions 5-6 times a day;
• completely eliminate any alcohol.

Include the following foods in your diet for steatosis:

• A large number of vegetables (beets, cauliflower, broccoli, etc.);
• greens (parsley);
• dried fruits (prunes);
• porridge (buckwheat and oatmeal);
• nuts (walnuts, cashews);
• low-fat fermented milk products (1% kefir, Varenets, etc.);
• dietary meat (rabbit, chicken breast) and white sea fish (cod);
• tea (preferably green without sugar).

It is necessary to consume foods that will help restore a weakened body and be saturated with useful substances (vitamins, macro- and microelements).

Drugs

This type of treatment is prescribed by the attending physician after a complete examination of the body. All drugs are prescribed individually for each patient.

Drugs for the treatment of liver steatosis:

Hepatoprotectors have choleretic, cholelitholytic, and hypolipidemic properties. Heptral also has an antidepressant effect.

Phytotherapy

• Grind milk thistle seeds and dandelion roots. Add to this mixture one tablespoon each of chopped birch and nettle leaves. All components of the collection are used dried. The prepared herbs are poured with boiling water and infused for 30 minutes. Strain and drink one glass twice a day.
• You can buy ready-made liver herbal preparations at the pharmacy. Brew and use according to the instructions on the pack.

Prevention

The main preventive measures should be aimed at a healthy lifestyle and proper healthy nutrition. It is necessary to stop drinking alcohol. It is important to promptly treat diseases of the digestive system and monitor the health of the body as a whole. When health problems arise, it is necessary to treat the disease, and not hope for self-healing.

When taking hepatotoxic drugs, it is necessary to monitor the condition of the body, take breaks between courses and use means to cleanse and normalize liver function.

Complications

The outcome without treatment is disappointing. Death may occur from acute liver failure. Every person at the slightest suspicion of liver disease should seek help from a doctor.

Forecast

The prognosis may be favorable. In the early stages, steatosis responds well to treatment. Damaged cells are restored, the liver performs its functions normally.

At later stages, the processes are already irreversible. Treatment is aimed at improving the patient’s condition and slowing down the progression of pathological processes in the liver.