Fatty livermedical aircraftFatty liver specimenFatty liver, refers to a variety of reasons caused by excessive accumulation of fat in the li
Fatty liver specimen
Fatty liver, refers to a variety of reasons caused by excessive accumulation of fat in the liver cells. Fatty liver disease is a serious threat to the health of Chinese people, has become the second largest liver disease after viral hepatitis, has been recognized as a common cause of concealed cirrhosis. Fatty liver is a common clinical phenomenon, not an independent disease. The clinical manifestations were not symptoms, severe illness ferocious. Fatty liver is a reversible disease, early diagnosis and timely treatment can often return to normal.
Western medicine name:
Department of Gastroenterology
Lipid metabolism disorder
Access to health insurance:
Disease classification etiology pathogenesis pathophysiology clinical manifestations diagnosis and differential diagnosis introduction of disease classification pathogenesis etiology pathophysiology clinical manifestations diagnosis and differential diagnosis
Fatty liver, refers to a variety of reasons caused by excessive accumulation of fat in the liver cells. Fatty liver disease is a serious threat to the health of Chinese people, has become the second largest liver disease after viral hepatitis, has been recognized as a common cause of concealed cirrhosis. Fatty liver is a common clinical phenomenon, not an independent disease. The clinical manifestations were not symptoms, severe illness ferocious.
In recent years, the incidence of fatty liver has increased rapidly in Europe, America and China, and has become the second leading cause of liver disease. In some occupation groups (white-collar workers, taxi drivers, occupation managers, individual owners, government officials and intellectuals etc.) the average incidence rate of fatty liver was 25%; patients with obesity and type II diabetes in the incidence of fatty liver was 50%; the incidence of alcoholism and alcoholic fatty liver rate was 58%; in the sleepless nights have no appetite, fatigue, the incidence of fatty liver, gastrointestinal disorders in sub-health population was about 60%. In recent years, the age of fatty liver has been declining, the average age is only 40 years old, more and more patients around the age of 30. Men under 45 years old were more likely to have fatty liver than women.
Fatty liver early asymptomatic, a lot of young people at the time of physical examination has been diagnosed with fatty liver and medical treatment, so everyone should pay attention to physical examination, effectively control the disease in the early stage.
According to pathological classification
How many fatty liver will become liver cancer?
1, simple fatty liver: liver disease only showed fatty degeneration of liver cells, the fatty degeneration of liver cells will be divided into diffuse fatty liver, fatty liver, focal fatty liver, and diffuse fatty liver and normal liver island.
The pathogenesis of fatty liver is complex, various pathogenic factors can lead to the accumulation of triglyceride in liver cells by affecting one or more of the following:
Elevated free fatty acid transport to hepatocytes due to high fat diet, hyperlipidemia, and peripheral adipose tissue breakdown.
The mitochondrial dysfunction leads to liver cell depletion of free fatty acid oxidative phosphorylation and B oxidation reduction.
The ability of hepatic cell enhanced synthesis of triglycerides or from carbohydrates into triglycerides increased, or liver cells from the liver sinus chylomicrons increased remnant direct uptake of triglyceride.
The very low density lipoprotein (VLDL) synthesis and secretion caused by liver cell triglyceride transfer disorder.
When the total amount of triglycerides and entering the liver cells and the consumption of more than 2 and transport of triglycerides, formation of fatty liver in the liver triglyceride accumulation.
2, fatty hepatitis: refers to the liver cell steatosis on the basis of inflammation of the liver cells. According to statistics, a large number of long-term drinking, about 40% will appear this kind of circumstance, and nonalcoholic fatty liver disease rarely occurs steatohepatitis.
3, fatty liver fibrosis: refers to the fibrosis around the liver cells, the degree of fibrosis and the presence of pathogenic factors and the severity of fatty liver. Alcoholic liver fibrosis can occur on the basis of simple fatty liver, but not on the basis of alcoholic hepatitis. The development of liver fibrosis is fatty liver cirrhosis.
4. Fatty liver cirrhosis: fatty liver cirrhosis is the result of progressive development of fatty liver disease. In recent years, with the increase in alcoholic liver disease and non-alcoholic liver disease, fatty liver cirrhosis has accounted for second of the causes of cirrhosis in China (the first is viral hepatitis and cirrhosis). The incidence of liver cirrhosis is more than 50% in alcoholic hepatitis, and a small number of nonalcoholic fatty liver disease may develop into cirrhosis.
1, obesity fatty liver: the degree of liver fat accumulation is proportional to body weight. About 30% to 50% of obese patients with fatty liver, severe obesity, fatty liver disease rate of up to 61% ~ 94%. The fat infiltration of obese individuals was also reduced or disappeared after being controlled. The treatment of fatty liver should be to adjust diet, as a basic principle of the "two low", namely, the amount of protein, low sugar and low fat diet, usually pay attention to light, not too full, the amount of fresh vegetables and fruits, caloric restriction. At the same time, we must strengthen the exercise, and actively lose weight, as long as weight loss, liver fat infiltration is significantly improved.
2, alcoholic fatty liver; long term alcoholic liver biopsy, 75% ~ 95% fatty infiltration. It was observed that drinking more than 80 to 160 grams per day, the incidence of alcoholic fatty liver increased from 5 to 25 times. Treatment should start from the restriction of alcohol intake, mild alcoholic fatty liver as long as the alcohol for 4 to 6 weeks, transaminase may be reduced to normal levels.
3, rapid weight loss of fatty liver: fasting, excessive dieting or other fast weight reduction measures can cause the decomposition of fat in the short term increased the amount of consumption of liver glutathione (GSH), the liver MDA and lipid peroxide increased, liver cell damage, leading to fatty liver. From the known research point of view generally through pure diet weight loss or drug weight loss a month weight loss of 1/10 or more of the possibility of fatty liver is very large, and once the weight loss rebound will be very fast. At present, many young people suffering from fatty liver is caused by blind weight loss.
4, dystrophic fatty liver: malnutrition protein deficiency is an important cause of fatty liver in inadequate intake or digestive disorders, cannot synthesize apolipoprotein, so that the accumulation of triglyceride in the liver, the formation of fatty liver. Such as severe nutritional deficiency patients showed protein deficiency edema, weight loss, skin depigmentation and fatty liver, given a high protein diet, liver fat quickly reduced; or input amino acids, protein synthesis with normal, rapid elimination of fatty liver.
