Contents
What is hepatic steatosis?
Liver steatosis is a disease of the liver, which is characterized by a metabolic disorder in the cells of this organ, resulting in their fatty degeneration. In this regard, the disease is also called fatty hepatosis.
In general, the causes of liver problems vary, but the most common are:
Alcohol abuse;
drug use;
drug and other intoxication;
unbalanced diet or starvation;
diabetes;
gastrointestinal disorders;
myxedema;
an excess of adrenal hormones in the blood (Cushing’s syndrome).
In liver cells, an excess of fatty inclusions is formed due to various processes.
Thus, a large amount of fatty acids are formed in the intestines, then they enter the liver. But at the same time, in hepatocytes (the so-called liver cells), there are violations of the oxidative processes of fats, which causes difficulties in terms of removing fatty inclusions from the liver.
As a result, fats accumulate in the liver cells, causing fatty infiltration.. In addition, problems with cholesterol metabolism begin in the liver, as the functions of certain enzymes change.
Types of steatosis:
Diffuse hepatic steatosis
If fat inclusions are 10% or more of the volume of the liver, then steatosis can be diagnosed. Most of the fat accumulates in the second and third hepatic lobes, and in a more severe form of the disease, they are diffusely distributed.
Thus, the main characteristic of steatosis is that it can be either diffuse or focal. If focal steatosis is manifested in the fact that fats are grouped together, organizing a continuous fatty spot, then diffuse steatosis involves the location of fatty inclusions on the entire surface of the organ.
Fatty steatosis of the liver
As a result of progressive fatty infiltration, the liver not only increases, but also changes color to yellowish or red-brown. Liver cells store fats as triglycerides. The result of such pathological storage is that the fat drop of fat moves the cell organelles in the hepatocyte to the periphery.
As a result of a sharp fatty infiltration, liver cells can die. Drops of fat are combined into fatty cysts, and connective tissue continues to grow around the latter.
Fatty liver disease is often asymptomatic. In many cases, the disease is detected by chance – during an ultrasound of the patient.
Sometimes with liver steatosis, heaviness appears in the right side, which increases during movement. Patients may complain of nausea, weakness, fatigue.
In general, fatty hepatosis proceeds stably, progressing very rarely. With a combination of fatty infiltration with inflammation (steatohepatitis), a third of patients may develop fibrosis, and 10% – cirrhosis.
Alcoholic liver steatosis
The primary phase of changes in the structure of the liver, which are caused by the chronic process of alcohol intoxication, is called alcoholic steatosis and is also called fatty degeneration of the liver.
There are many causes of this disease. For example, toxic effects on the body. The most common reason is the use of alcoholic beverages. And the higher the dose of alcohol consumption, the higher the rate and level of development of destructive changes in the liver cells.
The manifestations of this type of steatosis are mostly reversible. They are reduced after 4 weeks of withdrawal. However, alcoholic steatosis can progress to very serious liver damage. Clinical studies suggest that the severity of steatosis correlates with the risk of developing chronic liver disease.
The main forms of steatosis:
macrovesicular (one large fat vacuole contained in a hepatocyte);
microvesicular.
In the liver, mixed micro- and macroforms are also often found, and therefore it can be assumed that they represent certain stages in the development of the disease. Thus, the microvesicular form is an acute manifestation of steatosis, and the macrovesicular form is a chronic one.
Steatosis mainly develops in connection with the violation of lipid metabolism in hepatocytes, which is caused by changes in the hepatocellular redox potential. But during chronic intoxication (alcohol), normal indicators of redox potential return, regardless of the development of steatosis, which means that other factors are also involved in alcohol liver damage.
Non-alcoholic hepatic steatosis
In turn, non-alcoholic steatosis has many names (infiltration or fatty degeneration, non-alcoholic fatty disease). All these are the names of the initial stage of liver disease or a syndrome that is formed due to an excess of fatty inclusions (mainly triglycerides) in this organ.
It should be noted that with non-intervention during the course of the disease, in the future, in 14% of patients, it tends to develop into steatohepatitis, in 10% – into the development of fibrosis, and sometimes into cirrhosis of the liver.
Such statistics today make it clear why such a problem is of public interest. After all, if you clarify the etiology and pathogenesis of the disease, it will become clear how you can effectively fight and get rid of this fairly common pathology. It should be taken into account that some patients may have a disease, and some – only a symptom.
The main risk factors for the occurrence of non-alcoholic steatosis are:
overweight;
diabetes mellitus type 2;
presence of ileocecal anastomosis;
a sharp decrease in body weight (about 1,5 kg in a few days);
parenteral nutrition;
an increased number of bacteria in the intestines;
most medications (antiarrhythmic drugs, corticosteroids, anticancer drugs, etc.)
As mentioned above, unfortunately, with the help of a laboratory study, it is almost impossible to identify fatty infiltration. As a rule, the indicators of bilirubin, prothrombin and albumin are normal, while there is a slightly increased activity of serum transaminases.
