Symptoms and treatment of cholestatic hepatosis

Among liver diseases, hepatoses occupy a special place. They are not associated with inflammation in the liver cells (or it is very weakly expressed), with the effect of infection, oncological degeneration. This group of diseases is characterized by a pronounced impairment of metabolic processes in hepatocytes with subsequent dystrophy and death.

What are the forms of hepatosis?

For the common name hiding 3 different variants of the disease. They differ in the prevailing type of metabolic and morphological features. Classified as fat, cholestatic and pigment.

The causes of each disease are different, so in order to know how to treat a disease, you need to figure out the mechanism of the disorder. All are able to manifest in acute and chronic form. The most common fatty liver (steatosis).

In obese people with a body mass index of 30 or more, as well as in chronic alcoholics, fatty hepatosis is detected in 95% of morphological studies. Steatosis is common in 25% of all cases of diagnostic puncture.

Changes in liver cells develop immediately throughout the organ. But some authors allocate a focal form of steatohepatosis. They consider possible the formation of local fat deposits in the zone of branching of the portal vein.

What are the similarities and differences of hepatosis?

Liver damage in hepatosis develops under the influence of external (exogenous) and internal (endogenous factors). The toxic effect of any toxic substances is considered exogenous. Acute hepatosis is more likely to cause poisoning with arsenic compounds, fluorine, poisonous mushrooms, large doses of alcohol and surrogates, some medications.

Long-term alcoholism, malnutrition (lack of protein and vitamins), exposure to carbon tetrachloride, and organophosphorus compounds are more characteristic of the chronic course. Endogenous factors occur inside the body against the background of various diseases (thyroid, endocrine obesity, diabetes mellitus, Itsenko-Cushing syndrome).

The acute form can be a complication of sepsis, viral hepatitis, avitaminosis. With endogenous damage, the liver perceives a violation of the general metabolism in the body, changes become secondary to the underlying disease.

Fatty hepatosis

Variant of hepatosis due to fatty type of liver cell dystrophy. It develops with such a metabolic disorder, when cells either accumulate a lot of fatty inclusions due to massive intake of fatty acids, carbohydrates, or hepatocytes have defects, which do not cope with fats.

For the main reason are distinguished:

  • alcoholic infiltration of the liver with fat and subsequent transition to alcoholic steatohepatitis and cirrhosis,
  • non-alcoholic fatty infiltration (9% of all morphological studies of the liver), respectively, non-alcoholic steatohepatitis most often accompanies endocrine disorders, insulin resistance with hyperinsulinemia, cardiovascular diseases.

Both forms cause changes in the body, called metabolic syndrome. But possible causes of liver steatosis, not related to alcohol and metabolic disorders. It belongs:

  • to the negative effects of operations on the stomach and intestines, made about obesity,
  • hereditary metabolic disorders,
  • the effect of infection
  • the outcome of chronic diseases that deplete the patient’s body.

The biochemical criterion of the fatty form of hepatosis is the level of triglycerides in the liver more than 1/10 of the dry mass. Studies show that fatty inclusions are diffuse, when the fat content in the liver reaches 25%.

Pigment hepatosis

The liver disease of a dystrophic nature is caused by genetic disorders in the production of enzymes (enzymopathies) necessary for the process of intrahepatic bilirubin metabolism. Accompanied by temporary or chronic jaundice.

There are bilirubin increase and pigment metabolism disorders:

  • caused by unconjugated bilirubin (Crigler-Nayar Syndromes, Lucy-Driscoll, Gilbert's disease),
  • due to unconjugated and conjugated bilirubin (Dubinin-Johnson, Rotor syndromes).

The prevalence of hereditary manifestations is 2–5% of the total population. For example, let's look at the most common Gilbert's syndrome (other names: simple familial cholemia, idiopathic unconjugated hyperbilirubinemia, constitutional hyperbilirubinemia, familial non-hemolytic jaundice).

A form of pigmentary hepatosis, for which a non-constant increase in the blood levels of indirect bilirubin is typical. The reason is the impaired intracellular transport of pigment molecules and its attachment to glucuronic acid

What changes occur in the liver?

In the form of fatty hepatosis, the mechanisms of fat accumulation during liver overload are:

  • in excess dietary intake of fats and carbohydrates that are converted to fatty acids,
  • depletion of glycogen stores, causing fat release from the depot and increased deposition in the liver,
  • an increase in the production of growth hormone growth hormone, it is he who mobilizes fat from the depot,
  • the action of alcohol by increasing the synthesis of catecholamines, a violation of the reaction of biological oxidation of fats.