5, diabetic fatty liver; about 50% of patients with fatty liver in patients with diabetes, which is more adult patients. Because adults with diabetes from 50% to 80% are obese, the plasma insulin level and plasma fatty acids, fatty liver variable is associated with the degree of obesity, and eating too much fat or sugar. This patient should take etiological treatment, on the other hand, low sugar low fat, low calorie and high protein diet, patients accounted for total calories 25% calories of fat%.
6, drug induced fatty liver: certain drugs or chemicals through the inhibition of protein synthesis by fatty liver, such as tetracycline, adrenocorticotropic hormone, puromycin cyclohexylamine emetine and arsenic, lead, silver and mercury. Lipid lowering drugs can also interfere with the metabolism of lipoprotein and fatty liver. This type of fatty liver should be immediately discontinued the drug, if necessary, with supportive treatment until the fatty liver recovery.
7, pregnancy fatty liver: more in the first pregnancy of 34 to 40 weeks of onset, severe illness, poor prognosis, maternal and child mortality rate of up to 80% and 70%. The clinical manifestations were severe vomiting, upper abdominal pain and so on. Timely termination of pregnancy can make an illness reversal, a few after natural delivery or caesarean section and escape.
8, other diseases caused by the fatty liver: tuberculosis, bacterial pneumonia and sepsis infection can occur when there is fatty liver in patients with viral hepatitis, if too restrictive, and the intake of high sugar, high calorie diet, hepatic fat accumulation; receiving corticosteroids, fatty liver is more likely to occur. Control of infection or removal of the cause of the rapid improvement of fatty liver, as well as the so-called parenteral fatty liver, fatty liver disease, genetic diseases caused by fatty liver. Fatty liver is a pathological phenomenon, do not need to be treated as a disease alone, nor is it no medicine. When you find fatty liver, should go to the hospital to check carefully, find out the cause, for treatment, the vast majority of fatty liver is normal.
Classification by degrees
Early simple fatty liver.
Middle stage - steatohepatitis.
Advanced fatty liver cirrhosis.
Cause of disease
The fatty liver in the following: obesity, excessive drinking and high fat diet,
Pathogenesis of nonalcoholic fatty liver disease
Patients with chronic hepatitis B, chronic liver disease and endocrine. Obesity, excessive alcohol consumption and diabetes are the three main causes of fatty liver disease.
The etiology of large fat drop fatty liver
1, nutrition: children with malignant dystrophy (forashiorkor) gastrointestinal diseases, pancreatic diseases, obesity, intestinal bypass and long-term parenteral nutrition.
2, metabolism: diabetes and galactosemia, glycogen storage disease, fructose intolerance, hepatolenticular degeneration, tyrosinemia, hyperlipidemia, abetalipoproteinemia, Wolman disease, panniculitis.
3, drug: including alcohol poisoning, long-term use of adrenal cortex hormones or liver toxins.
4, the virus infection: including hepatitis C and hepatitis E virus infection and other systemic diseases.
5, occult: in the etiology of diabetes, obesity and alcohol fatty liver is the most common. The pathological examination of liver biopsy in patients with diabetes and obesity can be found from 60% to 90%.
The etiology of small fat drop fatty liver
Acute fatty liver of pregnancy, Reye syndrome, tetracycline, fatty liver disease, Jamaica vomiting of valproic acid (val- proate) poisoning, congenital defects, urea cycle enzyme alcohol poisoning and cholesterol deposition disease, especially in fatty liver of pregnancy, tetracycline, fatty liver and Reye syndrome is the most common.
Several causes of fatty liver formation
1, the wine is the culprit, long-term drinking, lead to alcohol poisoning, resulting in the reduction of oxidation of fat in the liver, chronic alcoholics nearly 60% fatty liver, 20% to 30% will eventually develop into liver cirrhosis.
2, the long-term intake of high fat diet or large quantities of sugar, starch and other carbohydrates, the liver fatsynthesis too much.
3, obesity, lack of exercise, so that excessive intake of fat in the liver.
6. Acute or chronic liver injury caused by some drugs.
The fat in food by enzyme hydrolysis and bile salt binding, absorbed by the intestinal mucosa, and the formation of chylomicrons and protein, cholesterol and phospholipids in chylomicrons into the liver sinusoids Kupffer cells into glycerol and fatty acids, fatty acid in the liver cell mitochondria in oxidation, decomposition and release of energy or esterification; the synthesis of three glycerol; or in the endoplasmic reticulum into phospholipids and cholesteryl ester formation. Most of the three acyl glycerol in liver cells, such as apolipoprotein, form very low density lipoprotein (VLDL) and enter the blood circulation. VLDL in the blood fat as fatty acid to provide a variety of tissue energy. Lipid metabolic disorder is the cause of fatty liver:
(1) excess fat, hyperlipidemia, and increased fat tissue mobilization (hunger, trauma, and diabetes) in the diet, free fatty acid (FFA) transport to the liver, providing a large number of precursors for the synthesis of the three acyl glycerol in the liver.
(2) the lack of essential fatty acids in food, acute alcohol intoxication, acute threonine deficiency, and high doses of barbiturates cause the increase of the synthesis of free fatty acid and free fatty acid in the liver cells of three.
(3) the intake of calories is too high, and the conversion from sugar to the increase of the amount of three acyl glycerol.
(4) clearance of free fatty acids in hepatocytes was reduced, and excessive consumption of alcohol, choline deficiency, carbon tetrachloride, and poisoning by B and l could inhibit the oxidation of free fatty acids in the liver. The synthesis of phospholipid can be blocked by the poisoning of B and the deficiency of choline.
(5) VLDL synthesis or secretion disorder of one or more links, destroy the dynamic balance between adipose tissue and liver cells and blood fat metabolism, synthesis of hepatocytes three glycerol balance and secretion, resulting in lipid based neutral fat in the liver cells in the excessive deposition of fat swollen.
The amount of total fat in the liver was about 5% of the liver weight, including phospholipids, triglycerides, fatty acids, cholesterol and cholesterol.
Fat content of more than 5% for mild fatty liver, more than 10% for moderate fatty liver, more than 25% for severe fatty liver. When the total amount of fat in the liver exceeds 30%, it can be checked out by B ultrasound, which is diagnosed as fatty liver by b-ultrasound". In the patients with fatty liver, the total lipid content could reach 40% ~ 50%, and some of them were more than 60%, mainly triglyceride and fatty acid. Fatty liver is the key to early detection, early treatment.
