What does hepatosis mean. What symptoms talk about the disease of the fatty hepatosis of the liver, what treatment is necessary and how to treat it correctly? Deficiency of digestive enzymes

The liver, as the digestive body performs the main function when splitting fats in the food. As a purification body, liver cells split all toxic substances penetrating into the body in the poisoning of alcohol, medicines, damaged by food, with breathing toxic evaporation or gases.

What is fat hepatosis?

Fatic hepatosis of the liver - This is a disease in which the pathological rebirth of hepatocytes (liver cells) occurs. Hepatocyte degeneration occurs due to the gradual grease accumulation in its structure.

Increasing the fat content in hepatocytes more than 5-10% of the weight of the body leads to the formation of free radicals, which gradually destroys the cell membrane.

Non alcoholic liver disease has medical names: steatosis, fatty degeneration (dystrophy, rebirth, infiltration) liver, fatty hepatosis.

Degrees of fat hepatosis

Depending on the duration of the disease, the volume of fatty infiltration, the number of degenerative hepatocytes and the rate of development of the disease, the hepatosis is distinguished by degrees.

0 degree

Focal accumulations of heavy hepatocytes, general number of fat deposits up to 10% affected hepatocytes. This is the primary degree of the disease, which is completely reversible, the degenerative process of rebirth of the liver tissue does not occur in the organ. Proceeds without symptoms and pain.

1 degree

Grease hepatosis of the first degree (simple steatosis), depending on the causes of the occurrence, separated by alcoholic and non-alcohol.

For the disease, characteristic the accumulation of fat in the body to 7-10% of the massSmall inflammatory processes in the tissues.

The process of degeneration of the organ completely reversible. At stage 1, symptoms may be present: lightweight in the liver area, periodic minor tingles.

The accumulation of fat deposits may be local and diffuse (throughout the body). Uzi determines up to 33% of affected hepatocytes.

2 degree

With 2 degrees, the inflammation of the organ is essential, the partial death of the liver cells occurs, the substitution of the normal liver tissue to the pathological (steatohepatitis). Hepatocyte damage is up to 66%.

The progressive disease is characteristic of systematic pains in the field of liver, shortness of breath, which gives pain in the area of \u200b\u200bthe stomach and lower back.

3 degree

With significant damage to hepatocytes, complete organ dysfunction occurs. Hepatocytic damage is more than 66%, fat cysts can be formed on the liver surface, intracellular large-scale obesity. The next stage of cirrhosis disease.

Causes of fat hepatosis

With alcoholic before hepatosis, the main reason is alcohol consumption. It is enough to use 60 ml of any drink with an alcohol content of 40% per day to begin the process of primary degeneration of the liver tissue.

With non-alcoholic liver dystrophy causes of the development of the disease:

Who is in the risk group?

Fat hepatosis multifactorial disease, which begins to develop asymptomatic.

In the risk group are faces:

• Suffering from elevated arterial pressure.
• With an increased level of triglycerides in the blood.
• With 2-type diabetes.
• Compliant with the mode of nutrition with a high content of simple (fast) carbohydrates and hydrogenated fats.
• With a tendency to obesity or elevated weight (abdominal obesity: the volume of the waist in women is more than 80 cm in men more than 94 cm).

Among people with normal weight, fatty hepatosis is diagnosed in 25% of cases, and in persons suffering from obesity in 90%.

Symptoms of fat hepatosis

Since the clinical diagnosis of hepatosis can be delivered only after a morphological study of the ultrasound, KP, the accumulation of fat in liver cells occurs asymptomatic, the following symptoms should alert the patients:

• Systematic or periodic pulling pain in the right side.
• Severity after meals.
• Owl of belly.
• Nausea nausea.
• Changing the skin structure (too dry or the opposite of oily).
• The appearance of acne rams on the back.
• Violation of the menstrual cycle.
• The emergence of allergic reactions.

Sharp pain, spasm in the liver appears only in violation in the operation of the gallbladder and its ducts or with a sharp increase in the size of the liver. The liver fabric has high compensatory capabilities, therefore the appearance of harsh pains indicate that the pathological process has long switched to the stage of chronic disease.

What is dangerous grease hepatosis?

Today, adequate hepatosis is a global problem, the disease leads to cirrhosis of the liver and cancer, which in 60% of cases ends with a fatal outcome.

• With hepatosis of the 2-3rd degree may develop the disease of Mos. (jaundice).
• In addition, hepatosis contributes to the development of cardiovascular pathology, leads to failures in the work of an endocrine system, varicose disease and the development of allergies.
• Fat hepatosis 2-3 degrees in 50% of cases leads to serious violations in the operation of the gastrointestinal tract. There is incomplete digestion of food at the fats splitting stage, the liver cannot function functionally.
• Frequent constipation or irregular stool appear, dysbacteriosis develops.

Diagnosis of the disease

When examining the patient, the analysis and use of methods are primarily carried out:

• General analysis of blood and urine.
• Palpation.
• Biochemistry.
• Percussion.
• Biopsy.
• Tomography.
• Hormone analysis.
• Radionuclide scanning.

An integrated approach eliminates diseases with similar symptoms (echinococcosis, viral hepatitis, abdominal cavity cystroids, etc.)

Diagnostic methods:

AST content standards

AST - Enzymeinvolved in the protein metabolic process (aspartatenotransferase) contributing to the synthesis of membrane amino acids in the cells and tissues of the body. With increased development of the enzyme AST, pathological changes begin in some organs and tissues.

The greatest amount of enzyme is in hepatocytes, myocardium, skeletal muscles tissue and brain neurons. An increase in AST activity leads to their high level in the blood flow system, so the overall blood test is mandatory for the accurate diagnosis of fat hepatosis.

When determining the AST indicator, various research methods are used. Standard are the standards given in the table

What doctors treat fat hepatosis?

During the examination, the patient should be inspected by doctors:

• Hepatologist.
• Endocrinologist.
• Therapist.
• Gastroenterologist.
• Endoscopist.

The first inspection holds a duty therapist, then follows the mandatory visit to the gastroenterologist. After the diagnosis is registered, the patient is a doctor hepatologist.

Treatment of fat hepatosis

1. The treatment of fatty hepatosis is aimed primarily on blocking factors that promote the development of the disease, changing the way of life and the transition to balanced nutrition.
2. Medicase treatment is prescribed depending on the stage of the disease and the rate of its development. Drug therapy includes receiving lipotropic drugs, for example, "essentially", "Forte Esssential", folic and lipolic acid, choline chloride, "Sirepar", vitamin group in 12. The reception of hepatotoxic drugs is excluded. Medicase treatment is aimed at maintaining and normalizing the functional state of the organ, biliary ducts, digestive organs.
3. Changing lifestyle and habits for food This is one of the important components of therapeutic therapy. The patient is most difficult to change food and start using those products to which he is not used to. Sports or an increase in physical activity causes the greatest resistance in people suffering from fat hepatitis. Preparations of traditional medicine, drug therapy will only bring a short-term effect and the disease may return again, if not changed lifestyle.

Preparations for treatment and prevention

Phospholipid group

• Essliver Contains natural phosphilipids Substance EPL, nicotinamide, pyridoxine. Dosage form: Capsules covered with shell. The drug contributes to the restoration of damaged hepatocytes, improves cellular metabolism and enzyme production. Cost of preparation from 300 rubles .
• Esssential. Phosphilipids based on soybean oil. Produced in capsules. Widely used to treat fat hepatosis of various degrees of gravity. The components of the drug are actively replaced by damaged liver cells, contribute to the production of healthy hepatocytes, improve the exchange processes in the hepatic tissue, contribute to the purification of the body from fat savings. average cost from 350 rubles .

Sulfoy-acid group

Sulfurno-acid group of drugs appointed during hepatosis of the 1.26 stage.

• Taurine preparations contribute to the formation of cell membrane hepatocytes and reduce oxidation processes, thereby providing a cleansing effect. Dibor preparations, Taufon are prescribed as basic forms containing the optimal amount of taurine. Cost of Dibicora from 700 rubles ., Taufona from 130 rubles .

Group of plant hepatoprotectors

• Liv-52.. Due to its composition, the drug restores the structure of damaged hepatocytes, contributes to the purification of liver tissue from fat, improves metabolic processes, has a choleretic effect. The preparation includes vegetable hoods from the root of chicory, gravel, cassia, yarrow seeds, cords of capers. Cost in pharmacies from 320 rubles .
• Carsil. The most famous preparation contains an active ingredient of silimarine, which optimizes cellular metabolism, restores damaged hepatocytes, has antioxidant properties. It is assigned to hepatosis of any degree, cirrhosis, toxic poisoning. Cost in pharmacies from 370 rubles .

Fitotherapy preparations have a positive effect in the treatment of fat hepatosis and are widely used as prevention. it Hepaben, turmeric extracts, milk thistle, Holyagol.

Folk treatments

Folk treatments have proven their practical benefit for a long time. When choosing medicinal herbs, patients must adhere to the reception rules.

Balanced nutrition is one of the components of therapeutic and restorative therapy.

From the diet, the "European diet" should be completely eliminated, these are fast carbohydrates and homogenized fats.

The main rules of the diet in the treatment of hepatosis:

• Eating with small portions 6-7 times a day in warm form.
• Dishes should be prepared in the oven, steamed or baked.
• Reduce sugar and salt consumption.
• Exclude alcohol and fried dishes.

Prevention of the disease

Physical activity should be considered not only as prevention or additional (adjacent) procedure in the treatment of hepatosis, but also as one of the main elements of therapeutic therapy.

Conclusion

Under the compliance with the elementary power rules, attentive attitude to its health, fatty hepatosis is well treated at all stages.

Of course, the treatment of a running form may last a year, followed by a constant diet, but at early stages, treatment takes up to 3 months without possible complications and relapses. Provided that patients refuse to independently destroy their health.

- These are non-inflammatory liver disease caused by exogenous or hereditary factors, accompanied by a violation of metabolic processes in the liver, hepatocyte dystrophy. Manifestations depend on the etiological factor that caused the disease. Uniform for all types of pathology are jaundice, lack of liver function, dyspeptic phenomena. Diagnostics include the ultrasound of the hepatobiliary system, the MRI of the liver or the MSCT of the abdominal cavity, the puncture biopsy with the study of bioptats of hepatic tissues. The specific treatment of exogenous hepatosis is to eliminate the cause of the disease, there is no specific treatment for hereditary hepatosis.

General

Hepatosis is a group of independent diseases combined by dystrophy and necrosis of hepatic cells due to the impact of various toxic factors or hereditary defects of the Bilirubin exchange. A distinctive feature of hepatosis is the absence of obvious manifestations of the inflammatory process.

The most frequent form of hepatosis is steatosis, or liver dystrophy - it is found in 25% of all diagnostic liver punings. In people with a body mass index, more than 30, in patients with chronic alcoholism of fatty hepatosis is recorded in 95% of cases of pathorphological studies. The least meeting of the form of hepatosis is the hereditary diseases of the exchange of bilirubin, however, they occur sometimes heavier, and there are no specific treatment of hereditary hepatosis.

Causes of hepatosis

There are many reasons for the development of the disease, all of them are divided into two groups: exogenous factors and hereditary pathologies. External reasons include toxic influences, diseases of other organs and systems. With excessive use of alcohol, thyroid diseases, diabetes, obesity, fatty hepatosis of the liver develops obesity. The poisoning of toxic substances (mainly phosphorodorganic compounds), drugs (most often these tetracycline antibiotics), poisonous mushrooms and plants lead to the development of toxic hepatosis.

Non alcoholic hepatosis

In the pathogenesis of non-alcoholic fat hepatosis, necrosis of hepatocytes plays a leading role with subsequent excess of fat both inside liver cells and beyond. The criterion of fat hepatosis is the content of triglycerides in the liver tissue more than 10% of the dry mass. According to research, the presence of fat inclusions in most hepatocytes speaks of at least 25% of the fat content in the liver. Non alcoholic adhesive hepatosis has a greater prevalence among the population.