Removal of fat from the liver is reduced due to a decrease in the concentration of low-density lipoproteins, increased triglyceride synthesis, inhibition of fatty acid breakdown in hepatocytes due to impaired phosphorylation, hereditary enzyme deficiencies that affect the regulation of fat in the liver.

In cholestatic hepatosis, the exchange of cholesterol and bile acids in liver cells is primarily affected. It is important, in addition to the impact of a harmful factor on the liver cells, a pronounced toxic-allergic reaction.

Pigmented hepatosis causes the accumulation of bilirubin in hepatocytes. The values ​​have:

  • an increase in the blood content of the unconjugated form of the pigment due to increased disintegration (hemolysis) of red blood cells,
  • decrease in the ability of hepatocytes to capture unconjugated bilirubin,
  • violation of the conjugation process of bilirubin inside the liver,
  • damage to the hepatocyte and pigment exit directly into the blood,
  • the difficulty of the transition of bile from the hepatocyte to the capillary passage of the biliary tract,
  • inhibition of free circulation of bile in the intrahepatic and extrahepatic ways.

Symptoms of cholestatic hepatosis

With cholestatic hepatosis, pruritus appears, jaundice develops, the stool becomes colorless, the urine turns dark, and body temperature can rise. The liver is most often enlarged. Patients feel pain and heaviness in the right hypochondrium.

When conducting laboratory tests, a high level of bilirubin and cholesterol is detected in the patient's blood, higher than the norm and the ESR indicator. There is a high activity in the serum of alkaline phosphatase, as well as leucine aminopeptidase. Reducing the concentration of stercobilin leads to discoloration of feces.

When making a diagnosis, a puncture biopsy can be performed. Cholestatic hepatosis causes the accumulation of bile pigment in hepatocytes, reticuloendothelial cells and in the intralobular bile duct. Dystrophic changes in liver cells are also noticeable, as a rule, of a protein nature, in severe cases, cholangitis can occur.

The disease may be acute or chronic. Protracted cholestatic hepatosis quickly becomes hepatitis due to a reticulohistiocytic stroma reaction of the liver and associated cholangitis.

Treatment of cholestatic hepatosis

The treatment of cholestatic hepatosis is practically the same as the treatment of chronic fatty hepatosis. It can be supplemented with corticosteroids. Patients are not recommended sanatorium treatment.

Measures of prevention include the elimination of causes provoking the development of pathology. It is important to limit the consumption of alcoholic beverages, to take drugs that have a hepatotropic effect, only on the recommendation and under the supervision of a physician. It is also necessary to ensure a healthy diet, timely treat diseases of the gastrointestinal tract, identify and treat diseases that may cause fatty hepatosis. Patients with fatty hepatosis require follow-up and regular examination by a specialist. Course treatment of the disease is carried out 1-2 times a year and more often.

Expert Editor: Pavel Alexandrovich Mochalov | D.M.N. general practitioner

Education: Moscow Medical Institute. I. M. Sechenov, specialty - “Medicine” in 1991, in 1993 “Occupational diseases”, in 1996 “Therapy”.

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Causes and symptoms of hepatosis of the liver

Acute hepatosis occurs with toxic organ damage. It can be poisoning with fluorine, arsenic, characteristic symptoms of acute hepatosis also appear after taking high doses of alcohol, with an overdose of drugs, the use of poisonous mushrooms. Sometimes acute liver dystrophy becomes a complication of viral hepatitis or.

Treatment of hepatosis liver folk remedies

In a ripe round-shaped pumpkin, cut off the top and remove the seeds. The vessel obtained in this way is filled with honey and is closed from above with a previously cut off top. Pumpkin is transferred to a dark place for a couple of weeks, the temperature in the room should be at 20-22 ° C centigrade. Two weeks later, pumpkin honey.

Symptoms and treatment of fatty liver hepatosis

Chronic fatty hepatosis of the liver is manifested in the form of fatty, in some cases, protein dystrophy of the organ cells. The disease is chronic. The cause of fatty liver hepatosis most often becomes alcoholism, in more rare cases, the disease develops against the background of endogenous deficiency of protein and vitamins.

Symptoms and treatment of alcoholic hepatosis

60–70% of patients with chronic alcoholism suffer from fatty hepatosis. The cause of alcoholic fatty hepatosis is a violation of the metabolism of ethanol, which proceeds with the use of a large amount of NAD (the compound required for the final stage of fatty acid oxidation).