Fatty liver is a kind of pathological state of abnormal accumulation of fat in liver cells. This pathological condition is the most common response of the liver to various injuries.
The fat in food by enzyme hydrolysis and bile salt binding, absorbed by the intestinal mucosa, and the formation of chylomicrons and protein, cholesterol and phospholipids in chylomicrons into the liver sinusoids Kupffer cells into glycerol and fatty acids, fatty acid in the liver cell mitochondria in oxidation, decomposition and release of energy or esterification; the synthesis of three glycerol; or in the endoplasmic reticulum into phospholipids and cholesteryl ester formation. Most of the three acyl glycerol in liver cells, such as apolipoprotein, form very low density lipoprotein (VLDL) and enter the blood circulation.
Palmar and spider nevus
The clinical manifestations of fatty liver are various, the patient has no self-conscious symptom, and the majority of patients are fat, so it is more difficult to find mild symptoms. Some only mild fatty liver fatigue, similar chronic hepatitis showed severe fatty liver, there may be loss of appetite, fatigue, abdominal distension, belching, nausea, vomiting, weight loss, liver or right epigastric distension pain sensation. The clinical examination, 75% patients with mild hepatic enlargement, a patient can appear splenomegaly, spider nevus and liver palms.
Because the patient transaminase often has or continues to rise repeatedly, but also has the liver to swell, is easy to misdiagnose as the hepatitis, should pay special attention to distinguish. CT has a higher diagnostic accuracy, but the diagnosis depends on liver biopsy.
The clinical manifestations of fatty liver are various, and mild fatty liver has no clinical symptoms. It is reported that about 25% of patients with fatty liver can be asymptomatic clinically. Some have only a sense of fatigue, and the majority of patients with fatty liver fat, it is harder to find mild symptoms. Therefore, patients with fatty liver more than physical examination found. Similar to chronic hepatitis showed severe fatty liver, there may be loss of appetite, fatigue, nausea, vomiting, weight loss, liver or right upper quadrant pain. Mild liver enlargement can have tenderness, texture, slightly tough edge obtuse and smooth surface, a minority of patients with splenomegaly and liver palms. When the fat deposition in the liver is overmuch, can make liver membrane swelling, hepatic ligament pull, caused severe right upper abdominal pain or tenderness, fever, leukocytosis, easily misdiagnosed as acute abdomen and laparotomy. When the bubble burst, the fat particles into the blood can also cause cerebral and pulmonary fat embolism and sudden death. The portal vein flow and bile excretion were blocked, and portal hypertension and cholestasis were found when the hepatic fat accumulation. Because of acute chemical poisoning, drug poisoning or acute fatty liver of pregnancy, the clinical manifestations of the patients with acute or subacute liver necrosis, and easily confused with severe hepatitis. In addition, fatty liver patients often have glossitis, angular cheilitis, skin ecchymosis, numbness of limbs, limbs feel abnormal change of peripheral neuritis. A small number of patients may also have gastrointestinal bleeding, gingival bleeding, epistaxis, etc.. Patients with severe fatty liver can have ascites and lower extremity edema, electrolyte disorders, such as low sodium, hypokalemia, fatty liver performance, when there is difficulty in diagnosis, liver biopsy.
Fatty liver often does not have self-conscious symptom, some are similar to mild disease hepatitis, jaundice is rare, if have also be mild. B ultrasound, CT can be of diagnostic significance, must rely on liver biopsy.
1, no history of alcohol consumption or alcohol equivalent to the amount of alcohol per week of 140 grams of men, women, 70 grams;
2, excluding viral hepatitis, drug-induced liver disease, total parenteral nutrition, liver degeneration can lead to fatty liver disease.
3, in addition to the primary clinical manifestations of the disease, have specific symptoms and signs of weakness, indigestion, liver pain, hepatosplenomegaly and other non.
4, there may be overweight / visceral obesity, fasting blood glucose, dyslipidemia, hypertension and other metabolic syndrome.
5, serum transaminase and glutamyl transpeptidase levels can be increased by mild to moderate (less than 5 times the upper limit of the normal value), usually with alanine aminotransferase (i.e. the past commonly known as "GPT") increased
6. The imaging findings of liver were consistent with the diagnostic criteria of diffuse fatty liver
7. Histological changes of liver biopsy accord with the diagnostic criteria of fatty liver disease.
Anyone who has any of the items mentioned above 1-5 and sixth or seventh can be diagnosed as fatty liver.
It is worth mentioning here is the BMI (body mass index) calculation methods and criteria. BMI= weight (kg) / height (m)]2. For Asian adults, BMI = 23kg/m2 BMI = 25kg/m2 that overweight showed mild obesity, BMI = 30kg/m2 indicated severe obesity. Central obesity refers to: male waistline is more than 90cm, female waist circumference greater than or equal to 80cm.
Fatty liver disease after the intervention and treatment should emphasize the comprehensive treatment, the patient should change the way of life, diet, exercise, alcohol and smoking, and the control of primary disease (such as hypertension, diabetes and hyperlipidemia). Normal or high risk population with cardiovascular disease is still not enough to fully carry out the treatment of lifestyle, the need for treatment by drugs, including lipid, lowering blood pressure and improving insulin resistance and glucose control etc..
It should be differentiated from other common liver diseases such as viral hepatitis, autoimmune hepatitis, metabolic liver disease and cirrhosis. Focal fatty liver, with primary or secondary liver cancer, liver hemangioma lesions identification.
Severe fatty liver
Severe fatty liver is a kind of fatty liver with severe clinical symptoms and poor prognosis. Strictly speaking, it is a pathological process in some critically ill patients. Acute fatty liver of pregnancy and fatty liver syndrome. It is obviously different from common fatty liver in clinical symptoms, signs and prognosis.
Acute fatty liver of pregnancy
Acute yellow atrophy of liver. It is a serious complication of pregnancy, which is rare in clinic, and the prognosis is bad. The disease occurred at the end of three months (30-40 weeks). It is believed that a large number of oral and oral doses of tetracycline during pregnancy, may induce the disease.