It is believed that the main cause of liver damage in non-alcoholic steatosis is the excess of a certain level of blood triglycerides. Mostly, this pathology proceeds asymptomatic, but occasionally can lead to cirrhosis of the liver, insufficient of hepatic functions, portal hypertension. About 9% of all liver biopsies detect this pathology. The total proportion of non-alcohol bezel hepatosis among all chronic liver diseases is about 10% (for the population of European countries).

Alcohol hepatosis

Alcoholic adhesive hepatosis is the second prevalence and relevance of the liver disease after viral hepatitis. The severity of the manifestations of this disease has a direct dependence on the dose and duration of alcohol consumption. The quality of alcohol to the degree of lesion of the liver does not affect. It is known that the complete rejection of the alcohol even at the unfolded stage of the disease can lead to the regression of morphological changes and the hepatosis clinics. Effective treatment is impossible without refusing to alcohol.

Toxic hepatosis

Toxic hepatosis can develop when exposed to the body of chemically active compounds of artificial origin (organic solvents, phosphorodorganic poisons, compounds of metals used in the production and everyday life) and natural toxins (most often it is poisoning with lines and pale toes). It has a wide range of morphological changes in liver tissues (from protein to fat), as well as various flow options.

The mechanisms of action of hepatotropic poisons are diverse, but all of them are associated with a disorders of the disinfective liver function. Toxins are falling with blood flow into hepatocytes and cause their death by violating various metabolic processes in cells. Alcoholism, viral hepatitis, protein starvation and severe common diseases enhance the hepatotoxic effect of poisons.

Hereditary hepatosis

Hereditary hepatosis arise against the background of violation of the metabolism of bile acids and bilirubin in the liver. These include the disease of the zhilter, Kriegler-Saular syndromes, Lucy Driscoll, Dabinda Johnson, Rotor. In the pathogenesis of pigment hepatosis, the initial role is played by the hereditary defect of the production of enzymes involved in the conjugation, subsequent transportation and separation of bilirubin (in most cases its non-conjugated fraction). The prevalence of these hereditary syndromes among the population is from 2% to 5%.

Pigment hepatosis is benign, subject to the correct way of life and nutrition of pronounced structural changes in the liver does not occur. The most common hereditary hepatosis is the housing disease, the remaining syndromes are quite rare (the ratio of cases of all hereditary syndromes to 3: 1000 diseases). Zhilbera disease or hereditary non-hymolytic unconjugated hyperbilirubinemia amazes predominantly young men. The main clinical manifestations of this disease occur when the impact of provoking factors, diet errors.

Crisses in hereditary hepatosis lead:

• starvation
• low-calorie diet
• traumatic operations
• receive some antibiotics
• heavy infections
• stress
• reception of alcohol
• the use of anabolic steroids.

To improve the patient's condition, it is enough to eliminate these factors, to establish a day, recreation and nutrition mode.

Symptoms of hepatosis

Symptoms depend on the cause of pathology. The most pronounced symptoms of toxic hepatosis: the patient is concerned about the obvious jaggility of the skin and mucous membranes, high temperature, dyspepsia. Most often there are severe pain in the right half of the abdomen. Water acquires the color of the dark beer. The fatty hepatosis has similar symptoms, but it has been expressed much weaker: periodic pains in the hypochondrium right, rare attacks of nausea, diarrhea, episodic jaundice.

Zhilbera disease is characterized by a moderate increase in liver, stupid pain in the abdomen on the right, which are found during the intergreacy period in two thirds of patients. At crisis, this symptomatics is registered with almost all patients, joy joins. Confirm this diagnosis allow provocative samples. The testing of the calorie content of the diet is to significantly reduce the overall energy value of food for two days, the study of the level of bilirubin before and after starvation.

Increasing the level of general bilirubin after a sample performed by more than 50% is considered a positive result. The sample with nicotine acid is carried out after the study of the initial level of the bilirubin, 5ml nicotinic acid is intravenously. Increasing the level of general bilirubin by more than 25% in five hours after the sample confirms the diagnosis.

The presence of fatty sediments, structural non-aggregative changes in the liver is a reason for conducting a puncture biopsy of the liver, morphological analysis of biopsy. This study will allow you to establish an accurate diagnosis.

Treatment of hepatosis

Typically, patients with hepatosis need outpatient therapy, with severe accompanying pathology, hospitalization may be required to the Gastroenterology department. The treatment tactics of each of the types of hepatosis is determined by its etiology. In the treatment of non-alcoholic fat hepatosis, diet and moderate physical exertion have the leading importance. Reducing the total amount of fat and carbohydrates in the diet, along with an increase in protein doses, leads to a decrease in the total amount of fat throughout the body, including in the liver. Also, with non-alcohol hepatosis, the prescription of membranestabilizers and hepatoprotectors is shown.

Medical measures for liver alcohol disease also include diet observance and moderate physical exertion. But the main therapeutic factor in alcohol hepatosis is a complete refusal of alcohol - a significant improvement occurs after 1-1.5 months of abstinence. If the patient does not refuse to eat alcohol, all therapeutic measures will be ineffective.

Hereditary pigment hepatosis requires a careful attitude towards their health. Such patients should choose to work, eliminating severe physical and mental loads. Food should be healthy and diverse, including all the necessary vitamins and minerals. Twice a year, a course of treatment with vitamins of group V. Physiotherapy and sanatorium-resort treatment in hereditary hepatosis are not shown.

Zhilbera disease does not require special treatment measures - even with the complete absence of treatment, the level of bilirubin usually be spontaneously normalized by 50 years. Among some specialists there is an opinion that hyperbilirubinemium in the disease of the Zhilbera requires the continuous use of funds that temporarily reduce the level of bilirubin.

Clinical studies prove that such a tactic does not improve the state of the patient, but leads to depressive disorders. The patient forms the opinion that he suffers from severely incurable disease requiring constant treatment. All this often ends with pronounced psychological disorders. At the same time, the lack of the need to treat the disease of the Zhilbera forms a positive view in patients on its pathology and state.

In the treatment of Kriegler-Saular (type 1 type syndrome, only phototherapy and the procedure for replaced blood transfusion are effective. In the therapy of the second type of disease, enzyme inductors (phenobarbital), moderate phototherapy are successfully used. An excellent therapeutic effect with jaundice of breast milk has a translation into artificial feeding. The remaining hereditary pigment hepatosis in conducting therapeutic measures do not need.

Prediction and prevention

With full elimination of the causal agent, the forecast of fatty non-alcohol hepatosis is favorable. Risk factors leading to the formation of fibrosis with this type of hepatosis are: more than 50 years, high body weight index, increase glucose levels, triglycerides, alt. Transformation in cirrhosis occurs extremely rarely. With alcoholic hepatosis without morphological signs of hepatic tissue fibrosis, the forecast is favorable, but only if the alcohol failure is complete. The presence of even initial signs of fibrosis significantly increases the risk of liver cirrhosis.

Among the pigment hepatosis, the most unfavorable forecast for the first type of Kriegler-Saular's syndrome. Most patients with this pathology die at an early age in connection with the toxic effect of bilirubin on the brain or due to the attachment of severe infection. The remaining types of pigment hepatosis have a favorable forecast.

Preventive measures to prevent hereditary hepatosis does not exist. The prevention of acquired hepatosis is a healthy lifestyle and nutrition, the elimination of uncontrolled drug intake. Random contact with poisons should be avoided, refuse to eat alcohol.

Hepatosis of a grease liver is a disease of non-inflammatory nature, which is characterized by dystrophic changes in cells, followed by the transformation of them into a fatty tissue.

For a long time, people suffering from obesity may not even guess what good hepatosis is and what consequences may have its development. The main risk group of incidence of hepatosis is represented by people over 40 years old, with such a liver disorder meets mainly in men.

What it is?

Fat hepatosis (in a different fatty dystrophy, or obesity of the liver) enters a group of reversible, dystrophic, chronic liver disease caused by the accumulation of a large number of lipids. Currently there is a rapid growth of this disease due to systematic disorders in nutrition, as well as the wrong way of life of a person.

Stop the development of the disease is possible when identifying factors affecting the occurrence of fat hepatosis. Changes for the better are observed a month after the treatment provided in a timely manner.

Causes of occurrence

The liver is a body with an amazing restoration capacity and huge internal reserves, 1/7 of its mass is enough to maintain life. The liver can work long with an increased load, since hepatocytes are restored, but everything has a limit. And when a person (especially from early childhood) loads the liver with an excess of fats, carbohydrates, amplifiers of flavors, preservatives, food additives, vegetable fats (palm, coconut oil) - the liver does not withstand a colossal toxic load and its diseases occur.

The main reason for the development of this disease in men (70%) is alcohol, such hepatosis is called alcohol fatty hepatosis. Adolescent is the abuse of energy drinks, the use of narcotic substances - Exthesis, cocaine, opiates, etc.

The remaining causes of the occurrence:

1. Any toxic defeat of the body is any poisoning, the reception of some drugs, the presence of toxic substances in water, air, food, emissions of industrial enterprises, pesticides in vegetables, household chemicals, regardless of the path of penetration into the body - provoke fathecase liver.
2. Diseases such as diabetes, elevated blood cholesterol (see blood cholesterol rate) - markers of the presence of a violation of fat metabolism in the liver. In addition, chronic hepatitis (especially viral hepatitis C), chronic pancreatitis is also accompanied by fat hepatosis.
3. Oxygen deficiency in diseases of the heart, bronchi and lungs leads to hepatosis.
4. In addition, fat surplus in the liver, oddly enough, can both form in thin people, with a deficiency in the diet of proteins (vegetarians), as well as those who are fond of various diets, slightly losing weight (from the "Austensian" prisoners during dystrophy "leather Yes, the bones, "there was a high content in the body of the inner fat).

With excessive admission to the lipid liver, small droplets of fat are settled in its cells, if it rarely, hepatocytes have time to process them and remove fat, with frequent and intensive lipid arrival, their accumulation occurs, and hepatocytes do not cope with their functions.

Such droplets begin to stretch the liver cells and the destruction of its internal structure occurs, which leads to a delay in the timely removal of toxins, recycled products, and the blood supply is disturbed and the flow of oxygen in the liver tissue is reduced.

The progression of such a state leads to the next step - hepatitis (inflammation of the liver), during the death of hepatocytes (they are replaced by a connective tissue) develops liver failure and its extreme degree - cirrhosis.

Symptoms of fat health hepatosis

In the initial stage of lively hepatosis, symptoms are completely absent. Later there appears discomfort, feeling of gravity in the right hypochondrium, fatigue, small jaggility of the skin. The liver is enlarged in size and at palpation, the patient feels pain.

Ultrasound accurately determines the size of the body and how much the initial boundaries of the location are. Blood test shows an elevated level of aminotransferase, cholesterol.

The amount of fibrous tissue in the liver is used to determine the severity of the disease. There are 4 stages, with "0" this is a healthy body, and the fourth stage - developed cirrhosis of the liver.

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

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

Diagnostics

There are several diagnostic methods that allow it to do it in the early stages and on the latter. The first thing the doctor will do is a general inspection of the patient. It makes palpation in the field of right hypochondrium, where the liver is located. The increase in the liver (hepatomegaly) will immediately be detected during primary inspection.

• first of all, it is necessary to do an ultrasound, the echo-discovers of this disease are detected with it, while this diagnosis is good during pregnancy;
• magnetic resonance therapy, which can be appointed by a doctor, will help to establish the presence of affected areas of the liver, as well as the form (stage) of the disease;
• computer tomography also helps to install the hepatomegaly of the liver, which is one of the main signs of this disease;
• the diagnosis of this disease is also detected if the blood is introduced into the blood, which falls into the liver, the heterogeneity of the liver tissue shows, but before entering such a microcraparation, the patient should not eat food for some time;
• the liver biopsy, that is, a study in which a sample of liver (tissue) is taken with the help of a special needle and is sent to the study, fat cells can be detected.