In addition, the echogenicity of liver tissues, even with ultrasound diagnostics, may turn out to be without any special deviations, or slightly higher than normal, which does not contribute to making a reliable and correct diagnosis. Therefore, in some situations, the detection of the disease is possible only thanks to magnetic resonance imaging.
However, even at the same time, the final diagnosis should be based on a histological examination of the liver tissue taken during a biopsy.
Focal hepatic steatosis
As a rule, there are no laboratory studies of deviations in the framework of a general clinical blood test. Sometimes it is possible to determine a slight excess of the activity of cholestasis and cytolysis enzymes.
Diagnosis of benign liver tumors is carried out in the course of instrumental studies. Scintigraphy in this case does not provide the necessary information, since it can be used to detect focal lesions in the liver that have a diameter of only more than 4 cm. Thus, it would be more appropriate to refer the patient to ultrasound after a physical examination.
The formation of a benign tumor is evidenced by focal hyperechoic formations with even and clear outlines with different diameters in the liver parenchyma. The number of such formations can vary from 1 to 45, and not only in one, but in two shares.
Diet for liver steatosis
One of the 15 main therapeutic diets (sometimes they can also be called tables) is diet number 5, prescribed for liver diseases, as well as problems with the gallbladder and penitent biliary tract. Its goal is to provide a complete diet for the patient, which helps to stabilize the functions of the liver, improve bile secretion, given the sparing regimen directly for the liver itself.
Products allowed and recommended for use:
Bakery products: pastry products (you can use boiled meat filling), rye bread, croutons or cookies.
Soups: milk soup with pasta, vegetable broth soup, cereal soup, vegetarian borscht, beetroot soup.
Poultry and meat: beef, turkey, chicken, pilaf with boiled meat, rabbit, lean lamb.
Low-fat fish: best boiled, fish meatballs, you can diversify by baking fish after boiling.
Fats as vegetable refined and butter.
Dairy products: low-fat and semi-fat cottage cheese, puddings, kefir, not very fatty (and not too spicy) cheese, low-fat milk, sour cream, lazy dumplings.
Eggs: protein omelette, soft-boiled, but no more than one yolk per day.
Cereals – oatmeal and buckwheat, all kinds of cereals, pilaf with carrots, pasta will be especially useful.
Vegetables: various vegetable dishes prepared from boiled, stewed or raw foods. You can use them not only as side dishes, but also in the form of salads and independent dishes. Sauerkraut is allowed (not very sour!), green peas in pureed form, onions, but not raw, but only in boiled form.
Snacks: fruit salads, low-fat herring (soaked), vinaigrettes, seafood and boiled meat salads, squash caviar, milk sausage, a variety of vegetable salads.
Fruits and berries, compotes, dried fruits, jam, honey, sugar.
Drinks: black, green tea, juices, coffee with milk, various decoctions (for example, from wheat bran or rose hips).
Thus, you can create suitable diet options for yourself and paint them by day.
Day one
For breakfast: fruit salad, steamed beef cutlets, coffee.
For an afternoon snack: a glass of ryazhenka.
For lunch: vegetarian borscht, baked hake with stewed cabbage, berry jelly.
For dinner: spaghetti with butter and cheese, mineral water.
Before bedtime: banana.
Day two
For breakfast: steamed protein omelette, rye toast with berry jam, fruit juice.
For an afternoon snack: pear.
For lunch: vegetable cream soup, stewed carrots with boiled chicken, raisin and dried apricots.
For dinner: mashed potatoes with baked vegetables, tea. Before going to bed: Borjomi.
Day three
For breakfast: penne with stewed rabbit meat, tea.
For an afternoon snack: juice from fruits and berries.
For lunch: potato soup, carrot cheesecakes, jelly.
For dinner: baked omelet, cheese, tea.
Before bedtime: a glass of ryazhenka.
Day four
For breakfast: pilaf, cottage cheese casserole with sour cream.
For an afternoon snack: carrot and apple salad.
For lunch: chicken meatballs with buckwheat, fruit compote.
For dinner: potato and cabbage zrazy, baked corop, mineral water.
Before bedtime: baked apple.
The above diet is followed along with medication and physiotherapy. It is not worth starting it on your own, it is necessary to get the advice of your doctor without fail.
Such a nutrition system is able to quickly achieve remission of the disease, relieve exacerbations, and normalize the imbalance of the digestive organs. In addition, the diet has another positive side – thanks to it, weight is significantly reduced, overall health improves, and an energy boost is observed.
For patients who are concerned about diseases of the bile and liver, it is extremely important to refrain from eating forbidden foods, not only for the period of the diet itself, but also after it ends. First of all, this applies to smoked meats, spicy and fat-rich dishes, and alcohol. Otherwise, the effect will be minimized and the course of treatment may have to be repeated.