The main clinical symptoms were: persistent nausea, sudden vomiting, and even vomiting blood, accompanied by abdominal pain, jaundice appeared a week, often without pruritus, jaundice after rapidly deepening, followed by different levels of consciousness or coma; mild to moderately elevated serum bilirubin, such as with DIC, vomiting coffee liquid or blood. As well as hematuria, hematochezia, purpura, and gum bleeding at the injection site, at the same time, platelet and fibrinogen decreased, FDP value increased and prolonged prothrombin time, half of the patients with oliguria, early renal failure, metabolic acidosis and other performance.
(two) encephalopathy fatty liver syndrome (Reye syndrome)
The disease occurs mainly in children and adolescents. Before the onset of the disease usually has a virus infection, flu like prodrome and varicella, infection symptoms improved after 2-3 days, suddenly appeared with frequent vomiting, severe headache, delirium, hours into spasm, stupor and cortical state, and finally into the coma. Often accompanied by fever, hypoglycemia, abnormal liver function. The onset of this disease is dangerous, high fatality rate.
Two, liver cancer, liver hemangioma, liver abscess, liver cyst
The changes of localized fatty liver should be differentiated with them. Hepatocellular carcinoma (HCC), especially small hepatocellular carcinoma (HCC) and AFP negative hepatocellular carcinoma (HCC), is difficult to differentiate from localized fatty liver. Under normal circumstances, small hepatocellular carcinoma (HCC) tends to be attenuated, often with subcapsular and portal vein invasion. Metastatic liver cancer was mostly enhanced by ultrasound, and there were multiple nodules and no portal vein invasion. CT showed that the liver cancer was more clearly defined in the area of density reduction. Selective hepatic arteriography can be used to show tumor vessel or hemangioma. Although there are some difficulties in the differential diagnosis of hepatic hemangioma and liver cancer, hepatic arteriography is still valuable for the prevention of liver abscess and liver cyst. Ultrasound guided liver biopsy is an effective method for the diagnosis of various kinds of liver space occupying lesions.
Three, viral hepatitis
Fatty liver in patients with hepatic steatosis showed diffuse distribution, often need to differentiate with viral hepatitis. In patients with viral hepatitis has fatigue, anorexia, fever, nausea, vomiting, jaundice, urine and other symptoms, epidemiology and aetiology are helpful in diagnosis.
Fatty liver refers to the excessive accumulation of fat in the liver, once suffering from fatty liver, how to deal with it?
1, to find out the cause, take targeted measures. Such as long-term abstinence should drink a lot. Excess nutrition, obesity should be strictly controlled diet, so that physical recovery. Diabetic patients with fatty liver should actively and effectively control blood glucose. Nutritional fatty liver patients should be appropriate to increase nutrition, especially protein and vitamin intake. In short, the removal of the cause is conducive to the treatment of fatty liver.
2, adjust the diet structure, promote high protein, high vitamin, low sugar, low fat diet. Do not eat or eat animal fat, sweets (including sugary drinks). Eat more vegetables, fruits and foods rich in fiber, and high protein meat, fish, bean products, do not eat snacks, do not eat before going to bed.
3, the appropriate increase in exercise, promote body fat consumption. Run every day, at least 6 kilometers a day to achieve weight loss. Sit up exercise or fitness equipment are very useful.
4, drug treatment, fatty liver is not terrible, early detection of active treatment, generally can be cured, and no sequelae. It is worth noting that the prevention of fatty liver should start with children, especially child, eat what to what, activity and less, once a small pier, may have fatty liver.
Anti hepatic fibrosis: A retinoic acid (Wei Jiasuan), interferon, proline analogs, proline hydroxylase inhibitor and colchicine intervention at least one or several steps in collagen production process. Vitamin A, such as vitamin A and beta carotene, has therapeutic potential. Interferon alpha, beta, gamma three, now that alpha interferon has obvious anti fibrosis effect, and the strongest anti fibrosis effect of interferon gamma. Therefore, the use of interferon in patients with compensated cirrhosis may lead to decompensation. At present, interferon is mainly used for the treatment of chronic viral hepatitis activity, to consider the anti virus and anti hepatic fibrosis, the application should not have been developed to decompensated cirrhosis after different stages; colchicine can act on collagen chain reaction, large-scale clinical studies but with colchicine treatment of liver cirrhosis patients is not successful in improving liver function, fibrosis and prolonged survival and is not significantly better than placebo; corticosteroids can inhibit the synthesis of collagen, and can inhibit the activity of collagenase, promote collagen degradation, but the long-term use of drugs have serious side effects, and decreased immunity, so it is difficult to be recommended for clinical treatment of hepatic fibrosis; liver cell growth factor stimulates collagenase activity to promote collagen degradation, and can inhibit the excessive expression of TGF- gene, and inhibit Hepatocyte apoptosis, which may play an important role in anti hepatic fibrosis. In addition, it can mobilize fat, it may reduce the degree of fatty liver, but its clinical efficacy remains to be further verified.
Up to now, there is no effective medicine to prevent and cure fatty liver. With some of the traditional Chinese medicine ingredients such as turmeric medicine, such as Campbell, are good. In traditional Chinese medicine with Radix Polygoni multiflori and hawthorn best, these two drugs can reduce blood fat, prevent the deposition of cholesterol in the liver. Western medicine often used in protecting liver cells, degreasing agents and antioxidants, such as vitamin B, C, E, lecithin, ursodeoxycholic acid, silymarin, inosine, coenzyme A, glutathione, taurine and carnitine orotate and Glucurolactone, as well as some lipid-lowering drugs (e.g. liver tasties clear) and so on. Although many of these drugs, but most still need to further verify the efficacy and safety, therefore, should be under the guidance of a doctor to choose correctly, must not abuse. But in general, if only instead of fatty liver, hepatic encephalopathy, safety of vitamin B in drug, C, above E, lecithin, inosine, coenzyme A, glutathione, taurine and carnitine orotate vitamins and endogenous amino acid drugs is very high, but also not like drug DDB after discontinuation of esters also appeared to rebound.
1, the movement to correct errors: fatty liver is to eat out, more exercise, less food, naturally good, the concept seems to everyone understand the superficial. As a result, some errors will appear. Such as: "every day I kept moving, I do all the housework"; "I did not empty, every holiday I will go to the fitness center half day"; "I have a lot of work every day, I consume enough, no other sport" and so on. In fact, the appropriate exercise according to the specific circumstances of the patient to develop a program of exercise therapy.