When conducting a study, an experienced specialist can also appoint other studies that will be aimed at establishing the causes of the disease and concomitant disease diseases in order to begin the complex treatment of the entire organism.

Treatment

When it becomes clear what adequate hepatosis of the liver is needed to determine the methods of treatment. Diet therapy is in the first place: it is able to save the patient from the fat rebirth of the liver. Treatment is carried out mainly at home.

The diet provides a limitation of heavy food, dosage of proteins, trace elements and vitamins in the body. Alcohol and Fast Food are completely excluded. Smooth weight loss contributes to rapid recovery (no more than 500 g per day). A sharp weight loss, on the contrary, can give a complication of the disease.

Medicines for liver diseases, in particular with fat hepatosis, have auxiliary effect. Assign:

• vitamins B6 and B12;
• folic and lipoic acid;
• Esssential.

Limpidemic statins could theoretically reduce fat deposits in the liver, but their strong hepatotropy often does not allow these drugs during hepatosis. Hepatoprotectors are discharged without fears, they have a beneficial effect on the parenchyma.

Diet at fat hepatosis

When the fat rebirth of the liver is diagnosed, a diet is considered one of the most important methods in the treatment. Normalization of nutrition can significantly speed up the process of recovery. Her main tasks:

• stabilization of bile production;
• supply of the required amount of glucose;
• restoration of all organ functions;
• normalization of fat metabolism;
• reduced cholesterol levels.

Powered by fatty hepatosis of the liver is desirable to organize so that the patient ate often - up to 7 times a day, but in small portions. During the diet, it will be necessary:

• use a lot of fiber;
• eliminate cholesterol;
• drink more water;
• limit salt, sugar;
• reduce animal fats;
• change cooking technology - cook, bake, soar.

Liver obesity requires excluding hot and carbonated drinks from the menu, refuse to eat coffee and tea. Not recommended for diet:

• radish;
• tomatoes;
• garlic;
• fatty dairy and meat products.

It is advisable to use:

• non-fat meat;
• milk;
• kissel;
• vegetable, dairy soups;
• carrot;
• porridge: rice, manka, buckwheat;
• non-fat dairy products: cheese, yogurt, kefir;
• poultry meat without fat.

Folk remedies

It is better to combine the diet and drug treatment of liver hepatosis with folk remedies. Repeatedly proved the positive effect of pumpkin eating. This vegetable protects the liver and helps the cells to recover faster.

For this prepare pumpkin honey. Receiver: Ripe fetal is cut off and cleaned seeds. Fill to the edges with honey, return the lid to the place, leave the pumpkin to appease for 2 weeks at room temperature. Then honey is overflowing into a clean dry jar and stored in the refrigerator. When hepatosis takes 1 tablespoon 3 times a day.

Cookies and decoction prepare from medicinal herbs. Recipes will not lead - it requires coordination with the attending physician.

Prevention

Prevention of liver hepatosis does not represent difficulties. It is enough to fulfill the following recommendations:

1. Reduced to the minimum consumption of animal fats. Full refusal to also be unacceptable.
2. Feed often and fractionally, small portions. So the liver will not overvolt.
3. Maintain at least a minimum level of physical activity: hypodynamics extremely negatively affects the work of the liver.
4. With caution to use alcohol, in no case to abuse.

All these tips will help avoid trouble with the liver in the future.

The adhesive hepatosis of the liver is characterized by a high risk due to the risk of rebirth in cirrhosis. To prevent problems, you should rationalize your nutrition and physical activity mode. And if the trouble still happened, it is necessary to urgently consult a doctor for advice. Treat hepatosis in the initial stages much easier. So the patient will help yourself, and the doctor.

Fat hepatosis, non-alcoholic liver disease (NAFF) - Symptoms and treatment

What is a fat hepatosis, non-alcoholic liver disease (NAFFP)? Causes of the occurrence, diagnosis and methods of treatment We will analyze in the article of Dr. Vasilyev R. V., a general practitioner with experience at 13 years old.

Definition of the disease. Causes of the disease

Non alcoholic liver disease / NAZHFP (steatosis of cooktic or fatty hepatosis, non-alcoholic steatohepatitis) is an non-alcoholic strategic liver disease, characterized by a change in the liver parenchyma tissue due to filling the liver cells (hepatocytes) with fat (liver steatosis), which develops due to violation of hepatocyte membranes , slowdowns and disorders of exchange and oxidative processes inside the liver cell.

All these changes steadily lead to:

• the destruction of liver cells (non-alcoholic steatohepatitis);
• accumulation of fat and formation of fibrous tissue, which causes irreversible, structural (morphological) changes in the liver parenchyma;
• changing the biochemical composition of blood;
• development of metabolic syndrome (, sugar diabetes);
• ultimately, cirrhosis.

Metabolic syndrome is a widespread condition characterized by a decrease in the biological effect of insulin (insulin resistance), a violation of carbohydrate exchange (), the obesity of the central type with the imbalance of fat fractions (plasma lipoproteins and triglycerides) and arterial hypertension.

In most cases, NAFD is developing after 30 years.

Risk factors This disease is:

• lifeline lifestyle (hypodynamia);
• incorrect meals, overeating;
• prolonged reception of drugs;
• excess body weight and visceral obesity;
• bad habits.

The main reasons for development Nicknap are:

• hormonal disorders;
• breased violation (plasma lipoprotein imbalances);
• impairment of carbohydrate metabolism (diabetes);
• arterial hypertension;
• night hypoxemia ().

In the presence of hypertensive disease, obesity, diabetes, regular reception of drugs or in the case of the presence of two states from the above, the likelihood of the presence of a clip reaches 90%.

Obesity is determined by the formula for calculating the body mass index (BMI): BMI \u003d weight (kg): (growth (M)) 2. If a person, for example, weighs 90 kg, and its growth is 167 cm, then it is implication \u003d 90: (1.67x1.67) \u003d 32.3. This Relettat speaks about the obesity of the I degree.

• 16 and less - a pronounced mass deficit;
• 16-17.9 - insufficient body weight;
• 18-24.9 - normal weight;
• 25-29.9 - excess body weight (resource);
• 30-34.9 - obesity I degree;
• 35-39.9 - obesity of II degree;
• 40 or more - obesity III degree ().

When you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of fat hepatosis, non-alcoholic liver disease (NAFF)

In the majority of patients, this disease in the early stages proceeds asymptomatic - in this is a great danger.

50-75% of patients can appear symptoms of general (chronic) fatigue, reduced performance, malaise, weakness, severity in the field of right hypochondrium, weight gain, long-term increase in body temperature without any reason, red dots on the skin in the chest and abdomen. The liver is often enlarged. Disorders of digestion arise, increased gas formation, skin itch, rarely - jaundice, "liver signs".

Often, NAFF is accompanied by the diseases of the gallbladder: chronic cholecystitis, biliary disease. Less frequently, in advanced cases, there are signs of portal hypertension: an increase in spleen, varicose veins of the esophagus and ascites (cluster of fluid in the abdominal cavity). As a rule, these symptoms are observed at the liver cirrhosis stages.

Pathogenesis of fat hepatosis, non-alcoholic liver disease (NAFLD)

To the accumulation of cholesterol, namely lipids (leaf-like organic compounds) in the liver, leads, first of all, the following factors:

In patients with obesity in the liver tissue, the content of free fatty acids is increased, which may be the cause of violation of the liver functions, since fatty acids are chemically active and can damage the biological hepatocyte membranes, forming a gate to them for admission to an endogenous fat cell, in particular Lipids (mostly low and very low density), and transport is a sophisticated ether - triglyceride.

Thus, hepatocytes are filling with fat, and the cell becomes functionally inactive, swells and increases in size. Under the defeat of more than a million cells, the macroscopically liver increases in size, in the sections of fatty infiltration, the liver fabric becomes denser, and these sections of the liver do not perform their functions or perform them with significant defects.

The peroxidation oxidation of lipids in the liver leads to the synthesis of toxic intermediate products that can run the process of apoptosis (programmed death) cells, which can cause inflammatory processes in the liver and form fibrosis.

Also, an important pathogenetic value in the formation of NAFFP has the induction of cytochrome P-450 2E1 (CYP2E1), which can be induced both by ketones and a high-fat diet and low carbohydrate content. CYP2E1 generates toxic free radicals, resulting in damage to the liver and subsequent fibrosis.

In addition, the pathogenetic value in the formation of NAFFP has endotoxin-indirect damage, which, in turn, enhances the production of pro-inflammatory cytokines (FNF-α, IL-6 and IL-8), leading to a violation of the integrity of hepatocyte membranes and even to their necrosis, As well as to the development of inflammatory cell infiltration, both in portal paths and in the lobes of the liver, which leads to steatohypatitis.

The products of lipid peroxidation, hepatocyte necrosis, TNF and IL-6 activate rack (ITO) cells causing damage to hepatocytes and forming fibrous changes.

Classification and stages of the development of fat hepatosis, non-alcoholic fatty liver disease (NAFF)

At the moment, the generally accepted classification of NAFF does not exist, but a number of authors allocates the stages of the course of the disease and the degree of non-alcohol steatogeatite (NAZ).

Assessment of the stootosis of the liver and histological activity of NAFF by E.M. Brunt:

• I degree (soft nat) - steatosis large-cap, not more than 33-66% of the amazed hepacitis;
• II degree (moderate NAZ) - large and fine-cape, from 33% to 66% of affected hepacitis;
• III degree (severe NAZ) - large and fine-coil, more than 60% of amazed hepacitis.

It is also possible to conditionally divide the degrees of steatosis, fibrosis and necrosis according to the result of the fibromax test - the degree of severity of fatty infiltration:

• S1 (up to 33% fat infiltration);
• S2 (33-60% fat infiltration)
• S3 (more than 60% fat infiltration)
• F1, F2, F3, cirrhosis.

Complications of fat hepatosis, non-alcoholic liver disease (NAFFP)

The most frequent complications of NAFFP are hepatitis, the substitution of the normal parenchymal liver tissue fibrous - functionally non-working fabric with the formation of ultimately the liver cirrhosis.

To a rarercyal complication, but still occurring, you can attribute liver cancer - hepatocellular carcinoma. Most often, it occurs at the liver cirrhosis phase and, as a rule, is associated with viral hepatitis.

Diagnosis of fat hepatosis, non-alcohol liver disease (NAFS)

The NAFP diagnosis uses laboratory and instrumental research methods.

First of all, the liver condition is estimated for inflammatory changes, infectious, autoimmune and genetic diseases (including accumulation diseases) with the help of generally clinical, biochemical and special tests.

The following is an assessment of the functions performed by the liver (metabolic / exchange, digestive, detoxification) by the ability to develop certain proteins, characteristics of fats and carbohydrates. The detoxification function of the liver is estimated primarily with C13-meticate test and some biochemical tests.

Code The first two stages are completed, the structural state of the liver is investigated using ultrasound, MSCT, MRI and Elastometry ( Fibroscan.), if necessary, the morphological state is investigated - liver biopsy.

With the help of elastometry, the elasticity of soft tissues is investigated. Malignant tumors differ from a kindly increased density, inelasticity, they are difficult to compress. On the monitor Fibroscan. More dense fabrics are painted in blue and blue, adipose tissue - yellow-red, and the connecting tissue is green. High specificity of the method avoids unreasonable biopsies.

After diagnostics, the final diagnosis is established and appropriate treatment is carried out.

Treatment of fat hepatosis, non-alcoholic liver disease (NAFF)

Taking into account the mechanism for the development of the disease, the cluster course treatment schemes were developed to restore the structure of cell membranes, exchange and oxidative processes inside the liver cells at the molecular level, cleaning the liver from intracellular and visceral fat, which makes it difficult to work.