Symptoms and treatment of hepatosis in pregnancy

During the normal course of pregnancy, the liver tissue, blood supply to the organ, as well as its structure and size, remain unchanged, despite the increase in load. In some cases, an increase in the viscosity of bile and a decrease in the tone of the biliary tract, associated with a change in the ratio of hormones in a woman’s body during pregnancy, can provoke.

Hepatosis Diet

In the treatment of hepatosis, dieting plays an important role. Properly balanced nutrition in some cases helps not only to stop the progression of the disease, but also contributes to the reverse development of pathological processes. It is also very important to stop drinking alcohol, especially when the symptoms of alcoholic fatty hepatosis appear. Patients need to remember.

Diet for fatty hepatosis

There are several main causes of fatty hepatosis. These include poor nutrition, alcohol abuse, uncontrolled medication (antibiotics), certain pathologies of internal organs, diabetes mellitus, and increased body weight. Treatment of hepatosis in the first place is to eliminate the causes.

Symptoms and treatment of acute fatty hepatosis

Hepatosis is a liver disease that is accompanied by dystrophic changes in the tissues of an organ without an apparent mesenchymal-cell response. The disease can occur in an acute and chronic form. Chronic hepatoses are divided into fat and cholestatic. Acute hepatosis has several names: toxic liver dystrophy, acute yellow atrophy of the liver, and.

Causes and treatment of pigment hepatosis

Functional hyperbilirubinemia (pigmented hepatosis) is a lesion of the liver of dystrophic genesis, which is inherited. Pathology develops due to deterministic enzymopathies caused by genetic changes. Functionally, this manifests itself in the form of a violation.

Treatment of cholestitic hepatosis

Cholestatic hepatosis on the principle of treatment is no different from fatty hepatosis, and in this clinical picture requires an integrated approach. First, it is required to adhere to a medical diet, and completely to exclude products, harmful to a liver, from a habitual diet. It:

  • Alcohol and nicotine,
  • Fatty and fried foods,
  • Confectionery and flour products,
  • Sparkling water.


But it is recommended to use in the diet proteins of animal origin, collected in dairy products, cereals and lean meats. Secondly, the sanitary and prophylactic course for cholestatic hepatosis is categorically contraindicated, however, as well as resort treatment.
Doctors recommend the systematic administration of lipotropic drugs, among which choline chloride, vitamin B12, lipoic acid and folic acid, preparations with extracts and liver hydrolyzates are especially in demand. In a more advanced clinical picture, it does not do without long-term use of corticosteroid hormones, which preserve the structure of the liver and promptly prevent the process of degeneration of its cells. Daily doses are individual, therefore, superficial self-treatment is highly undesirable.
In general, with timely initiated therapy, a positive dynamics of the disease is observed.

However, each patient should clearly understand that, having aggravated once, the disease in the absence of preventive measures, will remind of itself with extremely unpleasant and painful exacerbations. That is why patients with a diagnosis of "Chronic hepatosis" should be in the dispensary, and twice a year to undergo a therapeutic course of medication.

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Home »Diseases List» Hepatosis of the liver »Symptoms and treatment of cholestatic hepatosis

Cholestasis, accumulation of bile pigment in liver cells, disturbance of hepatocyte trophism with the development of dystrophy associated with insufficient protein intake are characteristic of cholestatic hepatosis.

The cause of this type of hepatosis can be a harmful effect on the liver of toxins or allergens, which are often drugs. The metabolic processes in hepatocytes with cholestatic hepatosis are disturbed, the cholesterol and bile acids metabolism suffers mainly, the formation of bile and its outflow are disturbed.

Cholestatic hepatosis - symptoms and treatment

First of all, let's look at what signs indicate the presence of this disease. It should be noted that the intensity of symptoms in cholestatic hepatosis depends on its form - mild, moderate or severe. Often at the initial stage, people are not even aware of the presence of problems.Symptomatology will begin to manifest as the disease progresses, and as a result it becomes clear that you cannot do without medical help.

Characteristic signs of cholestatic hepatosis are:

  • urticaria and pruritus,
  • pain in the right hypochondrium,
  • yellowness appearing on the sclera of the eyes, skin, mucous tongue,
  • urine becomes darker.