2, the specific situation of specific treatment: the patient's specific circumstances include: gender, age, weight, the size of the usual activity, exercise conditions, the particularity of the work and whether there are other diseases, etc.. For example, to walk after lunch is appropriate, but some patients may not be suitable for some; with lower limb joint degenerative disease, we should not choose like jogging, landing joint activities exercise greater degree; the same age and other health conditions similar to the young men and women, because of gender, body different amount of exercise given should be different, which is why in the treatment of fatty liver must make corresponding guidance for comprehensive evaluation by professional doctors according to the specific circumstances of patients after.
3, sports also need a prescription: the therapeutic exercise need to assess objectively and comprehensively to the patients according to the specific circumstances of patients in the Department of Gastroenterology physician and rehabilitation medicine, establish a scientific exercise prescription, make specific quantitative indicators in all aspects of the movement method, time, intensity, frequency and amount of exercise, then the adaptability and curative effect of the patients of stage assessment, continuous adjustment, continuous improvement. The movement of the project, due to its quantitative indicators, the resulting "oxygen consumption" is also different. Exercise prescription specialist for you, will you Shenliang system.
The formulation of exercise prescription is not only suitable for the specific circumstances of patients, but also to grasp the appropriate "oxygen consumption", so as to achieve a reasonable, scientific and safe standards.
4, moderate exercise instead of drugs; strongly recommended: fatty liver treatment of the 3 key
What projects are suitable for you? Dynamic systemic low intensity exercise on body strength and endurance as the goal, namely, aerobic exercise, such as jogging, fast walking (115 ~ 125/ minutes), riding a bicycle, stairs, climbing, playing badminton, shuttlecock, shoot the ball, dancing, jumping rope, broadcast gymnastics and swimming. The sympathetic nerve activity, plasma insulin decreased and catecholamines, glucagon and growth hormone secretion, inhibit the synthesis of triglycerides, and promote fat decomposition.
The movement of patients with fatty liver should be based on low intensity and long time aerobic exercise. The dynamic activity characterized by aerobic metabolism is effective in reducing fat and reducing liver fat in patients with fatty liver.
How long are you going to practice? With the "intensity * time" said the amount of exercise, high intensity exercise duration should be shorter, if the strength is low to long duration, should be in accordance with the background of life in patients with fatty liver and obesity consider collocation time and strength. The increasing amount of exercise, and do exercise and order and degree, must complete the exercise guidelines for each exercise time.
To walk as an example, from the 5000 steps / day, increasing to 7000 ~ 10000 step walk, trot and walk, gradually increase the amount of exercise; can follow the "3, 5, 7" principle, namely the daily 3000 meters (30min), 5 times a week, every time after walking with age and pulse 170.
1, incoordination between the liver and stomach, liver qi stagnation, blood stasis and phlegm
(1) clinical manifestations:
Liver area pain, chest discomfort, fatigue, nausea, anorexia and sigh with emotion, change change, liver enlargement or swelling, dark red tongue, thin white fur and greasy, pulse fine xuan.
(2) etiology and pathogenesis:
Because of the emotional discomfort, liver qi stagnation, blood stasis, phlegm retention, caused by fatty liver.
(3) treatment principle:
Liver qi, phlegm and blood stasis.
2, spleen dampness, dampness, phlegm stagnation and blood stasis type
(1) clinical manifestations:
Right rib fullness, belching nausea, anorexia, fatigue, thin stool, pale red tongue, thick white greasy moss, pulse moisten relief.
(2) etiology and pathogenesis:
Due to the long eat fat Atsumi of the goods, or emotional disorders and certain disease factors, the spleen and dampness. Become phlegm, liver qi, phlegm dampness in the liver meridian that a fatty liver.
(3) treatment principle:
Liver and spleen, eliminating dampness and phlegm:
3, phlegm and blood stasis, liver and kidney deficiency, spleen deficiency type.
(1) clinical manifestations:
Slightly overweight, dizzy, tinnitus, forgetfulness, occasional headache, five upset hot, dry mouth and throat, insomnia, red tongue, little coating, thready pulse.
(2) etiology and pathogenesis:
Water is not Han wood, liver qi and spleen deficiency in transport, phlegm and blood stasis in the liver, a fatty liver.
(3) treatment principle:
Nourish liver and kidney, blood stasis, phlegm.
4, phlegm and blood stasis, qi stagnation and blood stasis, phlegm stasis stagnation type.
(1) clinical manifestations:
The original XiaoKeBing, ferrite Yin Huo Wang, chronic persistent hepatitis, rib swelling, matter refused to press, reduced diet fatigue, dark purple tongue with ecchymosis, thin white fur, thready pulse astringent.
(2) etiology and pathogenesis:
Block phlegm, blood stasis, phlegm and blood stasis in the liver meridian, liver area pain and tingling in the formation of fatty liver.
(3) treatment principle:
Qi and blood, phlegm and blood stasis, detumescence......
1, fatty liver of traditional Chinese medicine prescriptions 1- Danshen cream orange peel
[Medicine] Salvia 100 grams, 30 grams of dried tangerine peel, honey 100 ml.
[usage] salvia, Chenpi water decoction, to slag take concentrated juice with honey paste. 20 ml each time, 2 times a day.
[effect] blood stasis, Qi expectorant. Suitable for fatty liver qi stagnation and blood stasis.
2, fatty liver 2- Bergamot Decoction of traditional Chinese medicine prescriptions
[Medicine] Bergamot citron, each 6 grams, sugar amount.
[usage] Bergamot citron, water decoction, to slag juice add sugar and mix thoroughly, 2 times a day.
[effect] Shugan Jieyu huatan. Applicable to the stagnation of liver Qi type fatty liver.
3, fatty liver of traditional Chinese medicine prescriptions 3- Hawthorn Salvia honey drink
 prescription of Salvia miltiorrhiza, hawthorn 15 grams, 9 grams of sandalwood, licorice 3 grams of honey, 30 ml.
[usage] salvia, hawthorn 15 grams, 9 grams of sandalwood, Zhigancao 3 grams of water decoction, to slag juice with honey, then fry some boiling, 2 times a day.
[effect] blood stasis, liver and spleen. Apply to blood stasis type fatty liver.
4, fatty liver of traditional Chinese medicine prescriptions 4- drink two red tangerine peel
[prescription] peel, safflower 6 grams, red dates 5.
[usage] water decoction, juice tea.
[efficacy] activating blood circulation and removing blood stasis, promoting qi circulation and resolving phlegm. Suitable for fatty liver qi stagnation and blood stasis.