In the process of treatment, it is produced:

• correction of carbohydrate, fat (lipid) metabolism;
• normalization of oxidation processes in the cell;
• influence on the main risk factors;
• reducing body weight;
• improved liver structure on reversible stages.

After treatment, there is a noticeable improvement in the disintellation (protective), digestive and metabolic (synthetic) liver function, patients are lost in weight, the overall health improves, the mental and physical performance increases.

Currency treatment programs occupy from three to six months and are selected depending on the degree of severity of metabolic disorders. These include:

1. program "Light";
2. program "Medium";
3. program "Premium";
4. the individual treatment program is developed on the basis of concomitant diseases, the patient's current state and the necessary treatment intensity.

Programs include a preliminary examination, diagnosis and medication treatment, which consists of two stages:

• infusion therapy with prolongation of drugs of drugs inside, selection of diet and physical activity;
• delivery of control analyzes and evaluation of results.

Forecast. Prevention

In the early stages of the disease, the forecast is favorable.

Normal prevention suggests proper nutrition, active lifestyle and regular calendar dispensarization.

The inclusion of omega-3 polyunsaturated fatty acids, short carbohydrates, the restriction of consumption of seasonings, very oily and fried food can be included in its correct nutrition. The diversity of the diet is also a key point of full nutrition. The consumption of products rich in vegetable fiber is shown.

For an active lifestyle, it is enough to walk from 8,000 to 15,000 steps per day and to devote three hours a week with exercise.

With respect to calendar closerization, an ultrasound of the abdominal bodies should be carried out annually and evaluate the level of their liver enzymes (ALT, AST, common bilirubin), especially when receiving any drugs on an ongoing basis.

Hepatosis - This is a collective name diseases of the livercharacterized by impaired metabolic processes in hepatocytes ( hepatic cells) and, as a result, damage to the structure of cells and the intercellular substance, disruption of metabolism and the function of the organ ( dystrophy). According to the type of exchange processes, fatty and pigment are distinguished ( pigment - a substance that gives the color of the body tissues) Hepatosis.

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

Hepatosis () - the most common reversible chronic process in which in hepatocytes ( hepatic cells) there is an excessive accumulation of lipids ( fat). Gradually, in the liver, an increasing amount of cell is replaced by fat, which form a fatty tissue. As a result, the liver is increasing in size, its color changes to yellowish or dark red, cells die, fatty cysts are formed ( pathological cavities in tissue or organs with content), the functions of the body are violated. Very often fatty infiltration ( cluster in tissues of substances that are not defined) liver goes into fibrosis ( the reversible process of replacing normal tissue on the coarse scarning locally either throughout the body), and then to cirrhosis ( irreversible progressive disease of the liver, in which a healthy tissue is replaced by scar).

Fat hepatosis is a fairly common disease. On average, they suffer from 10% to 25% of the population in different countries, among them 75% - 90% - people suffering from obesity and diabetes. In Russia, every fourth person suffers fat hepatosis.

Anatomy of the liver

The liver is a vital unpaid organ, the largest iron ( specific chemicals organ) In the human body. Located on the right in the upper body of the abdominal cavity under the diaphragm. Sometimes there is also a left-sided liver location, which must be taken into account when ultrasound ( Ultrasound) Organ. The liver has an irregular shape, a reddish-brown color, a mass of 1300 - 1800 grams in an adult. It consists of two shares - the right lobe ( larger) and left ( less in size). To facilitate the definition of the liver zone during surgical and diagnostic procedures, the liver is divided into 8 segments. The segment is a pyramidal liver section adjacent to the hepatic triade, which consists of a branch of the portal vein, the branches of the branch of the liver and the branch of the hepatic duct.

Cells from which the liver consists are called hepatocytes. The structural and functional unity of the liver is the hepatic slicing. It has a prism shape and consists of hepatic cells ( hepatocyto), vessels and ducts. The center of the hepatic liquefit is located central vein, and on the periphery, bile ducts, branches of the hepatic artery and hepatic veins. Hepatocytes produce up to one liter of bile ( liquid consisting of bile acids, water, cholesterol, inorganic compounds and participating in the process of digestion) per day. Bile acids contribute to splitting and sucking fat, stimulating the motility of the small intestine, as well as products of gastrointestinal hormones. On intrahepatic small capillaries ( canals) Bile enters larger bile ducts, and then into segmental ducts. Segmental ducts merge into the right ( from the right lobe of the liver) and left ( from the left lobe of the liver) Bile ducts that are combined into a common liver duct. This duct is connected to the gallbladder duct and forms a common bile duct, from which bile enters directly into the lumen of the duodenum.

Nutrients and oxygen liver gets with blood from its own hepatic artery. But, unlike other organs, the venous blood is also coming into the liver, saturated with carbon dioxide and deprived of oxygen.

Two veins are distinguished in the liver:

• Portal.The portal vein system is formed by portal branching ( mortar) Vienna. Portal Vienna - a large vessel in which blood gets from all the unpaired abdominal organs ( stomach, delicate intestines, spleen), and already from the portal vein - to the liver. In the liver there is a purification of this blood from toxins, products of vital activity and other substances, harmful to the body. Blood can not get from the gastrointestinal bodies ( gastrointestinal tract) In general blood flow, without passing "filtering" in the liver.
• Cavalny.It is formed from the totality of all veins that carry blood from the liver. This venous blood is saturated with carbon dioxide and is deprived of oxygen, due to the gas exchange occurred between the liver cells and blood cells.

The main functions of the liver are:

• Protein exchange. More than half of the proteins ( basic building material), which are produced in the body per day, are synthesized ( form) In the liver. The main blood proteins are also synthesized - albumin, blood coagulation factors ( performing a stop of bleeding). In the liver, the stocks of amino acids are stored ( basic structural components of proteins). In case of insufficient receipt or loss of protein, the liver begins to produce ( synthesize) Proteins from amino acid reserves.
• Lipid exchange.The liver plays an important role in the exchange of fats. She is responsible for synthesis ( developing) Cholesterol ( ) and bile acids ( hampered fat droplets, activate substances that split fats for simpler components). One of the functions is also a stock of fat. Supports the balance between the exchange of fats and carbohydrates. With an excess of sugar ( the main source of energy) The liver turns carbohydrates into fats. With insufficient glucose admission ( sahara) The liver synthesizes it from proteins and fats.
• Carbohydrate exchange.In the liver of glucose ( sugar) turns into glycogen and deposited ( forest). In the event of a lack of glucose glycogen goes back to glucose and provides the body with the necessary energy.
• Pigment exchange ( pigment - a substance that gives the color of the tissues and skin). In the destruction of red blood cells ( red blood cells) and hemoglobin ( iron-containing protein - oxygen carriers) Free bilirubin falls into the blood ( galline pigment). Free ( indirect) Bilirubin toxic to the body. In the liver, it is converted to the associated ( straight) Bilirubin, which has no toxic effect on the body. Then the direct bilirububin is derived from the body, and its slightly part enters the blood again.
• Exchange of vitamins.The liver is involved in synthesis ( developing) Vitamins and suction of fat-soluble vitamins ( A, D, E, K). With an excess of vitamins data, the liver postpones them about the supply or derives from the body. With a lack, the body receives them from the liver reserves.
• Barrier function.It is one of the most important liver functions. Its purpose is to neutralize, disintellation of substances that are formed in the body or come from the environment.
• Digestive function.This function lies in the permanent generation of bile hepatocytes ( hepatic cells). Bile enters the gallbladder and stored there before the need. During food, bile enters the intestinal lumen, thereby contributing to the digestive process. Bile acids contribute to emulsification ( mixing with water) Fats, thereby providing their digestion and suction.
• Enzymatic function.All biochemical reactions are accelerated by special substances - enzymes. Such enzymes are contained in the liver. And when the body urgently needs any substances ( for example, glucose) The liver enzymes accelerate the processes of their preparation.
• Immune function.The liver is involved in the maturation of immunity cells ( immunity - a set of protective forces of the body), as well as in many allergic reactions.
• Excretory function.Together with the biliary, the liver displays the products of the exchange, which further enter the intestine and are derived from the body.

Interesting Facts

• The liver takes second place by weight among all organs ( average mass - 1500 g).
• 70% consists of water.
• In one hour, about 100 liters of blood passes through the liver and, accordingly, more than 2000 liters per day.
• Daily liver performs more than 500 functions.
• The liver could function up to 300 years thanks to its unique property - self-healing ability.
• Over 25% of liver diseases are caused by alcohol use.
• In the cells of the liver per minute there are about a million chemical reactions.
• Currently, more than 50 liver diseases are known.
• ).
• More than 11,000 transplants are held annually ( surgical transplant operations) Liver.

Forms and stages of hepatosis

For the wording of an accurate diagnosis, describing the degree of damage to the liver and the prevalence of the pathological process, there are classification of hepatospotosis on various features. It provides a doctor more detailed understanding of the patient's disease, even if the doctor is not familiar with his history ( history of the disease).

Steatosis can be:

• Alcoholic - Pathological changes in the liver against the background of chronic alcohol intake.
• Non alcoholic(non alcoholic steatohepatosis - Nash, non-alcoholic fatty disease - clinch) - fat rebirth of the liver, which occurs in the improper lifestyle, power mode, various concomitant diseases.

In fat hepatosis distinguish:

• I stage - minimal obesity. In the liver cells, fat droplets accumulate without damage to hepatocytes.
• II stage - the obesity of moderate gravity. In the cells occur irreversible processes leading to their destruction and death. Their content falls into the intercellular space. Cysts are formed ( pathological cavities).
• III Stage - Heavy Obesity.Precriminal condition ( cirrhosis - an irreversible chronic process for replacing the liver tissue on the scarsing).

According to the degree of damage to the structure of the liver allocate:

• Focal disseminated - accumulation of small sections of fat in various liver deposits with asymptomatic flow.
• Pronounced disseminated - accumulation of fat droplets in large quantities in various liver deposits with the manifestation of symptoms.
• Zonal - Lipid location ( fat) in various parts of hepatic lobes ( structural and functional liver units).
• Diffuse - The lesion of the liver, in which the accumulation of fat occurs evenly throughout the liver salt with the appearance of symptoms.

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

• Primary- congenital intrauterine disruption of metabolism.
• Secondary- Violation of metabolism, which appears as a consequence of concomitant diseases, improper nutrition and lifestyle.

According to the microscopic picture of hepatosis, that is, pathological changes in the cellular level, allocate:

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

Morphologically(cell structure and shape) Allocate:

• 0 degree of steatosis - locally in hepatocytes appear fat grease.
• I degree steatosis - clusters of lipids ( fat) Inspection and merge into foci with damage to the liver cells - up to 33% of the affected cells in the field of view.
• II degree steatosis - clusters of lipids of various sizes that are distributed over the entire surface of the liver - 33 - 66% of the liver cells ( small Capel, large-scale intracellular obesity).
• III degree of steatosis - the accumulation of fat occurs not only in the cells, but also beyond the formation of cysts ( pathological cavity in fabric), destruction and death of cells - more than 66% of affected hepatic cells in sight.

Causes of liver steatosis

Many factors lead to the development of pathological changes in the liver and impaired its functions. On the liver health affects lifestyle, power mode, drugs, heredity, concomitant diseases, viruses. Often it leads to steatosis, there is not one certain reason, but a combination of several. Therefore, to install etiology ( the reasons) Diseases The doctor should ask the patient about his bad habits, diseases, medicines that he accepted or accepts and so on. Correctly identified reason will allow not only to eliminate the factor itself and its disastrous effect on the health of the liver, but also to design effective treatment. This will significantly increase the chances of the patient for recovery.

The causes of steatohepatosis are combined into two large groups:

• causes of alcohol steatohypatosis;
• causes of non-alcohol steatohepatosis.