The patient also feels general discomfort. Often the disease is accompanied by fever. As already mentioned, the severity of symptoms depends on the stage of hepatosis. Also important are factors such as the age of a person and the state of his immune system. The severity of symptoms also depends on the presence / absence of other chronic diseases.

Laboratory tests, including needle biopsy, will help to make an accurate diagnosis. It is this one that helps determine the amount of yellow pigment in reticuloendothelial cells, intralobular bile duct and hepatocytes. Using a blood test, you can set indicators for cholesterol, ESR and bilirubin. If they are too high, it means that the preliminary diagnosis was made correctly. Increased alkaline phosphatase activity will be detected in the serum against a background of reduced stercobilin concentration.

Now let's talk about the treatment of cholestatic hepatosis. The main task of the doctor in this case is the selection of the correct therapy and the appointment of a diet to the patient. Changing the diet is necessary in order to prevent the emergence of new relapses. This will also contribute to the reception of appropriate medications. The patient, in turn, must strictly follow all prescriptions - be sure to follow a diet and not indulge in excesses.

From the diet, in particular, should exclude carbonated water, flour products, fried and fatty foods. You also have to give up sweets and, of course, put an end to bad habits. In other words, the ban covers everything that may adversely affect the work of the liver.

The diet is recommended to enrich with animal proteins - they are in sufficient quantities, for example, in lean meats, cereals, jelly. You will also need to systematically take lipotropic drugs. If the disease has progressed, it will be necessary to take corticosteroid hormones for a long time, contributing to the preservation of the structure of the liver and at the same time preventing the degeneration of the cells of this organ.

It should be specially emphasized that without proper prophylaxis, the disease that has appeared at least once will certainly remind of itself with very unpleasant symptoms. That is why this moment should be given special attention. All patients with the chronic form of hepatosis must be registered. 2 times a year they undergo a medical treatment-and-prophylactic course.

Cholestatic hepatosis in pregnant women, chronic alcoholics, and other individuals with liver problems is a pathology in the acute phase at which bile pigment accumulates. Dystrophic changes occur in the liver due to its inadequate supply of protein. Suffering from this primarily cholesterol and bile metabolism, and the outflow of bile itself slows down.

Etiology and pathogenesis

Medicine cannot name the exact etiological causes of the disease. It has been established only that the phenomenon of pregnancy, transient alcoholism, poisoning with toxins or medications takes the pathological process into an acute phase.

In the chronic phase, hepatosis rarely makes itself felt and may not be detected in patients throughout their lives.

  • Most often, such diseases are detected in individuals dependent on ethanol. Ethyl alcohol has an important feature to destroy the proteins and vitamin complexes entering the body, a chronic deficiency of which leads to an exacerbation of hepatosis. Hepatotropic agents such as bacterial and viral toxins, FOSy, carbon tetrachloride can also cause this dystrophic state of the liver.
  • In hepatosis, the key point of the disorder is the exchange of lipoproteins involved in the construction of cell membranes. The functions of the liver cells are impaired due to their weakness of the structure, and the long absence of treatment and the continued effect that predisposes to the disease can completely destroy the hepatocytes. New lipoproteins for membranes simply have nothing to build, and old ones to reconstruct and fill defects.
  • As a side effect of drug therapy, cholestatic hepatosis is caused by chlorpromazine, gestagen preparations, and testosterone. They are obtained exogenously, so the liver is able to react to them as foreign agents, disrupting cholesterol and bile exchanges at the cellular level, followed by bile stagnation and cessation of its formation.
  • The pathological process of the disease begins with a decrease in the membrane permeability of the liver cells, due to the inclusion of large amounts of cholesterol in their structure. In turn, this plays a hindering effect on other types of metabolism, slows down the enzymatic activity of transport proteins, and blocks the synthesis of the energy basis of the cell. Thus, the hepatocyte reduces the performance of bile, and eventually it stops it completely, suffering from the destructive processes of its own cellular metabolism.

Symptoms and treatment

Cholestatic hepatosis in the acute course develops rapidly and polysymptomno. Painful nausea in patients, bright jaundice staining of the skin, digestive dyspepsia come to the fore.

The liver may first grow significantly, and then surrender positions and become small and soft.

