fatty liver

Fatty liver: description

In fatty liver (steatosis hepatis), liver cells store more fat (especially triglycerides). The fat content of the liver is usually less than five percent of the liver cells. Depending on the degree of fatty degeneration different degrees of fat liver are differentiated. To determine the exact extent of Leberzellenverfettung a histological examination (histopathological) of a tissue sample from the liver is necessary (liver biopsy).

The following severity levels are distinguished:
•    Moderate fatty liver: Less than a third of liver cells are overly greasy
•    Moderate fatty liver: Less than two thirds of liver cells but more than a third are overly greasy.
•    Heavy fatty liver: More than two thirds of liver cells are overly greasy.

A fatty liver itself is not dangerous at first. By using a suitable fatty liver diet you can break down the fatty liver. If the fatty liver remains unrecognized and untreated for a long time, the liver structure changes. It can cause inflammation (hepatitis). In addition, between the liver cells increased connective tissue can be formed and the tissue scar (cirrhosis). If that’s the case, no fatty liver therapy will help anymore.

A fatty liver (steatosis hepatis) is a very common liver disease in Germany. About 20 percent of people are affected. Most fall ill between the 40th and 60th year of life. Nevertheless, fatty liver can develop even in children and adolescents.

The disease is subdivided into fatty alcoholic causes into an alcoholic and a non-alcoholic form. Alcohol is, as the name suggests, the trigger of the alcoholic fatty liver (ASH). The non-alcoholic fatty liver disease (NAFLD) is also referred to as “prosperity disease”. Women are slightly more affected than men. Almost all patients are overweight. About every second with fatty liver is also diabetic or has elevated blood lipid levels. In addition, fatty liver is often the concomitant of the metabolic syndrome.

Fatty liver: symptoms

Everything important to the typical signs of the fatty liver read in the contribution fatty liver symptoms.

Fatty liver: causes and risk factors

Even if you can answer the question “What is a fatty liver” relatively well, so far is not fully understood how it arises. It is clear that there is a mismatch between calorie intake and calorie consumption. As a result, there are too many neural fats in the liver cells. These fats are produced by the liver itself, namely from fatty acids, which are transported from the food via the blood to the liver. A certain proportion of the fatty acids are immediately burned and made available to the body as energy. If more stored than burned, it comes to fatty liver. There are various explanations for why this imbalance occurs. On the one hand, certain transport proteins in the liver could transport too much fat into the organ. In the case of vitamin B deficiency, for example, the fat in the liver is not properly processed, it accumulates.

Fatty liver: alcohol as a cause

There is a clear link between alcohol consumption and fatty liver. Alcohol is very energetic and is broken down in the liver. These include fatty acids that are stored in the liver. Drinking people steadily alcohol, this can lead to fatty liver. For women, the critical limit is 20 grams of alcohol (equivalent to 0.5 liters of beer) per day, for men 40 grams. However, these are only approximate guidelines. In addition, it is crucial whether other metabolic diseases such as diabetes or obesity (obesity) are present in addition to alcohol and how long the alcohol consumption already exists.

In addition, the liver is often damaged by the toxic effects of the alcohol and its degradation products. These substances can cause liver remodeling and liver cirrhosis. In addition, the liver is easily inflamed with steady consumption of alcohol. Even a single alcohol excess can trigger an acute liver failure.

Even so, not all people who drink alcohol develop a fatty liver. This is due to individual sensitivity, gender, but also to the individual equipment with enzymes that break down the alcohol.

Non-alcoholic fatty liver has many causes

Many people with fatty liver are often confronted with the prejudice of drinking too much alcohol. In fact, while alcohol may play a role in some cases, non-alcoholic fatty liver is significantly more common overall. It can also occur in people who do not drink alcohol at all.

Fatty liver: diet and diabetes as a cause

Fatty liver patients usually have too many fats in their blood. These fats come from the diet and are absorbed into the blood via the intestine. Fatty liver diseases are greatly promoted by too fatty foods. The right fatty liver diet should therefore be healthy and balanced. This also improves the intestinal flora. If this is disturbed that is also considered as a possible trigger of a fatty liver.

Diabetes (diabetes) can also cause fatty liver disease. In diabetic people, the hormone insulin no longer works properly or is insufficiently formed. This has consequences for the fat metabolism: In insulin resistance, more fats are released in the body, as a result, the liver cells take up more free fats. These factors make diabetic people more likely to develop fatty liver disease. When the body has developed some resistance to insulin, more iron is also deposited in the liver. This creates harmful substances (oxide radicals), which cause an inflammatory reaction faster. Diabetic people therefore have a higher risk of liver inflammation.