Causes of alcohol steatohepatosis

Alcohol Reception - the only reason for alcohol steatosis . The accumulation of fat droplets in hepatic cells occurs under the action of ethanol ( pure alcohol, the content of which is indicated as a percentage on alcohol) In chronic alcoholism or excessive alcohol consumption. Large doses are considered 30 - 60 grams of ethanol per day. Under the action of alcohol, hepatic cells die faster than renewed. In this period, excess scar tissue is formed in the liver. The flow of oxygen into cells is significantly reduced, as a result of which they wrinkle and dying. The formation of a protein in hepatocytes is reduced, which leads to their swelling ( due to the accumulation of water in cells) and hepatomegaly ( pathological increase in the liver). Enhance the risk of developing alcoholic steatosis Heredity, protein deficiency in food, hepatotropic ( property liver) Viruses, concomitant diseases, obesity and others.

Causes of non-alcohol steatohepatosis

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

Causes of non-alcohol steatosis

Risk factors are:

• female;
• age older than 45 years;
• body mass index ( BMI - weight ratio in kilograms to the square of growth in meters) more than 28 kg / m 2;
• hypertonic disease ( elevated blood pressure);
• diabetes ( the disease caused by the lack of insulin - the hormone of the pancreas responsible for reducing blood sugar levels);
• ethnicity - the most susceptible to the disease Asian, and the smaller risk of African Americans;
• humidated hereditary history - the presence of a disease in relatives or factors transmitted genetically.

Symptoms of hepatosis of the liver

Steatohepatosis can flow asymptomaticly for a long time. It is revealed more often by accident at annual medical examinations and diagnostic procedures about other diseases. At the initial stages of hepatosis, the patient does not impose no complaints. With the progression and involvement of the increasing field of liver in the pathological process, the functions and structure of the body begin to be violated. This leads to the appearance of symptoms.

Symptoms of hepatosis

Stage Steatohepatoma	Symptom	Development mechanism	Manifestation
Stage I Stage	Proceeds asymptomatic	–	–
Stage II	Pain syndrome (aggregate symptoms)	The liver does not have pain receptors ( proteins receiving information from the stimulus and transmitting it to the analyzer). Pain occurs with the increase in the liver in size and stretching its capsule ( sheath covering liver).	Discomfort, the severity in the right hypochred region appearing regardless of food. The feeling of squeezing organs, pain when taking the liver.
	Weakness	Weakness and disabilities are caused by a disadvantage of energy due to the violation of the nutrient exchange.	Lomotation in the body, constant feeling of fatigue.
	Nausea (permanent or parietal)	Developed due to disorders of digestion associated with a disadvantage of the brightening liver function. With a lack of bile, the process of digesting fat is disturbed, as a result of which food can be stated in the gastrointestinal tract, which leads to the appearance of nausea.	Discomfort, discomfort in the area of \u200b\u200bthe stomach and esophagus. Disgust for food, smells. Increased salivation.
	Reduced appetite	Many liver functions are violated, associated with the metabolism, which leads to incorrect assessment of the body of the supply of nutrients and the need for them, the stress in the gastrointestinal tract. Also appetite decreases with nausea.	No feeling of hunger, reducing the number of techniques of writing and its volume.
	Reducing immunity (protective forces of the body)	The liver plays an important role in maintaining immunity. Its disease leads to a violation of this function.	Frequent colds, aggravation of chronic diseases, viral infections, inflammatory processes.
III Stage	The jaggility of the skin and visible mucous membranes	Increased bilirubin - yellow pigment, as a result of the inability of the liver, bind it and remove from the body.	Skin cover, mouth mucosa, eye sclera ( dense outer shell) Get yellow color of different intensity.
	Itch	With impaired liver function, bile acids are not distinguished with bile, and fall into the blood. This leads to an irritation of nervous endings on the skin and the appearance of itching.	Pronounced burning sensation. Intense itching, often appearing at night.
	Sweeping on the skin	Disinfective liver function disrupts. Under the action of toxins and products of the life of the body appears rash. Hemostasis is broken ( a complex biosystem that ensures blood maintenance in a liquid state under normal conditions, and when the integrity of the blood vessel is disturbed by the ceasing of bleeding), the fragility of blood vessels increases.	Small spots on the skin around the body. Hemorrhagic rash ( small hemorrhage).
	Dislipidemia manifestations (violation of lipid exchange)	As a result of a violation of fat exchange,	Xanthomy - The disease that appears in violation of fats and is manifested by focal skin formations consisting of cells with fat inclusions. Xantellasma - Flat xanthoms appearing on the eyelids. Lipoid arc cornea - Circular fat deposition in the outer shell of the eye.

Diagnosis of hepatosis

To determine the type, stage, the shape of steatosis it is necessary to carry out a number of surveys. The doctor will select optimal diagnostic methods individually for each patient.

Diagnosis of the disease includes:

• anamnese collection ( information about the life of the patient, the history of the disease and others);
• inspection;
• laboratory examination methods ( common blood test and biochemical blood test);
• instrumental examination methods ( ultrasound examination, computed tomography, magnetic resonance imaging, liver biopsy, elastography).

Collect Anamneza

Anamnese collection is basic in the diagnosis of the disease. The conversation with the patient is the first stage of the survey. The more the history will be assembled, the easier it will be to identify the cause of the disease, choose treatment, diet and give the right recommendations to change the lifestyle.

At the reception, the doctor will analyze:

• Complaints of the patient - Complaints for pain, discomfort, severity in the right hypochondrium, the presence of vomiting, nausea.
• Anamnesis of the present disease - Time when the first symptoms appeared, as they manifested themselves, as the disease developed.
• Anamnesis of life - What concomitant diseases are available in a patient, what kind of lifestyle he leads, what surgery suffered, which drugs received or accepts and for what period.
• Family history- What diseases suffered the next relatives.
• Patient nutrition character- What products prefers the patient how often it feeds what a diet is observing whether there is an allergy to products, there is an alcohol taking ( threshold - 20 g / day for women and 30 g / day for men).

Inspection

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

During the examination of the patient:

• Carefully examine the skin and visible mucous membranes, the jaggility of the skin, mucous membranes and its intensity, the presence of combs, rash is estimated.
• Percussion is held ( tapping) and palpation ( turning) Belly to determine the size and soreness of the liver.
• Alcoholic dependence is also determined - ethylism ( chronic alcohol consumption). With alcoholism, the patient will have a female face, tremor ( jitter) Hands, untidy appearance, alcohol smell.
• Determines the degree of obesity. To do this, all sorts of formulas for calculating the normal mass of man are used, depending on the floor, age, type of physique and determine the degree of obesity on the tables.

To determine the degree of obesity are used:

• Body mass index ( BMI). This is an objective factor that estimates the compliance of the growth and weight of a person. The calculation formula is very simple - the BMI \u003d M / H 2, that is, this is a human weight ratio in kilograms and growth in m 2. If the index is 25 - 30 kg / m 2 - in the patient the excess body weight ( score), if BMI is more than 30 - the patient suffers to obesity.
• Calculation of the perfect mass of the body ( BMI). The patient's sex is also taken into account in this formula and its optimal weight is determined, which should be followed. It is calculated by formulas - BMI \u003d 50 + 2.3 x ( 0,394 x Growth in cm - 60) - for men and BMI \u003d 45.5 + 2.3 x ( 0,394 x Growth in cm - 60) - for women.
• Measurement of the waist circle centimeter tape.Used to predict complications and risk diseases. If a woman has a waist amount more than 80 centimeters, and a man has more than 94 centimeters, then risk of sugar diabetes and hypertension increases ( increased blood pressure) And grows with each additional centimeter.
• The ratio of the waist circumference length to the thigh circumference length. For women, the ratio of the waist circumference length to the thigh circumference length is less than 0.85, for men - less than 1.0. Studies have shown that people possessing the type of "Apple" shape ( waire wider thighs) more predisposed to various diseases than people with a "pear-shaped" type of figures ( hips wider than waist).

General blood analysis

The procedure consists in blood intake from veins and analysis on special laboratory devices.

In order to gain reliable results, the following rules should be followed. :

• blood fence is carried out in the morning on an empty stomach ( no earlier than 12 hours after meals);
• dinner on the eve should be light and early, without coffee and strong tea;
• for 2 - 3 days, alcohol, oily food, some drugs are excluded;
• during the day, physical exertion is excluded, visiting the sauna;
• analyzes are rented to x-ray examination, massage.

With general, blood test may reveal:

• Possible anemia ( anemia). With anemia, the number of red blood cells is reduced ( red blood cells) - less than 4.0 x 10 12 / l in men and less than 3.7 x 10 12 / l in women. And also decreases the amount of hemoglobin ( squirrel - oxygen carrier) - less than 130 g / l in men and less than 120 g / l in women.
• Signs of possible inflammation.In the blood increases the number of leukocytes ( white blood cells) - more than 9.0 x 10 9 / l, ESP increases ( erythrocyte sedimentation rate) - more than 10 mm / h in men and more than 15 mm / hour in women.

Blood chemistry

Blood fence procedure for biochemical analysis is identical to blood intake procedure for general analysis. Only dinner is added to the restrictions on the eve ( more than 12 hours of starvation), cancellation of hypolipidemic ( lowering blood lipids) Medicinal preparations two weeks before analysis.

When biochemical blood research can reveal:

• Increased transaminase activity ( ). Aspartatenotransferase level increases ( Act.) more than 31 ed / l in women and more than 41 units in men and alaninotransferase ( Alt.) More than 34 units in women and more than 45 units / l in men. The increase in their blood concentration indicates the process of destroying liver cells.
• Dislipidemia ( violation of protein exchange). Increases cholesterol concentration ( zeper-like component of all cells) more than 5.2 mmol / l. The concentration of HDL decreases ( lipoproteins - complexes of proteins and fats of high density, "Good cholesterol") Less than 1.42 mmol / l in women and less than 1.68 mmol / l in men. The concentration of LDL increases ( lipoproteins of low density, "bad cholesterol") more than 3.9 mmol / l.
• Disturbing carbohydrate exchange.Hyperglycemia is observed ( increase blood sugar level) more than 5.5 mmol / l.
• Hepatic cell failure ( reduced function). Albumin concentration decreases ( chief protein of blood) Less than 35 g / l, blood coagulation factors. This indicates the inability of the liver to produce proteins and provide hemostasis ( hemostasis - a complex biosystem that ensures blood maintenance in a liquid state under normal conditions, and when the integrity of the blood vessel is disrupted, a contributor to stopping bleeding).

Ultrasound procedure ( Ultrasound)

Ultrasound procedure ( Ultrasound) - non-invasive ( without penetration into the body of a person and disruption of the integrity of the skin, tissues, vessels) Research method. The essence of the method is to supply ultrasonic waves into the human body. These waves are reflected from the organs and are tracked with a special sensor with the subsequent display of the picture on the monitor. The denser the structure of the organ or environment, the less waves pass through them and more reflected. On the screen, such fabrics and organs look brighter and lighter. A special gel is applied to the patient to the right of the liver area to facilitate the sliding of the sensor. Then get the image of the liver on the screen. The doctor describes the results. This is an absolutely painless and harmless procedure, so there are no contraindications to ultrasound.

Indications for ultrasound liver are:

• an increase in liver in the amount of tacking;
• palpation soreness ( turning);
• changes in biochemical blood test.

With ultrasound examination, liver can reveal:

• Hyperachege ( increased reflection of waves from tissues) The liver - This indicates the compaction of the tissue of the organ.
• Increased liver in size ( hepatomegaly) - as a result of inflammatory processes and accumulation of fatty sediments in the liver.
• Fat infiltration ( calculation in the tissues of substances that are missing normally) more than 30% liver- All changes in the liver are detected on the ultrasound only with fat degeneration of more than 30% of the area of \u200b\u200bthe organ.
• Alternation of hyperheogenic sites ( with high reflection of waves from tissues) and hypoethogenic ( with reduced reflection of waves from tissues) - dense areas reflect the rays, less dense absorb them, which indicates the heterogeneity of the liver damage.