1, control the intake of calories, so that the oxidation of fatty acids in the liver cells. Obese people should gradually lose weight, so that the weight of the standard weight range. In the standard body weight, per kilogram of body weight can be 84 ~ 105 thousand coke heat energy (20 ~ 25 thousand cards). The standard weight (kg) = height (CM) -105 (or 100), male 165 cm above minus 105, while women and men below 165 centimeters by 100.
2, restrictions on fat and carbohydrate intake, calculated according to standard weight per kilogram of body weight per day to 0.5 to 0.8 grams of fat, should use vegetable oil or containing long chain unsaturated fatty acids in foods such as fish; carbohydrate per kilogram of body weight per day to 2 ~ 4 grams, sugar intake should not be too much.
3, high protein diet, daily weight per kg can be 1.2 ~ 1.5 grams, high protein can protect the liver cells, and can promote the repair and regeneration of liver cells. The supply of high quality protein, protein should account for an appropriate proportion, such as tofu, Yuba bean products, lean meat, fish, shrimp, milk etc..
4, to ensure the supply of fresh vegetables, especially green leafy vegetables, in order to meet the body's needs for vitamins. But not too much sugar and vegetables and fruits can not eat too much.
5, the right amount of water, in order to promote the body metabolism and metabolic waste excretion.
6, containing methionine rich foods, such as millet, naked oats, sesame, rape, spinach, cauliflower, beet, dried shrimps, scallops, mussels and other food can promote the in vivo synthesis of phospholipids to change the fat in liver cells.
Fatty liver diet, fatty liver patients can be supplemented by the following therapeutic methods:
1 take 20 grams of porridge Polygonum multiflorum, rice 50 grams, jujube 2 pieces. Will there are washed and dried, smashed the spare, then put rice, red dates with 600 ml of water, into the pot boiled porridge, add into the end of Polygonum multiflorum mix, simmer boiling number, take warm morning fasting.
2 red bean carp soup, take 150 grams of red bean, 1 carp (about 500 grams), 6 grams of roses. The carp killed to intestinal mixed, and other flavor of adequate water, cook until overripe. To take the seasoning, 2 ~ 3 times to take.
3 take spinach spinach soup 200 grams, egg 2. Wash the spinach, into the pot and stir fry, add appropriate amount of water, after boiling, into the egg, add salt, MSG seasoning, table.
Patients with liver disease more irritable, so in the conditioning process, we must attach importance to relieve emotional and psychosomatic and governance, maintain a common heart". Because in normal physiological circumstances, if the liver function is normal, neither excitement nor depression, so the body can better coordinate their own mental performance, the spirit is happy, happy. Otherwise will be manifested as melancholy, irritability etc..
The core is to learn emotional liver anger, even angry, not more than 3 minutes. Fatty liver people through appropriate entertainment to achieve the purpose of regulating emotions, such as listening to music, watching comedy, people can secrete some healthful hormones, enzymes and acetylcholine and other substances, can make gastric peristalsis more regularly and is conducive to the improvement of digestive function. At the same time, fatty liver crowd also want to make friends, communicate with friends, etc..
For people with fatty liver, good habits are also very important. The usual diet should be light, more exercise, alcohol and other restrictions. Can also be appropriate to choose to take the liver has nourishing and protecting liver, fatty liver
1 reasonable meals three meals a day to be reasonable allocation, so that the thickness of the nutritional balance, a sufficient amount of protein to clear the liver fat.
2 appropriate exercise every day to adhere to physical exercise, physical fitness can choose their own suitable sports, such as jogging, playing table tennis, badminton and other sports. To start from a small amount of exercise gradually to achieve the appropriate amount of exercise, in order to strengthen the body fat consumption.
3 using drugs the liver is the body's chemical factory, any drugs into the body to go through the liver detoxification. So do not usually take medicine. For patients with symptoms of fatty liver, in the choice of drugs should be more careful to guard against the side effects of drugs, especially for the liver damage drugs can not be used, to avoid further damage to the liver.
4, in addition to the mood cheerful rage, less angry, etc. it is important to pay attention to work and rest.
5 control energy intake: for fatty liver patients, energy supply should not be too high. In the light of the activity, the body weight in the normal range of patients with fatty liver should be 126 kg ~ 147KJ per day (35kcal ~ 30), in order to prevent weight gain and avoid aggravating fat accumulation. For those who are overweight or obese, the daily weight should be 84 ~ 105KJ (~ 20 ~ 25kcal), in order to control or reduce weight, and strive to achieve the ideal or suitable weight.
6 improve the quality and quantity of protein: supply sufficient protein for lipoprotein synthesis, clear liver fat accumulation, promote the repair and regeneration of liver cells. The daily supply of protein to 110 ~ 115g, heavy manual workers added to the daily 115 ~ 210g, accounting for the total energy of 10% ~ 15% is appropriate, and to ensure a certain amount of quality protein. In addition, it is important to maintain the balance of amino acids. Methionine, cystine, tryptophan, threonine and lysine in the protein have the effect of anti fatty liver.
7: amount of fat fatty liver patients still should be given the right amount of fat, and essential fatty acid synthesis in phospholipids, can make fat from the liver and smooth out, favorable for fatty liver. Recommended daily fat < 30g, accounting for about 20% of the total energy is appropriate. Vegetable oil contains sitosterol, soybean sterols and essential fatty acids have good convergence effect can prevent or eliminate fat, fatty degeneration of liver cells, useful for the treatment of fatty liver. Cooking oil should use vegetable oil. Appropriate restrictions on foods with high cholesterol.
8 control carbohydrates: should a low carb diet, fasting food rich in mono - and disaccharides, such as sugar cakes, ice cream, candy and dry, in order to promote the elimination of leg fat in the liver. But too much carbohydrate can reduce the body's sensitivity to insulin. Daily carbohydrates accounted for about 60% of the total energy.
9 add enough vitamins, minerals and trace elements: the liver stores a variety of vitamins. Storage capacity in liver disease, if not timely attention to supplement, will cause the body of vitamin deficiency. Note that the addition of vitamin C, vitamin B6, vitamin B12, vitamin E, folic acid, choline, inositol, potassium, zinc, magnesium and other foods, in order to maintain normal metabolism, protect the liver, to correct and prevent the lack of.