  • Laboratory liver markers do not always reflect the pathological process in the liver, so the examination scheme should include a simple blood test where ESR is elevated. The acid-base state of venous blood reflects a drop in potassium, and biochemistry clearly shows an increased concentration of aminotransferases.
  • In palpation, the liver becomes very painful, although not enlarged, which distinguishes the disease from cirrhosis. The spleen does not enlarge, as with hepatolienal syndrome of inflammatory diseases. Pain in the right hypochondrium occurs at rest, regardless of food intake, sleep and rest. The exact diagnosis and direction of treatment is established after the analysis of liver bioptic material.
  • When cholestatic hepatosis is present in the patient in a chronic form, attention should be paid to possible dark urine staining, while the feces are colorless, to barely noticeable yellowness of the sclera and skin. Blood biochemistry can reflect high cholesterol and bilirubin.

All deaths are more likely to occur from acute hepatosis of the liver. The situation is aggravated by the sudden onset of coma with the sometimes irreparable consequences for the brain. Hepatic failure and possible secondary hemorrhages worsen the quality of life of patients, but the rejection of provoking factors and a competent treatment plan allow patients not to feel sick.

If the slightest suspicion of hepatosis occurs, the patient urgently needs hospitalization. Immediately it is necessary to eliminate all provocative factors and carry out detoxification measures. With a threat to life and an acute beginning, these activities begin already with first aid.

Support the function of the liver can be corticosteroid therapy. But first of all, it is necessary to replace the deficiency of lipoproteins, which are necessary for the membranes of hepatocytes. For treatment, lipoic acid preparations are prescribed, as well as vitamin B 12. Saturated animal fats should prevail in the diet and there should not be a single drop of alcohol.

Hepatosis in future mothers

Cholestatic hepatosis in pregnant women is a fairly common pathological condition during pregnancy. Most of the gestational period, it does not manifest itself, and in the third trimester begins to manifest itself in full force.

The physiological phenomenon of pregnancy implies an increased load on all organs.

Some abnormalities in the normal function of the liver in the absence of such loads may not be detected, but the strongest hormonal changes provoke all latent pathologies.

  • The onset of the disease in women in position is marked by severe skin itching.
  • All the symptoms of pregnancy are significantly increased: nausea, odor susceptibility, excessive fatigue.
  • Attaches to this excruciating pain in the right upper rim, on the periphery of the liver.
  • The skin color may also change to a yellowish color.
  • Along with this, a woman can notice the colorlessness of the chair.

Nevertheless, the disease is difficult to diagnose. The pregnant uterus closes the access to the detoxification organ during palpation, and the biochemical analysis with elevated hepatic markers can be considered as the norm during pregnancy due to hormonal changes.

A number of the most accurate methods, which are key in the diagnosis, including biopsy, by liver puncture, and radionuclide studies are not carried out in pregnant women. The diagnosis is made on the basis of history, careful examination of the clinic and laboratory reflections of the disease. For therapy prescribed hepatropic drugs, which in general significantly reduce the severity of symptoms. Vitamin complexes normalize placental, and plasmapheresis removes excess toxins.

However, the disease often provokes premature labor, can cause the hypoxic state of the fetus. Specified Diagnosis

hepatosis during pregnancy

requires close observation tactics of such women who usually are artificially delivered before the 38th week of gestation. Natural childbirth usually provokes severe bleeding.

After pregnancy is resolved, symptoms gradually go away, but re-conceiving and carrying the child most often returns the disease.

Causes of cholestatic hepatosis

The etiology of the disease is unknown. There is an assumption that pesticides and toxic components that have entered the woman’s body become a provocateur of the disease. Cholestasis (another name for cholestatic hepatosis) often develops after a course of therapy with synthetic drugs.

With the development of pathology in the cells of the liver, cholesterol metabolism and the production of bile acids change. This triggers a decrease in the production and outflow of bile along the bile ducts in the liver. Cholestatic hepatosis causes significant damage to the health of the pregnant woman. Bile acids provoke the following pathological problems:

  • cause itching on the skin,
  • disrupt the process of normal digestion,
  • have a toxic effect on the cells of the liver and bile canaliculi, developing an inflammatory process in the liver tissue.

Often, the pathology in pregnant women manifests itself at 31-33 weeks of pregnancy. If the disease manifests itself in early pregnancy, then for the health of the woman it can turn into complications. Cholestasis, diagnosed once, increases the risk of developing the disease in all subsequent pregnancies. To prevent the risk of developing complications, women who have previously had cholestatic hepatosis have been given a full examination from early pregnancy. In the future, pregnant women with such a diagnosis are under strict control by a hepatologist.