CT scan ( Kt.)

CT scan ( Kt.) - non-invasive ( without penetration into the body of a person and disruption of the integrity of the skin, fabrics and vessels) Examination method. This method is based on the passage of X-rays through the human body from different points and at different angles, which allows you to create a volumetric and layer-by-layer image of organs on the monitor.

For the examination, the patient should take off all clothes, decorations, removable dentures and put on a special bathrobe. Then it is placed on the bed with a scanning system having a type of circle. This system is placed in the liver area, after which the scanning sensor performs rotational movements, passing X-rays through the patient's body. To improve the quality of visualization, the doctor can make a CT with a contrasting agent that will more clearly display the organ structures on the screen.

Computer tomography is shown:

• with focal ( local) liver lesions;
• with unsatisfactory results of ultrasound ( ultrasonic research);
• if necessary, in a more detailed, layered image;
• in the presence of formations, cyst ( pathological cavities in fabric).

Computer tomography(Kt.) contraindicated:

• in mental illness;
• with inadequate patient behavior;
• with the mass of the patient's body, more than 150 kilograms;
• during pregnancy.

When steatosis of the liver on computed tomography can be detected:

• reducing the X-ray liver density due to the accumulation of fats;
• sealing of the vessels of the liver compared to its cloth;
• focal clusters of fats.

Magnetic resonance imaging ( MRI)

Magnetic resonance tomography is also a non-invasive method. Its essence is as follows. When placing a human body into a strong electromagnetic field of hydrogen core in its tissues, they begin to radiate special energy. This energy is tracked by special sensors and is displayed on the computer monitor.

For the procedure, the patient must remove all the clothes, decorations, removable dentures and everything that contains metal. It is placed on the bed, which moves to the MRI apparatus. After the procedure, the monitor appears an image of the organ that the doctor can study in detail in all positions, cuts and at various angle.

Indications for magnetic resonance tomography are:

• the need for a more detailed visualization of liver structures;
• the presence of a cyst, neoplasms;
• great accuracy in visualization of tissues, compared with computed tomography, more suitable for studying bone structures.

Contraindications to magnetic resonance tomography are:

• mental diseases;
• inadequacy of the patient;
• the presence of a pacemaker ( the device in the heart helps to control the heartbeat);
• the presence of metal implants ( implants of teeth or bones);
• claustrophobia ( fear of closed, close spaces);
• the presence of tattoos containing iron in paint;
• patient weight more than 160 kilograms.

With fat intiltribution of MRI liver allows you to identify:

• liver seal;
• increase liver in size;
• cysts and neoplasms, determine their size and location;
• heterogeneity of the structure of the liver;
• focal or diffuse fat clusters.

Biopsy liver

Biopsy ( excision of the body of the body for its further study under the microscope) Liver is an invasive examination method, that is, with impaired integrity of the skin, organs, vessels. For the procedure, the patient is located on the diagnostic table. It is carried out with an ultrasound survey of the liver to determine the site from which the cloth will take. After determining the doctor the required area for biopsy begins the procedure itself. Skin section in the liver area is processed by antiseptic ( disinfecting). Must in the field of puncture is performed by leather pain relief. The doctor will explain how to breathe during the procedure. Then a special needle for biopsy under the control of the ultrasound is introduced into the liver region. ultrasonic research) And the small part of the body fabric is excised. Excised section ( bioptat.) Direct the laboratory to study under the microscope.

After a biopsy, the patient must be under the supervision of medical staff for four hours. It is strictly forbidden to get up. Cold compress is applied to the puncture area. For some time, a small discomfort will be felt in this place. After a day, the ultrasound is repeated ( ultrasound procedure) Liver, general and biochemical blood test.

Testimony to biopsy(excision of the area of \u200b\u200bthe body for its further study under the microscope) Liver are:

• Hepatocyte destruction ( hepatic cells) For an unknown reason revealed with biochemical blood test in patients over 45 years old.
• The need to determine the stage and the degree of liver hepatosis.
• Differential diagnosis ( exception of other diseases) Steatosis and other related liver diseases.
• The need for a detailed study of the cell structure.
• Suspicion of fibrosis ( reversible replacement of normal tissue organ on the ruled) or cirrhosis ( irreversible replacement of the tissue of the organ).
• Determination of severity of steatohypatosis, fibrosis, cirrhosis, when other methods are less informative.
• Carrying out surgical operations on obesity or removal of the gallbladder.
• Absolute contraindications to computed tomography and magnetic resonance tomography.

Contraindications to liver biopsy are:

• patient failure;
• the presence of purulent processes in the liver, intra-abdominal cavity;
• infectious skin lesions in the field of biopsy;
• mental diseases;
• increased tendency to bleeding;
• focal liver damage ( tumor);
• intense ascites ( cluster of a large amount of liquid in the abdominal cavity).

The liver biopsy will allow you to determine:

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

Elastography

Elastography ( elastosonography) - the non-invasive method of studying the liver, which is performed using a special apparatus - "Fibrickan". It allows you to estimate the degree of fibrosis ( reversible process of substitution of normal tissue organ on the ruled). It is an alternative to the invasive method - liver biopsy.

The principle of its action is similar to the principle of operation of ultrasound. The doctor presses the area of \u200b\u200bthe body under study by a special sensor and evaluates the elasticity of tissues in the image before and after compression. Modified areas of the fabric section are reduced differently ( due to unequal elasticity) and displayed on the screen in various colors. The elastic fabric is displayed in red and green, and more rigid - blue. Normally, the liver fabric is elastic, but with structural changes ( fibrosis, cirrhosis) Her elasticity decreases significantly, the tissue becomes more dense, tough. The less elastic fabric, the more expressed fibrosis. The procedure is safe and painless, therefore there is no contraindications. Not performed in pregnant and patients with ascites, due to uninformativity.

Indications for elastography liver are:

• diagnosis of liver fibrosis;
• establishing the stage of fibrosis.

Elastography allows you to identify:

• structural changes in liver in the form of fibrosis or cirrhosis;
• the severity of fibrosis ( F0, F1, F2, F3, F4 by special scaleMetavir.);
• the severity of steatosis ( minimum, low-rise, moderate, heavy).

Patients with fat hepatosis should periodically repeat diagnostic procedures. This will allow to evaluate the effectiveness of the prescribed treatment, therapeutic diet, physical activity. And also warns the progression of the disease with complication in the form of fibrosis ( reversible substitution of healthy fabric on the scarsing) and cirrhosis ( irreversible substitution of the tissue on the scarsing with damage to the structure and function of the organ).

Periodic medical control

Indicators	Periodicity
Control of weight reduction, treatment efficacy, diet and physical activity.	Twice a year.
Biochemical analysis ( Alt, Ast, Cholesterol) And overall blood test.	Twice a year.
Glycemia level ( sugar in blood).	Every day for patients with diabetes mellitus and every 6 months for the rest.
Ultrasound ( ultrasound procedure) Liver.	Twice a year.
Liver elastography ( Fibromban).	Once a year.
Liver biopsy.	Every 3 - 5 years, depending on the results.
Consultation of the hepatologist.	The first year is once every six months, then annually.
Consultation of a nutritionist, cardiologist, endocrinologist.	Every year, and in the presence of heart disease, the endocrine system is much more often.
Other methods.	According to the testimony of the doctor.

Treatment of hepatosis medicines

Specific treatment of fat hepatosis does not exist. Mostly, treatment is aimed at eliminating or reducing the negative impact of the reasons that contribute to the fat rebirth of the liver, as well as to strengthen the body as a whole, the protection and restoration of hepatic cells ( hepatocyto), maintaining diseases in a compensated state ( condition when the body adapts to the disease, which leads to the minimum negative impact of the pathological process). The dosage and duration of treatment are selected by the doctor individually for each patient, taking into account weight, concomitant diseases, stage and degree of its disease.

Treats of treatment and main drugs

Therapeutic strategy	Group of medicines	Name	Mechanism of therapeutic action
Protection of liver cells from the negative impact of many factors, as well as the restoration of the structure and function of hepatocytes (cells of the liver)	Hepatoprotectors (preparations protecting liver cells from damage)	Essential Phospholipids (phospholipids - components of the cell wall): liventian; essliver Forte; phosphoglie; cut pro; anthral.	Phospholipids are a structural element of cell walls. The reception of these drugs contributes to the restoration and preservation of hepatocytes, prevents the substitution of normal liver tissue on the cutting, that is, the appearance of fibrosis and cirrhosis.
		Preparations of natural (vegetable) Origin: allohol; carsil; lIV-52; hepaben; legalone; silimar; maksar.	Antioxidant ( protection of cells from the damaging action of the active forms of oxygen) Action. Have a choleretic effect, preventing the bile and high load on the liver. Stimulate the production of proteins, contributing to reparative processes ( cell functions correct and restore) hepatocytes.
		Preparations of ursodeoxycholic acid (the least aggressive, natural component of bile that does not have toxic effect on cells): uRSOFALK; urdoxa; ursodez; lodhodeksa.	Immunological liver functions. Strengthen the formation and removal of bile, preventing the formation of stones in the bustling bubble. Prevent the death of cells under the action of toxic bile acids. Delay the spread of fibrosis ( reversible process of replacing a healthy tissue on the Rubtsovaya). Reduce cholesterol levels ( the component of cell membranes, the excess of which leads to an increase in the risk of developing cardiovascular diseases).
		Derivatives of amino acids (amino acids - the main structural component of proteins): prokpar; heptor; hep-Merz; lecithin.	Contribute to improving local blood circulation in the liver. Restore damaged cell structures and liver sections. Delay the formation of a connecting ( rubatova) Fabrics in the liver. Accelerate the exchange of proteins for liver diseases with parenteral ( intravenous) Power. Reduce ammonia level ( toxic product metabolic product) in blood.
		Bad (biologically active additives): ovesol; hepagard asset.	Contain natural components. Contribute to the acceleration of decay ( decomposition of fats for simpler substances) Fats that protect liver from fatty infiltration ( clusters in the tissues of substances that are missing normally). Disposal toxins are removed, the spasms are eliminated, they have an anti-inflammatory effect.
Increased cell sensitivity to insulin (pancreatic hormone, contributing to the absorption of glucose)	Hyogolcemic (reduced blood sugar concentration) funds	metformin.	Normalizes, reduces body weight. Reduces the concentration of LDL ( lipoproteins of low density - "bad cholesterol", promoting the development of diseases of cardiovascular diseases) and fats in the blood. Increases tissue sensitivity to insulin, which contributes to the best absorption of glucose.
		syphorn.	Normalizes lipid exchange ( fat), reduces the concentration of general cholesterol and LDL ( lipoproteins of low density, "Poor cholesterol").
Reduced lipid levels (fat)	Hypolypidemic (reduced blood lipid concentration) funds	Statins: atorvastatin; rosavastatin.	Reduce cholesterol and lipoprotein concentrations ( complexes of proteins and fats) in blood. Enhance the capture and disintegration of LDL ( lipoproteins of low density - "Poor cholesterol").
		Fibrats: hemofibrate; cloofibrate.	Reduce the number of lipids ( fat) In the blood, LDL, cholesterol. At the same time, increases the content of HDL ( high density lipoproteins - "good cholesterol" impede the development of heart disease and vessels). They have serious side effects, so they are less likely to use.
Reducing body weight	Other hypolypidemic products	orlistat.	Suppresses the splitting and suction of fats from the gastrointestinal tract, which leads to a decrease in body weight.
		sibutramine.	Accelerates the offensive of the saturation sense and retains this feeling for a long time, which leads to a decrease in the frequency of food intake. Increases energy consumption.
Antioxidant action (protection of cells from destruction in oxidative processes, that is, with excessive exposure to cells of active forms of oxygen)	Antioxidants	Antioxidants include: mexidol; vitamins A, E, C.	Regeneration processes are stimulated ( recovery)) The processes of cell destruction are stopped, microcirculation is improved, the fragility of blood vessels is reduced, the level of cholesterol in the blood is normalized, the oxygen consumption is stimulated by cells, transport and glucose disposal is adjusted.
Antihypoxic effect (improving the utilization of oxygen by the body, increase the stability of tissues and organs to oxygen starvation)	Antihypoxants	Antihypoxic action possess: carnitine; trimetazidine; hypoxen; actovegin.