10 add enough dietary fiber: dietary fiber can reduce the time of gastric emptying, reduce fat and sugar intake and absorption, with the role of lipid-lowering, hypoglycemic. Diet should not be too fine, the staple food grains should be thick collocation, eat more vegetables, fruits and algae, to ensure sufficient quantities of dietary fiber intake.
Fatty liver is not all fat and alcohol lovers "patent", excess nutrients can eat a fatty liver, excessive drinking can drink out of the current prevalence of fatty liver, weight loss, excessive hunger can also cause liver metabolic disorders, leading to fat accumulation in the liver can also be "hungry" fatty liver. No matter what is the cause of fatty liver, some patients can develop steatohepatitis and liver fibrosis, and ultimately lead to cirrhosis, therefore, must be carried out as soon as possible effective prevention and treatment of fatty liver.
Causes of the formation of fatty liver is various, and now there is an important relationship between the people's diet and lifestyle, with the improvement of living standards, people eat too much food with high fat and high protein, coupled with the increase in alcohol, cause less exercise and obesity. In fact, through the adjustment of lifestyle and scientific diet, weight control and reasonable treatment, fatty liver can be cured.
"Picky" can help you to stay away from fatty liver
Eat: visceral avoid eating high cholesterol foods, such as animal offal, chicken skin, etc.. Pepper, pepper, curry.
Drink: chicken soup, fish soup, broth containing nitrogen leaching of high food should be avoided.
Limit: 6 grams of salt a day is appropriate, do not eat animal oil, vegetable oil consumption should be limited.
The following foods to eat:
Oats: contains very rich linoleic acid and rich saponins, not only can reduce the serum cholesterol, triglycerides, but also has laxative effect on diabetes patients to lose weight is also very effective.
Tremella: rich in protein, fat, dietary fiber, pectin and trace elements, is very beneficial to the human body of Tremella polysaccharide.
Tremella polysaccharides can not only improve the function of liver and kidney, can reduce serum cholesterol, triglyceride, promote liver protein synthesis, enhance human immunity.
Corn: rich in calcium, selenium, lecithin and vitamin E and so on, have a role in reducing serum cholesterol.
Garlic: a mixture of sulfur compounds that reduce blood cholesterol, prevent thrombosis, and help increase HDL levels.
Kelp is rich in taurine, can reduce cholesterol in blood and bile; also contain dietary fiber alginic acid, can inhibit the absorption of cholesterol, promote its excretion.
Cordyceps: studies have found that Cordyceps sinensis can improve and restore liver function. Cordyceps sinensis in clinical use in recent years, improve liver function have a certain effect, according to the study of cordycepin and Cordyceps polysaccharide can enhance the phagocytic function of liver cells, cordycepic acid, SOD and vitamin E can resist hepatic fibrosis, anti lipid peroxidation, and enhance immune function due to the detoxification of Cordyceps effect of liver enhancement, which can effectively protect the liver cells.
Whole grains of starch containing foods and various fruits, honey, can supply sugar, add daily calories, improve liver detoxification function. Sesame, peanut, soybean, rapeseed, sunflower, corn, coconut and other food and vegetable oil, egg yolk, milk, etc., can provide supplemental heat for fatty acids, fatty liver patients, help the absorption of fat soluble vitamins. Fish, shrimp, shellfish, cattle, sheep, pig meat, eggs and other food, can add protein, which can promote the repair and regeneration of liver cell metabolism, supplement consumption, provide some heat.
Reasonable diet control and exercise is the most important method for the treatment of patients with chronic fatty liver, and it is also an important measure to prevent and control fatty liver. But the vast majority of patients, it is difficult to adhere to long-term exercise and diet behavior therapy. Prevention and elimination of fatty liver, not only to regulate the diet, but also the right amount of exercise.
Fatty liver can be an independent disease or may be a manifestation of certain systemic diseases:
The 1 is often associated with other manifestations of alcoholism: such as alcohol dependence, pancreatitis, peripheral neuritis, anemia, glossitis, alcoholic hepatitis and liver cirrhosis.
2 nutritional excess fatty liver and other diseases associated with management often appear, such as: obesity, diabetes, hyperlipidemia, hypertension, coronary heart disease (CHD), gout, cholelithiasis, etc..
3 fatty liver, often associated with chronic wasting diseases such as tuberculosis, ulcerative colitis, etc..
4 acute fatty liver of pregnancy, often accompanied by renal failure, hypoglycemia, pancreatitis, sepsis, disseminated intravascular coagulation (DIC), etc..
5 severe fatty liver patients can have ascites and oedema of the lower extremities, may also have other spider nevus, male breast development, testicular atrophy, impotence, amenorrhea, infertility and other woman.
6 hyperlipidemia due to fat deposition in the liver to liver damage, high density lipoprotein and Taiwan into reduction, increased relatively low density and very low density lipoprotein, causing high blood lipids, become the risk of heart disease and stroke. And a variety of reasons can cause hyperlipidemia and fatty liver, forming a vicious cycle. Mainly manifested as dizziness, headache, chest tightness and other symptoms.
7 hypoglycemia and hemolytic anemia alcoholic hyperlipidemia syndrome (Zieve syndrome): mainly in patients with alcoholic liver disease, Zieve syndrome refers to patients with jaundice, hyperlipidemia and hemolytic anemia in chronic alcoholism.
8 there is no direct causal relationship between nonalcoholic fatty liver disease and liver cancer, but there is a small incidence of liver cancer. However, the incidence of liver cancer is increased if the cause of liver cirrhosis or the cause of fatty liver also plays a role in the formation of liver cancer. Alcoholic fatty liver can be complicated with liver cancer.
9 fatty liver fibrosis and cirrhosis of the liver although few symptoms, but the liver itself is not a healthy liver, in the tired, medication, unclean diet under the influence of various pathogenic factors and fatty infiltration of the liver damage, can cause liver cell degeneration, necrosis, regeneration and fibrous tissue hyperplasia and other pathological changes and this change occurred repeatedly in liver tissue, the liver fibrosis, eventually lead to cirrhosis of the liver. Manifested as fatigue, indigestion, bleeding, ascites and other symptoms
1 serum enzyme test
(1) ALT, AST: generally mild, up to the normal upper limit of 2 ~ 3 times. The AST of alcoholic fatty liver was significantly increased, AST/ALT> 2 had diagnostic significance. Non alcoholic fatty liver ALT/AST> 1. ALT> 130U, suggesting that the hepatic lobule fat infiltration was obvious, and the continuous increase of ALT indicated that there was fat granuloma.