Fatty liver: rare causes

However, fatty foods or alcohol are not always responsible for the fatty liver. Longer periods of starvation, pronounced weight loss, long-term sugar infusions (for example, in pancreas defects) or an artificial diet can also trigger a fatty liver.

Certain medications can also cause the liver to become fat, such as tamoxifen, synthetic estrogens or steroids. In addition, there are operations on the small intestine, liver and pancreas, which leads to increased fat deposits in the liver. Furthermore, inflammatory bowel disease or inflammation in the colon are rare but possible causes of this disease.

In very rare cases (about one in every one million pregnancies) there is an acute pregnancy fatty liver. It comes in the late pregnancy, usually after the 30th week of pregnancy to a sudden fatty liver. The disease is very threatening and can lead to death in 30 to 70 percent of cases. How the acute pregnancy fatty liver develops is unclear. Maybe a genetic enzyme defect is responsible for it.

Fatty liver: examinations and diagnosis

Anyone who has the suspicion of suffering from a fatty liver, should contact his family doctor or an internist. In order to diagnose a fatty liver, the doctor first asks about complaints and existing medical conditions (history). He could ask the following questions:

• Do you drink alcohol and if so, how much?
• What is your nutrition like?
• What medications do you take?
• Do you increasingly suffer from bloating or push it in the upper abdomen?
• Is your diabetes known?
• What’s your weight?

As part of a physical examination can often palpate an enlarged liver (hepatomegaly). Lack of other symptoms, this is a clear indication of a fatty liver. However, liver enlargement can also have many other causes and is not specific to fatty liver. To make the diagnosis of fatty liver, further investigations are necessary.

Further investigations

To consolidate the diagnosis, a number of studies are possible. For one, a blood analysis is helpful. For this blood is taken, and the liver values ​​gamma-GT, GPT and GOT determined. Ferritin, egg albumin and blood clotting can also provide clues. On the other hand, an ultrasound examination of the upper abdomen reveals a fatty liver.

However, the most important study to detect a fatty liver is an ultrasound (sonography) of the upper abdomen. In the case of a fatty liver, the liver of the liver is typically much brighter in the image, because fatty liver tissue is denser and thus reflects the sound more strongly.

In order to determine the exact extent of the fatty liver and if necessary even to obtain information about the cause, a so-called liver biopsy must be made. The doctor takes under local anesthesia with a thin hollow needle a small tissue sample from the liver. The tissue sample is then examined histologically under the microscope.

Fatty liver: looking for the cause

If the diagnosis is fatty liver, it is important to find out the causes. This sometimes requires further examinations such as the determination of blood sugar. Also, it is important for the doctor to get truthful information about alcohol consumption to determine the cause of fatty liver. Suspected liver cirrhosis often requires additional laparoscopy.

Fatty liver: treatment

What to do with fatty liver? A specific drug fatty liver therapy does not exist. Rather, it is about eliminating the causative causes. A targeted lifestyle change can break down a fatty liver. This means those affected reduce excess weight (but not too fast, which even favors a fatty liver), drive more sport and abstain completely from alcohol. Also on a low-fat diet in fatty liver, the concerned should pay attention. In addition, it is important to have the blood sugar, blood pressure and blood lipid levels set correctly by the doctor. If the fatty liver of medication, it may be an alternative drug can be found.

For the treatment of fatty liver also regular check-ups (“liver tests” and ultrasound), to quickly detect the progression of the disease into hepatitis or liver cirrhosis.

If the disease has progressed further and has the liver cells connective tissue rebuilt (liver cirrhosis) before, the fatty liver therapy is primarily to treat any complications occurring. The liver should be examined regularly to detect liver cancer early. If the liver tissue is completely destroyed, you can not cure fatty liver. A liver transplant is the last possible fatty liver treatment. If there is a suitable donor, the liver of another person can be used and resume the failed liver function.

Fatty liver: disease course and prognosis

In the case of steatosis hepatis, the prognosis depends on the time of its discovery and whether it is an alcoholic fatty liver or not. If alcohol is the cause, the prognosis is a little worse. Nevertheless, it is initially a benign disease. If patients quickly do something against the causes of their fatty liver disease, the disease can heal completely, as the liver is one of the most regenerative organs.

However, if liver cirrhosis develops from fatty liver, severe complications, including liver failure, can occur. From liver cirrhosis, the liver can – unlike fatty liver – no longer recover. Because the liver cells are destroyed and replaced by dysfunctional scar tissue. So that it does not come so far, it is advisable that fatty liver to treat as soon as possible.