Diet with hepatosis

Fatic hepatosis differs from other liver diseases by a more favorable course. It is amenable to treatment with full liver recovery. Often, for recovery, it is enough just to reconsider your nutrition and lifestyle. Therefore, compliance with the diet can be the main treatment of the initial stages of steatohepatosis. With proper nutrition in the body, the metabolism is normalized, the amount of fats in the liver decreases, the operation of the gastrointestinal tract organs is improved.

Together with weight loss, the risk of developing diabetes is reduced, hypertonic ( high blood pressure) Diseases, cardiovascular diseases.

Dietherapy should be selected by a nutrient physician individually for each patient, taking into account age, weight, gender and related diseases. Incorrectly chosen power mode can only harm. In case of diseases of the liver and gallbladder, a specially designed diet should be observed - table No. 5 according to Pevznera and Diet No. 8 during obesity. The purpose of the diet is gentle nutrition for the liver.

When observing a diet it is important to remember that:

• Power must be balanced and contain the necessary daily protein rate ( 110 - 130 g), fats ( 80 g, 30% - vegetable) and carbohydrates ( 200 - 300 g).
• A sufficient amount of water should be used ( 1.5 - 2 liters excluding tea, compote, soups).
• It is necessary to limit the consumable amount of salt ( 6 - 8 g) and sugar ( 30 g).
• The number of food meals must be up to 6 - 7 times a day ( fractional food), dinner for 3 - 4 hours before sleep.
• Food should not be cold or hot.
• Completely excluded fried foods, and preference to give only boiled, steam, baked and stewed products.
• The products irritating the gastric mucous membrane and increasing bore - sour products, pickles, spices and others are excluded.
• Overbinding and take food in small portions.
• Alcohol consumption completely excluded.
• Green tea, coffee, cocoa, chicory, carcade are excluded.

It is mistaken to think that in steatosis should be completely excluded from the diet of fats. You should simply reduce the amount of fats used. Fats with proteins protect the liver from fat rebirth and contribute to the speedy recovery. With a lack of fats, the body receives them from carbohydrates, which does not most affect health. A naughty diet causes the same damage to the body as abuse of oily food. Fats are part of the cell structure, needed for assimilating fat-soluble vitamins ( A, d, k, e), participate in the development of some hormones, bile acids. The main sources of fats should be vegetable oils ( olive, sunflower) And more than half - food of animal origin.

Allowed and forbidden sources of fats for fatty hepatosis

Fat.
degreased cottage cheese, up to 500 ml of milk per day, kefir, prostrochy; non-fat beef, rabbit meat, turkey, chicken; cutlets for a couple; seafood ( oysters, mussels, squid); non-fat fish ( tuna, Sudak).	fatty dairy products; fat; bold grade meat ( duck, goose, pork, beef); caviar, sushi, fatty fish ( trout, Som.), salt and smoked fish; sub-products ( liver, Language); mayonnaise, ketchup, mustard; sausages; canned food.

With food there must be a sufficient number of proteins of plant and animal origin. Proteins play an important role in the normal functioning of the liver, so their deficiency will only strengthen the liver body infiltration.

Allowed and prohibited sources of proteins at fat hepatosis

Carbohydrates support the balance of metabolism, normal liver operation, and the fiber reduces cholesterol concentration ( structural leaf-like cell element) in blood. This leads to a decrease in the risk of diseases of the cardiovascular system, intestinal tumors and stomach. Carbohydrates are simple ( easy-friendly) and complex ( difficult digestible). Simple carbohydrates ( glucose, fructose) Contained in sweets, sugar, confectionery. They are instantly cleaned, hunger will rollet bluntly and contribute to the laying of fat about the supply. Complex carbohydrates ( fiber, starch) Digested by the body for a long time, for a long time to dull the feeling of hunger. They remove harmful substances, purify the intestines, contribute to the proper operation of the digestive organs.

Allowed and prohibited sources of carbohydrates with fatty hepatosis

Carbohydrates

The permitted products include: vegetables in boiled and baked form; raw vegetables in limited quantities; dried fruits; wipe compotes; prunes; nuts; porridge ( oatmeal, buckwheat, pearl, muesli); rye bread, crackers, loaf, bran; honey, marmalade, grazing, lollipops; weak black tea, roshinka decoction.

Forbidden products include: bakery products; ice cream; sugar ( more than 30 g per day); roasted and sweet drinks ( Sprite, Coca Cola, Fruit Juices); manka; products from the flour of the highest grade; pasta; bean products ( warm, lentils); adzhik, hell; pickles; chocolate, confectionery with cream, condensed milk, waffles; berries and fruits – Apples, raspberries, grapes, cranberries, cherry and others; vegetables – radishes, eggplants, garlic, onions, corn and others; freshly squeezed juices.

The approximate menu on the day must comply with the requirements of the diet and include:

• First breakfast- Oatmeal on water with milk, low fat curd, black tea.
• Lunch- dried fruits, apple, prunes.
• Dinner- vegetable soup with vegetable oils ( corn, olivkov), buckwheat porridge, compote.
• Afternoon person- Bread, unsweetened cookies, decoction of rosehip.
• Dinner- Potato mashed potatoes with fish cooked for a pair, beet salad, low-fat kefir.

Observe the diet not only a certain period before recovery. This should become a lifestyle and stick it to you constantly. To achieve a better result and maintaining a diet must be combined with sports. Heavy physical exertion is not recommended. Best of all go swimming, yoga, pilates, cycling.

Does hepatosis are treated with people?

Folk remedies help in the treatment of fat hepatosis no worse than expensive medicines. The positive effect can be expected only at the initial stages of the disease. In this period, not to drug treatment is discharged, but compliance with a properly chosen diet, which can be combined with decoction, teas on herbs, tinctures. But you need to remember that it is even more dangerous for health to engage in self-diagnosis and self-treatment than the complete absence of treatment. The appearance of symptoms of the liver disease indicates the progression of the disease with damage to the structure of the liver and its function. And folk remedies will only lead to the exacerbation of the situation and the impossibility of further recovery. Therefore, before applying any means you need to consult with your doctor.

The purpose of folk treatments is to improve the liver, restoration of hepatic cells ( hepatocyto), removal of slags, reducing the number of fats in the body, weight loss. Many medicines are based on medicinal herbs. Therefore, these natural tools can be effective treatment. Herbs can be used separately either in herbal fees with complex therapeutic effect on the liver.

For the treatment of steatohepatosis apply :

• Bran. Help to remove excess fat from the body. Bran should be insisted in hot boiled water until it is completely cooling. After the water has cooled, you should remove bran and eat two tablespoons. You can also add them to porridge and soups. It should be used up to three times a day.
• Seeds of millet. Miller is part of many hepatoprotectors ( hepaben, Silimar). Has an antioxidant action ( protects the liver from the negative effect of oxidative processes, that is, damage to hepatocytes by an excessive amount of active forms of oxygen). Enhances immunity, which helps the body to cope with many negative factors. For the preparation of tincture, the separation seeds are poured boiling water ( 200 ml) for an hour. After that, they focus and take 1/3 glasses 3 times a day for half an hour before meals.
• Flowers of immortals. The immortal has a choleretic effect, normalizes metabolism ( metabolism) Liver. Flowers of immortelle pour 200 ml of water temperature and heat half an hour on a water bath. After that, it was insisted for 10 minutes and add warm boiled water to the original volume. Take 1 - 2 tablespoons 3 - 4 times a day 10 minutes before meals.
• Dog-rose fruit. Help to remove toxins from the body, enrich it with trace elements and vitamins. About 50 g of rosehip fruits insist 500 ml of boiling water for 12 hours. Take three times a day at 150 ml.
• St. John's wortStrengthens the walls of the vessels, has an antibacterial effect. Table spoon of dried grass pour 300 ml boiling water, heated on a water bath for 5 minutes. The resulting composition to strain and add boiled water to the initial volume.
• Mint leaves. Mint leaves have a choleretic effect, suitable for the prevention of liver diseases. One tablespoon of dried leaves pour 200 ml of boiling water. Interest 20 minutes and take in the morning and evening before meals.
• Calendula flowers.Possess anti-inflammatory, disinfectant, choleretic action. Contribute to the acceleration of metabolic processes in the liver. One tablespoon of calendula pour 200 ml of boiling water and insist for 20 minutes. Take 100 ml 3 times a day.
• Flowers chamomile.It has a disinfecting, healing effect. Chamomile flowers must be inspected 20 minutes, then strain and take 30 minutes before meals 2 - 3 times a day.
• Turmeric. Spice that contributes to the restoration of damaged liver cells. Can be added in small quantities ( 1 - 2 chopping) When cooking.
• Pine nuts.Strengthen hepatocytes ( liver cells), warning their destruction.

What is dangerous liver steatosis ( complications, consequences)?

Steatosis ( accumulation of fat droplets in liver cells with their destruction) It is dangerous progressing in fibrosis and cirrhosis of the liver. Steatosis is a completely reversible process. To do this, you need to change the power and lead a healthy lifestyle. But with prolonged negative impact on the liver of many factors and the absence of treatment, the disease passes into more severe stages of the flow. The speed of progression is different in each of the patients. For fatty dystrophy with accompanying diabetes mellitus, obesity, alcohol intake, viral hepatitis, the process is significantly accelerated and passes into fibrosis.

Fibrosis - reversible growth of dense connective tissue ( rubatova) In the liver when damaged hepatic cells - hepatocytes. In this way, the inflammatory process is limited to prevent its further distribution. Currently, it is proved that fibrosis is amenable to treatment. But despite this, fibrosis often goes into cirrhosis of the liver.

Cirrhosis is a progressive irreversible disease in which the liver fabric is replaced by Rubtsovaya. At the same time, the number of functioning cells is significantly reduced. At the initial stages of the development of cirrhosis, you can suspend and even partially restore damaged structures, but with a severe course, the disease leads to a fatal outcome ( patient's death). The only treatment is liver transplant.

Can pregnancy provoke fatty hepatosis?

Periodically, the pregnancy is complicated by such a pathological condition as a well-fat hepatosis of the liver ( cholestatic hepatosis of pregnant women). Hepatosis is manifested at the beginning of the third trimester ( from 25 - 26 weeks of pregnancy). Diagnosed in 0.1% - 2% of pregnant women. There is no unambiguous answer about the reason for the occurrence of hepatosis during pregnancy. However, most doctors converge in the opinion that the starting mechanism is the high level of sex hormones - pregnancy hormones, which causes the manifestation of genetic defects in the processes of borter and berevel. Therefore, pathology often acquires family character and is inherited by the maternal line. Other reasons, in addition to genetic predisposition, there may be an uncontrolled intake of vitamin preparations with which the liver cannot cope with full, unbalanced nutrition with an excessive amount of fats and carbohydrates, which leads to fat rebirth of the liver and the development of acute fatty hepatosis. Only a doctor on the basis of a laboratory and instrumental examinations conducted can be put in the correct diagnosis.

The symptoms of the manifestation of fat hepatosis of pregnant women are:

• skin common itching;
• jaundice staining of mucous membranes and skin;
• nausea, heartburn, periodic vomiting, loss of appetite;
• feeling of gravity and moderate pain in the upper half of the belly on the right;
• discoloration feces;
• general weakness, malaise, fast fatigue.