The manifestation of cholestatic hepatosis symptoms during pregnancy is affected by the form of the pathology (mild, medium, severe). In most cases, on the mild stage of the development of the disease, there are no obvious signs. Women do not pay attention to minor changes occurring in their bodies. The progression of pathological signs occurs when the disease becomes moderate or severe.

Cholestatic hepatosis is classified into 2 stages:

For the acute stage is characterized by the manifestation of pronounced signs that encourage a woman to promptly seek medical help. The signal for going to a doctor is general weakness, apathy, pain whining on the right side under the ribs. If you ignore the pathological signs, the disease gradually turns into a chronic stage.

Chronic form does not have bright symptoms. Therefore, it is difficult to determine the existence of a problem in a timely manner. The periods of exacerbations indicate when the woman is actively manifesting the symptoms of the disease.

Signs of Pregnant Cholestatic Hepatosis

Signs that appear during cholestatic hepatosis in pregnant women:

  • Itchy skin. Unpleasant irritation increases at night. Itching occurs due to irritation of the skin receptors, which is caused by the introduction of yellow pigments into the bloodstream.
  • Yellowness of the skin. In 20% of pregnant women suffering from hepatosis, the yellowness of the mucous membrane and skin appears. The reason for this condition is an increase in the level of bilirubin in the blood.
  • Nausea, often turning into vomiting.
  • Lack of appetite.
  • Change the color of feces (becomes light).
  • Discoloration of urine (becomes dark).

Pregnant women can also show individual signs - an increase in body temperature patterns, the appearance of apathy, irritability.

Confirmation of the preliminary diagnosis are laboratory tests (puncture biopsy and blood tests). The development of hepatosis is confirmed if increased blood levels of bilirubin, ESR, cholesterol are present in blood tests. A biopsy analysis shows the presence of a yellow pigment in the bile duct, reticuloendothelial cells and hepatocytes.

Cholestatic hepatosis, promptly identified and corrected with the correct therapy, cannot harm the health of the child.

Manifestations

General symptoms of liver hepatosis show the degree of organ dysfunction. At the initial stage of fatty degeneration, they are minimal, then liver failure gradually increases. Symptoms of the disease can appear immediately after birth (in case of an enzyme pathology) or after years.

Chronic disease is accompanied by the appearance of:

  • dyspeptic disorders (nausea, vomiting, stool disorders),
  • unclear fatigue and weakness
  • reduced appetite
  • losing weight
  • dull pains or a feeling of heaviness in the hypochondrium on the right,
  • in connection with the breakdown of the synthesis of sex hormones, women often go to a doctor for infertility, and men are treated for impotence.

Over time, changes in brain functions appear: attention, sleep, and character change. The course of the chronic form of hepatosis is more favorable, it is impossible to get rid of the disease, but there is time to support and compensate for the lost functions of the liver.

Symptoms in the acute course develop rapidly. The patient has severe intoxication, jaundice, vomiting and nausea. The development of acute liver failure can lead to hemorrhagic manifestations and hepatic coma with a fatal outcome.

On examination, the palpator doctor finds a dense margin of the liver protruding from under the costal arch. Hepatomegaly (enlarged liver) is considered the leading clinical sign, smooth to the touch, moderately painful. An enlarged spleen is not characteristic.

Cholestatic hepatosis is manifested by symptoms of bile stasis (cholestasis syndrome), which is characterized by jaundice of the sclera and skin, painful itching, dark urine color, discolored gray feces, fever.The cholestatic form of hepatosis most quickly becomes hepatitis due to a pronounced stromal reaction of the liver tissue.

Gilbert's syndrome usually occurs at the age of puberty. In childhood, occasionally yellowness of the skin after physical exertion or a previous infection is possible. Symptoms stimulate long-term hunger, low-calorie diet.

Pigmentation can be in the form of stained spots on the skin, eyelid xanthelasm, small scleral icterus. The pain in the right hypochondrium is not intense, there is nausea, disorders of the stool. Rare forms of pigment hepatosis manifest themselves:

  • Lucy-Driscol syndrome - yellowing of breast milk, stops after the child is transferred to the nutritional formula,
  • Dubin-Johnson syndrome - a violation of the synthesis of bile, sclera jaundice, typically increased after taking contraceptives, against the background of pregnancy.