(2) -GT and ALP in alcoholic fatty liver were more common than those of -GT, and the ALP was also increased, reaching the normal upper limit of 2 times. The -GT of patients with nonalcoholic fatty liver disease could be increased.
(3) GST: can reflect stress liver injury, more sensitive than ALT.
(4) glutamate dehydrogenase (GDH) and ornithine Carbamoyltransferase (DCT). GDH is a mitochondrial enzyme, which is mainly active in the liver acinus zone, and DCT is a urea synthase. Two enzymes were elevated in fatty liver. Especially alcoholic fatty liver, its GDH/OCT> 0.6.
(5) cholinesterase (CHE) and lecithin cholesterol acyltransferase (LCAT) fatty liver:80% serum CHE and LCAH increased, but the low nutritional status of alcoholic fatty liver increased significantly. CHE has certain significance in the differential diagnosis of fatty liver.
2 plasma protein changes
(1) beta globulin, alpha 1, alpha -, beta lipoprotein increased significantly, and so on.
(2) albumin more normal.
(3) LDL-C increased, HDL-C decreased significantly, Apo B, Apo E, Apo C and III increased in obese patients with fatty liver.
3 plasma lipids TG, FA, cholesterol, phospholipids often increased, of which cholesterol increased significantly, often > 13mmol/L.
4 the excretion of BSP and ICG were decreased. In obesity and nonalcoholic fatty liver, because fat storage in liver acinus and pigment processing zone 3, also in this area. The liver fat storage affected liver cell pigment excretion function. The extent of excretion was related to the degree of fatty infiltration of the liver.
5 bilirubin serious fatty liver can be increased when the blood bilirubin, mild moderate fatty liver bilirubin more normal.
6 prothrombin time (PT) of nonalcoholic fatty liver is more normal, some can be extended.
7 the level of serum insulin was delayed, and the peak of glucose tolerance curve was increased and the latency was delayed.
8 blood urea nitrogen and uric acid were increased.
The ultrasonic images of 1 ultrasound diffuse fatty liver is mainly manifested as echo attenuation, attenuation according to the degree of fatty liver can be divided into 3 types: (1) mild fatty liver: enhanced performance for near-field far-field echo, echo attenuation is not obvious, intrahepatic tubular structure is still visible.
(2) moderate fatty liver: front echo back echo attenuation, tubular structure fuzzy.
(3) severe fatty liver: near field echo significantly enhanced, far field echo attenuation, tubular structure is not clear, can not be identified. The sensitivity of ultrasound to severe fatty liver was 95%.
2.CT examination of fatty liver CT images and real time ultrasound (US) images showed different. CT diagnostic accuracy is better than that of B ultrasound, mainly for liver or density of the limitations of reducing, even lower than the spleen and liver vascular density, by contrast, in the portal vein increased echogenicity, lower density is consistent with the severity of fat. Dynamic CT changes can reflect the increase or decrease of fatty infiltration in the liver. Diffuse fatty liver (CT) showed that the density of liver was generally lower than that of spleen and liver, while the CT value of liver could be reduced to about 10Hu (6 ~ 12Hu) in severe fatty liver. The enhanced CT scan, fatty liver and intrahepatic blood vessels showed clearly that the morphology and trend are no exception, sometimes small, variable vascular narrowing, but no time, wrapped around the phenomenon, is helpful in the differential diagnosis of hepatocellular carcinoma and fatty liver in the focal region (involving non normal liver,).
CT is generally considered to be less valuable than US and 3.MRI. Magnetic resonance imaging of fatty liver (MRI) for the performance of the whole liver, or a focal fatty infiltration, spin echo (SE) sequence and inversion recovery (IR) pulse sequence of normal T1 weighted signal. Short IR sequences and SE weighted images of the T2 signal may be slightly higher, but only show a fat like proton; fat infiltration zone is high signal, the normal location of the liver blood vessels. In recent years, MRI has been used to measure the fat content of liver tissue.
4 liver biopsy is an important method for the diagnosis of fatty liver, especially for the patients with fatty liver. It is more accurate and safe to take the liver biopsy under the guidance of B ultrasound than the previous method. The significance of biopsy is to determine whether there is fatty infiltration in the liver.
(1) focal fatty liver or diffuse fatty liver with normal liver island is difficult to distinguish from malignant tumor.
(2) the etiology proved some rare fatty liver disease, such as cholesterol ester storage disease, glycogen storage disease and Wilson disease.
(3) liver biopsy is the only means of diagnosis in patients with asymptomatic suspected nonalcoholic steatohepatitis.
(4) patients with alcohol and alcoholic liver disease or alcoholic liver disease who are not able to explain the clinical or biochemical abnormalities, and the need for liver biopsy to exclude active infection prior to corticosteroid therapy.
(5) in patients with obesity and fatty liver, the liver function was still abnormal after reducing the original weight by 10%.
(6) suspected of severe hepatitis caused by fatty liver, the need for a clear diagnosis of liver biopsy and understanding of its causes.
(7) evaluate certain serological indexes and ultrasonography and CT imaging in diagnosis of fatty liver fibrosis, reliability, to liver histological changes as the gold standard, and the exact effect to a treatment objective evaluation of treatment of fatty liver fibrosis.
(8) any suspected liver steatosis or liver damage caused by a variety of factors, such as the absence of simple steatosis or the need for liver biopsy, should be made clear by a liver biopsy.
The relationship between fatty liver and liver cirrhosis
Fatty liver and liver cirrhosis are the common liver diseases, liver cirrhosis if daily attention, can develop into liver cirrhosis, consequences be unbearable to contemplate.
Fatty liver, refers to a variety of reasons caused by excessive accumulation of fat in the liver cells. Fatty liver disease is a serious threat to the health of Chinese people, has become the second largest liver disease after viral hepatitis, has been recognized as a common cause of concealed cirrhosis. Fatty liver is a common clinical phenomenon, not an independent disease.
Liver cirrhosis is a common chronic progressive liver disease in the world, which is caused by one or more causes of chronic liver injury. On the histopathology of liver cell necrosis, extensive residual hepatocellular nodular regeneration and hyperplasia of connective tissue and fibrous septa formation, which led to the destruction of liver pseudolobule lobules and liver, deformation, harden and gradually develop into liver cirrhosis