Cholestatic hepatosis of pregnant women can be dangerous for mother and fetus, as the risk of oxygen starvation increases ( hypoxia) Child and premature birth. A fair partition is carried out ( ) At 38 week or even earlier, taking into account the severity of the state of the woman. Patigue hepatosis of pregnant women can lead to strong postpartum bleeding, since the liver of the blood coagulation factors is disturbed, which leads to an infallible work of the hemostasis system ( complex biosystem that ensures blood maintenance in a liquid state under normal conditions, and with a violation of the integrity of the blood vessel, which contributes to stopping bleeding).

Can children hurt hepatosis?

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

Hereditary hepatosis - liver damage against the background of genetically determined metabolic disorders, manifested by violation of intrahepatic bilirubin exchange ( the main component of bile). Manifests itself from birth in the form of a chronic or periodically emerging jaundice ( the jaggility of the skin and mucous membranes). These hepatosis are usually benign, almost without affecting the quality of life of the patient, with the exception of Kriegler-Saular's syndrome, accompanied by a high level of bilirubin in blood with toxic damage to the central nervous system, heart and internal organs.

Secondary hepatosis develops against the background of concomitant diseases and the wrong lifestyle. Type I diabetes mellitus ( appears in childhood), obesity, congenital hepatitis, toxic effect of drugs, cholestatic disorders ( stast bile), irrational nutrition - the main causes of liver disease in children.

Is it possible to cure fatter hepatosis?

Fat hepatosis is a reversible liver disease. This pathology successfully treats in the early stages. There is no certain treatment. Everything comes down to changing the lifestyle, the revision of the nutrition, the exception of etiological ( causes) Factors. In many cases, it is not possible to eliminate the reasons that contribute to the development of hepatosis. For example, incurable diabetes mellitus, congenital metabolic disorders, many endocrinological diseases. In this case, hepatoprotectors supporting therapy ( drugs that contribute to the protection and restoration of liver cells), hypolipidemic means ( reduced blood fats concentration), antihypoxantic ( improving oxygen utilization by the body that increase the stability of tissues and organs to oxygen starvation) and antioxidant ( protecting cells from destruction with excessive exposure to active forms of oxygen) Preparations and others. And also support concomitant diseases in the compensation stage, that is, adapting the body to a pathological condition with a decrease in negative consequences.

Basically, fatty hepatosis proceeds asymptomatic. It is diagnosed by accidentally on preventive inspections or diagnostic procedures about other diseases. Therefore, to identify hepatosis in the early stages is rare. Over time, the situation is only aggravated and complicated by fibrosis ( reversible replacement of normal tissue organ on scar cloth) or cirrhosis ( irreversible chronic replacement of fabric on the scarsing). In this case, cure the liver is very difficult or impossible.

What is the difference between hepatosis from liver steatosis?

Steatosis is a kind of hepatosis. Hepatosis is a combination of liver diseases, which are based on a violation of exchange processes in violation of the structure and function of hepatic cells ( hepatocyto). Steatosis is a pathological ( abnormal) The accumulation of fat in the cells of the body when impaired metabolism. Distinguish pigment hepatosis ( violation of the exchange of pigments - substances, painting skin and fabric) and adhesive hepatosis ( synonyms - liver steatosis, liver fatty, liver fatty infiltration, steatohepatosis, fatty dystrophy, "fatty" liver).

The development of fat hepatosis ( steaatoma) Patients with type 2 diabetes are more susceptible to ( disease frequency from 70% to 90% of patients), with obesity ( from 30% to 95% of patients), with violation of fats ( from 20% to 92% of cases).

To diagnose steatosis, laboratory and instrumental methods use. Laboratory methods include a general and biochemical blood test. In steatosis in blood tests, an increase in transaminase activity is detected ( enzymes in hepatic cells accelerating the flow of chemical reactions) at 4 - 5 times, increasing cholesterol concentration ( zeper-like structural cell element), lipoproteins ( complexes of proteins and fats) low density, increasing blood sugar, bilirubin ( gallged pigment), Reducing the concentration of proteins and others. To instrumental analyzes include ultrasound research ( Ultrasound), Magnetic resonance imaging ( MRI), CT scan ( Kt.), Elastography ( Fibromban) and liver biopsy. With these surveys, there is an increase in liver in size ( hepatomegaly), local or diffuse fat clusters in liver cells, cysts ( pathological cavities in tissues), fibrosis ( reversible replacement process of healthy liver tissue on scar cloth).

Violation of metabolic processes affects not only liver. Therefore, steatosis is characteristic not only for the liver ( as in the case of hepatosis), but also for the pancreas. The reasons for the pancreatic steatosis are the same factors as for the liver - it is an excessive taking alcohol, obesity, diabetes, receiving some medicines and many others. Therefore, when making the diagnosis of "Steatosis", it is necessary to clarify the pathology of which organ.

Is it possible to make a cubage at fat hepatosis?

Fat hepatosis is not a contraindication for the tubing. Tuba ( from French - installation of tube, intubation) - This is the medical manipulation of the purification of the gallbladder ( the digestion organ located under the biscuit and bile duct connected with it).

The essence of the method is irritation of the gallbladder with choleretic ( preparations or substances stimulating the production of bile) Means with subsequent reinforced bile removal. This procedure is carried out in order to prevent bile stagnation ( cholestasis) and the formation of stones in the bustling bubble. It is used for diseases of the liver, gallbladder and bile ducts with phenomena phenomena and disorders of bile selection. The absolute contraindication to the exercise is calculous cholecystitis ( inflammation of the gallbladder due to the presence of stones). This can lead to a gallbladder from the gallbladder in the bubble duct, as a result of which the lumen of the duct is cleaned. Associate in this case can only urgent surgical interference.

It is possible to carry out the tube with a duodenal probe or by taking choleretic tools with simultaneous heating of the liver. In the first case, a probe is introduced into the duodenum ( hollow tube) and parenterally ( intravenously) Or through the tube introduces choleretic substances. This leads to the reinforced conclusion of bile in the duodenum, from where it is aspirated ( sucking with a special device called aspirator) Through the probe. Inside taking such gilent substances as a solution of magnesium sulfate, sodium solution chloride, 40% solution of glucose, intravenous histamine, atropine and others.

The second method is a free-reason tube ( blind Tuba). To carry out this procedure, the patient falls on the right side, bent the legs in the knees, and drinks the groil tower. Under the right side at the level of the liver is underlying the warm heater. A decoction of rosehip is used as cholesterol, a solution of magnesium sulfate, adjustable mineral water and others. In this position, the patient is about 1.5 - 2 hours. The procedure should be carried out once a week for 2 - 3 months.

What doctor treats steatosis of the liver?

A hepatologist is engaged in the diagnosis, prevention and treatment of liver disease. But since the cause of liver steatosis can be various diseases, pathological processes and improper lifestyles, the treatment and diagnosis of the disease should be made comprehensively. And the hepatologist can appoint advice with other specialization doctors.

The hepatologist can assign advice with such doctors as:

• Gastroenterologist.This is a doctor who is engaged in the treatment of the gastrointestinal tract ( Zhkt.). Chronic diseases of the gastrointestinal tract, as well as surgical interventions on the gastrointestinal organs and long-term parenteral ( intravenous) Power lead to an incorrect processing and suction process of nutrients. This leads to a violation of metabolic processes and a liver disease with excessive accumulation in it fat inclusions.
• Endocrinologist.A doctor specializing in diseases of the internal secretion glands ( thyroid gland, pancreas). Endocrine diseases ( sugar diabetes, diseases of the thyroid gland, metabolic syndrome - a set of exchange, hormonal and clinical disorders) lead to obesity, violate the functions of many organs. All these factors are the cause of steatosis. Therefore, the treatment of this pathology without elimination or compensation for the initial reason has no effect.
• Nutritionist.A nutritionist will help the patient to adjust the power and lifestyle. Since it is incorrect meals more often leads to obesity with all the ensuing consequences ( cardiovascular Diseases, Endocrinological Diseases). It will also determine the lack of either excess of vitamins, minerals, proteins, fats and carbohydrates coming with food, and selects the diet individually for each patient.
• Obstetrician gynecologist.Pregnancy may be complicated by the staitosis of the liver. This disease can adversely affect the fruit and mother, even lead to a death. In severe cases, they come to artificial completion of pregnancy. Therefore, the hepatologist and obstetrician-gynecologist choose supporting drug treatment or conduct a delivery ( artificial completion of pregnancy) With severe disease. Receiving contraceptives ( contraceptive drugs) Changes the hormonal background of women, which is also the cause of steatosis. In this situation, the gynecologist should pick up another method of contraception that does not have a negative impact on the liver.
• Cardiologist.Heart and liver diseases are closely interrelated. Violation of the liver function can be caused by heart failure, chronic oxygen starvation, circulatory disruption. But also liver diseases can lead to aggravation of existing heart pathologies. Often it is accompanied by endocrine diseases.
• Expert in narcology.A narcologist is in the treatment of alcohol dependence, which is the cause of a separate group of steatosis - alcohol steatohypatosis. With liver diseases, alcohol use is absolutely contraindicated, because it can lead to cirrhosis of the liver ( irreversible replacement of normal liver tissue on scar cloth) And subsequently to the death of the patient.

Life expectancy at greed hepatosis

Unambiguously answer the question of life expectancy at fat hepatosis is impossible. It is all strictly individually and depends on the age, the stage of the pathological process, concomitant diseases, complications, the effectiveness of the treatment and desire of the patient to change their lifestyle. Significant influence on the life expectancy of steatosis does not. Moreover, this disease is easy to treat in the initial stages. The forecast varies significantly when moving to fibrosis ( reversible process of string of scar tissue) and cirrhosis ( irreversible process of string of scar tissue). This negatively affects the structure and functions of the liver. With a strongly launched current, the absence of proper treatment and the presence of provoking factors, the disease rapidly progresses and the lifespan is significantly reduced.

Fibrosis proceeds more favorably than cirrhosis. Distinguish five stages of fibrosis. Progression can occur at different speeds. For example, from stage 0 to stage 2 may pass for several years, and step 3 go to 4 in a rather short period of time. The progression of fibrosis is significantly influenced by diabetes, obesity, violation of lipid metabolism, age ( progression is significantly accelerated after 50 years) other. When observing a diet, healthy lifestyle and proper treatment of fibrosis can be cured.

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

Hirudotherapy helps ( treatment of leeches) When hepatosis?

Hirudotherapy ( treatment of leeches) It can help in the complex treatment of hepatosis. This procedure is used for inflammatory liver processes ( for example, chronic hepatitis, toxic hepatitis), cirrhrodes ( irreversible replacement of normal tissue organ neither scar tissue).

Contraindications for hirudotherapy are:

• pregnancy;
• hypotension ( low blood pressure);
• anemia ( malokroviya manifested by the low concentration of red blood cells and hemoglobin);
• hemophilia ( congenital blood clotting);
• individual intolerance.

Hirudotherapy technique is very simple. Before conducting therapy, the area of \u200b\u200bprocedure is processed with alcohol. Then leeches are placed on the skin into the zone of biologically active points. Their bite is practically not felt, as they distinguish special painkillers. After about 30 - 45 minutes, the saturated leeches themselves disappear. A sterile bandage is superimposed on the wounds. The course of treatment is 12 sessions with a frequency of 1 - 2 times a week.

Massage gymnastics, yoga contribute to improving the liver work. All exercises performed standing on all fours or lying on the right side, minimally load the liver and contribute to the outflow of bile. Among the exercises for the liver can be allocated "scissors" ( in the position lying on the back Mahi are performed by legs in the style of scissors), "bicycle" ( in the position lying on the back imitates cycling), squats, swelling. A favorable liver effect also has respiratory gymnastics.

To achieve the therapeutic effect of physical exertion, the power supply mode should be observed, a diet, not neglected with a full-fledged rest, as well as completely abandon smoking and taking alcohol.