Diagnostics

Changes in biochemical blood tests are typical for fatty hepatosis:

  • moderately increased activity of alanine and aspartic aminotransferase, alkaline phosphatase, fructose-1-phosphataldolase, urokinase,
  • a severe course is indicated by a decrease in potassium concentration, an increase in ESR,
  • violation of fat metabolism is judged by the level of cholesterol, triglycerides and β-lipoproteins,
  • on ultrasound they find: an increase in the size of the liver, an increased echogenicity of the parenchyma, an unclear “blurred” vascular pattern, the appearance of a “grain” indicates the beginning of the development of hepatitis,
  • computed tomography and nuclear magnetic resonance imaging detect a decrease in tissue absorption coefficient, sometimes limited areas of fatty infiltration are detected, around which healthy tissue is located,
  • a radioisotope method reveals a slowdown or complete cessation of the function of liver cells,
  • morphological examination of the biopsy shows fat deposits in the central hepatic lobules.

In cholestatic hepatosis, a high level of bilirubin, a significantly increased activity of alkaline phosphatase and leucine aminopeptidase are found in the blood, an elevated cholesterol index, and a high ESR are determined.

To exclude pigment hepatosis, special diagnostic tests are done: during fasting, the serum bilirubin concentration increases 2 times, after taking Phenobarbital, a fall in the level of bilirubin is recorded, after intramuscular administration of nicotinic acid, after five hours, the bilirubin content increases by 25%.

How is the degree of liver damage?

The study of liver biopsy material of different people led to the classification of the development of hepatosis by degrees:

  • The initial - small fat drops appear in separate hepatocytes. Clinical signs are absent.
  • Grade 1 - fat drops become large, accumulate in certain areas. The course of the disease is lethargic and it is practically impossible to detect it at this stage.
  • Grade 2 - cell obesity is mixed, available throughout liver tissue. The patient complains of pain in the hypochondrium on the right, a feeling of heaviness, possibly an increase in the liver.
  • Grade 3 - obesity diffusely covers the entire organ, fatty inclusions are located and extracellular, form fatty cysts, there is an increased proliferation of connective tissue.

What is dangerous hepatosis?

In modern conditions of life and production, a person constantly meets with toxic toxic substances. If the symptoms of liver damage do not appear everywhere, this does not mean the absence of morphological changes at the level of 1-2 degrees.

The progression of the process is recorded when clinical manifestations appear. Liver biopsy is performed only if there is serious suspicion of pathology. Over time, hepatosis becomes non-viral hepatitis. Further development is cirrhosis. Experts believe that in the next 3 decades, hepatosis will become the main reason for liver transplantation.

Methods of treating hepatosis

Treatment of hepatosis of the liver requires: strict adherence to a diet that restricts the intake of fats and carbohydrates with food, the proper selection of exercises and exercise for "burning" fat, the correction of hormonal disorders, the use of drugs of the group of hepatoprotectors, choleretics and cholekinetics, for severe obesity - bariatric surgery .

Power Features

Patients are shown the menu of the table number 5 according to the Pevsner classification. Animal fats (beef, pork, butter, cooking oil, sour cream, lard, smoked meat and fish products, fat cottage cheese, sweets and cooking products), hot sauces, strong tea and coffee are contraindicated.

The menu includes only boiled, stews, allowed to steam, bake. The increased protein content is provided by their low-fat meat and fish, low-fat cottage cheese, kefir, cereals. To compensate for the loss of vitamins and electrolytes, vegetables and fruits are recommended.

The approximate composition of the daily diet includes:

  • proteins - 110 g,
  • fat - 80 g,
  • carbohydrates - up to 300 g

Calories - 3200–3500 kcal. The disease can be cured in the initial stage, if you stop the effect on the liver of toxic factors. Especially important is the rejection of alcohol. If, after a course of treatment, the patient started drinking again, the process cannot be stopped.

Drug use

In acute toxic hepatosis, the patient is shown hospitalization and elimination of the pathology caused by poisoning. To remove intoxication, Hemodez, Poliglukin, salt electrolyte solutions are introduced. Panangin helps to restore the content of potassium in the blood.

With hemorrhagic manifestations, you may need a platelet mass, corticosteroids. To restore normal fat metabolism, you need vitamins, especially group B, folic acid. For the treatment of chronic fatty hepatosis used:

  • drug treatment with lipase blocking drugs (Orlistat), which increase insulin sensitivity (Metformin), they reduce triglyceride levels,
  • antioxidants (vitamin E, Betaine, S-adenosylmethionine, and N-acetylcysteine) reduce transaminases,
  • from the group of hepatoprotectors, essential phospholipids are used, Silybin, Silymarin, herbal remedies Legalon, lipoic acid, Ursosan - a preparation of ursodeoxycholic acid.

A cautious attitude to preparations from the liver tissues is required (Syrepar, Prohepar). They give allergic reactions.

In cholestatic hepatosis, preparations stimulating the production of bile (Allohol, Cholensim) and cholekinetics (Holosas, Flamin, Sorbitol, Mannitol) are used, promoting bile through the ducts, beginning with interlobular.

Patients with pigmented hepatosis are shown symptomatic therapy with the progression of the process. If signs of inflammation of the gallbladder appear, then antibacterial drugs are prescribed. People with genetic disorders are not recommended sanatorium treatment.

To the question: "Is it possible to cure hepatosis of the liver?", - the doctor is able to answer after a full examination of the patient. Most often, the complete elimination of the pathogenic factor with non-alcoholic hepatosis contributes to a favorable course.

If the patient has an age of “over 50”, the body mass index exceeds 30, there is a high level of alanine transaminase and triglycerides, cholesterol and glucose, then there is a favorable “situation” for early hepatic fibrosis, which increases the risk of cirrhosis.

Hepatoses are not harmless diseases. They seriously worsen the life of the patient, require constant dietary restrictions. Timely correction of diet and exercise, regular cleansing of the liver with a tendency to obesity helps keep the body in working condition.

Why appears

Experts believe that this pathology is innate. But it is in latent form in many people. Only in the presence of predisposing factors do symptoms of the disease appear. Such provoking factors include: a negative effect on the organ of toxic substances or allergens, most often the latter are contained in medications.

In cholestatic hepatosis, disorders of the metabolism of cholesterol and bile enzymes occur, and the flow of bile worsens.

Symptoms of the disease

If hepatosis of the liver develops, the symptoms are pronounced. The very first clinical manifestations of the disease:

  • Intensive epidermis itching.
  • Yellowness of the skin.
  • Sleep disturbance
  • The chair becomes very light.
  • Urine becomes darker.
  • Temperature indicators are low-grade.
  • Painful sensations in the right iliac region.
  • Enlarged liver in size.

When the pathological process continues to progress, cholestasis is noted by such manifestations: disorders in the digestive system, nausea or vomiting, loss of appetite, weight loss. Symptoms usually disappear after giving birthit rarely becomes chronic or long lasting. But if the woman becomes pregnant again, the disease can worsen.

Diagnostic measures

Symptoms and treatment of the disease are closely related. Depending on the severity of the clinical picture, the doctor will prescribe a treatment or limit only to recommendations for the correction of the diet.

If the diagnosis is carried out in a timely manner, the prognosis for recovery is favorable.

The main diagnostic activities are:

  • Laboratory study of blood liquids, it is important to determine the concentration of enzymes and acids.
  • Ultrasound procedure.
  • Doppler sonography explores the fetus.
  • CTG is performed in the third trimester to establish the frequency of contractions of the heart of the future child.

Features of therapy

Treatment of cholestatic hepatosis is to clear the body of bile acids, as well as in the restoration of its functions. Since the exact cause of the disease is almost impossible to establish, the elimination of the causes is not carried out. Only cleansing and restoration.

What drugs are used to treat:

  • Polyphelan - blocks excessive bile production.
  • To suppress elevated estrogen levels, glucocorticoids are prescribed.
  • To cleanse and restore the work of the body, prescribe hepatoprotectors - Kars, Essentiale, Enertiv.
  • Vitamin substances, multivitamin complexes.
  • Herbal medicines - Galstena, Gepabene.
  • Medications for the outflow of bile - Ursosan.

A prerequisite is a diet, which is to minimize the use of fatty foods, sweets, spirits, smoked and pickled dishes. Using this power can reduce the load on the liver.

If you comply with all medical recommendations, you can overcome this disease without harm to the health of the future mother and her baby.

Preventive actions

It is very important to exclude predisposing factors to the possible development of the disease. For this, before and during pregnancy, a diet is recommended. One of the prerequisites for prevention is the intake of hepatoprotective medications prescribed by a doctor. Do not use any medication on your own, only after prior consultation with a doctor.

Important is the observance of proper nutrition, timely treatment of diseases of the digestive system organs. If there is such a pathology in the history as fatty hepatosis, it is very important to systematically visit the attending doctor and pass all necessary examinations. Undergo treatment at least once a year.

Watch the video: Signs of Liver Disease (January 2020).