What are degenerative processes in the liver called? Course and prognosis of liver dystrophy of non-alcoholic etiology

Fatty liver is a pathological condition that develops as a result of excessive accumulation of fats (lipids) in the tissues of the organ. The second name of the disease is fatty hepatosis or fatty liver. Fat accumulation in the liver can occur due to various reasons associated with concomitant diseases or toxic lesions. Let's try to figure out what triggers the development of pathology, what symptoms manifest fatty hepatosis and how to deal with it.

Fatty liver - the main causes

Fatty hepatosis is a chronic disease not inflammatory in nature. The disease develops gradually, most often in adulthood (after 45 years). Moreover, women suffer from fatty liver one and a half times more often than representatives of the stronger sex.

As you can see, there are many reasons for the development of fatty hepatosis. Disorders of lipid metabolism in the liver in some patients develop against the background of gout, arterial hypertension, endocrine (thyroid disease) and immune disorders.

The disease mechanism can be triggered by a sedentary lifestyle, hormonal imbalances, vegetarianism, which leads to impaired carbohydrate metabolism, or a predominance in the diet of sweets, baked goods, confectionery and other foods rich in “fast” carbohydrates that quickly transform into fats.

How does fatty liver develop?

The mechanism of development of fatty hepatosis is simple. After the fats that enter the gastrointestinal tract with food are broken down by digestive enzymes, triglycerides and fatty acids are formed. With an excess of fats in the diet and under the influence of provoking factors, these components begin to enter the liver in large quantities, disrupting lipid metabolism and causing the opposite reaction (increased fat synthesis).

Another mechanism for the formation of fats in the liver is associated with the intake of large amounts of “fast” carbohydrates. In this case, the liver simply cannot cope with their utilization, and lipids begin to accumulate inside hepatocytes (liver cells). When examining liver tissue under a microscope, an accumulation of fat cells can be seen. different sizes. When they accumulate inside hepatocytes (liver cells), they speak of the development of fatty hepatosis. If accumulations of fat appear in the intercellular space, this process indicates fatty liver.

Classification of fatty hepatosis

Depending on the characteristics of the pathological process, it is customary to divide fatty liver into several forms:

Liver dystrophy is focal disseminated. This is the initial form of pathology, in which small patches of fat are located in different lobes of the liver. In this case, the disease is asymptomatic.
Severe disseminated dystrophy. The disease gradually progresses, and fatty patches appear everywhere on the surface of the organ. At this stage, the first symptoms of trouble appear.

Diffuse liver dystrophy is characterized by uniform filling of the hepatic lobe with adipose tissue. This form of the disease is accompanied by quite pronounced symptoms that force the patient to seek medical help.
liver disease occurs in a specific form, which is called Zieve syndrome and is characterized by pronounced symptoms that occur suddenly. At the same time, there is an increase in the level of bilirubin and cholesterol in the blood, an increase in the number of triglycerides (fatty compounds that destroy small capillaries) and a decrease in hemoglobin levels.

Acute and chronic fatty liver degeneration

In addition, depending on the form of the process, doctors distinguish between chronic and acute liver dystrophy:

Acute fatty degeneration liver is different sudden occurrence and rapidly increasing symptoms, which threatens severe complications, including cirrhosis. Typically, such conditions develop against the background of severe intoxication of the body, food poisoning, secretive hepatitis, chronic alcoholism. In this case, the patient’s condition is usually serious, characterized by high fever, enlarged liver, nausea, stool upset, pain, bleeding, convulsions, and delirium. The patient needs emergency medical care and hospitalization.
Chronic fatty liver is accompanied by a gradual accumulation of fat in the cytoplasm of liver cells. Subsequently, they merge into a large formation, move the cell nucleus to the edge and completely fill the cytoplasm. Hepatocytes filled with adipose tissue are destroyed and form cysts. With extensive lesions of the liver tissue, a diagnosis of fatty hepatosis is made.

Pathological changes can also affect neighboring organs, resulting in the development of fatty degeneration of the liver and pancreas, accompanied by disruption of digestive processes, the development of the inflammatory process and the addition of a concomitant disease such as chronic pancreatitis.

Symptoms

Timely detection of hepatosis is difficult, since in the initial stages the pathology is asymptomatic. Subsequent manifestations of fatty degeneration depend on the stage of the disease. The first unfavorable signs usually appear at the second stage of hepatosis and are expressed in the following:

Periodically there is a pulling sensation, Blunt pain in the liver area (on the right, under the ribs), which intensifies with alcoholic libations, consumption of fatty foods, spicy dishes, smoked meats and other harmful products.
In the morning, a bitter taste appears in the mouth, followed by belching with an unpleasant aftertaste.
Appetite decreases, attacks of nausea become more frequent, which can result in vomiting (especially after overeating).
Are getting worse dyspeptic disorders(flatulence, bloating, alternating constipation and diarrhea).
The liver gradually increases in size.
A thick yellow coating appears on the tongue.

At the third stage of the disease, the above symptoms worsen and are accompanied by the following manifestations:

increased fatigue, weakness;
sleep disturbances (insomnia at night and drowsiness during the day);
irritability, depression;
symptoms of ascites (increase in abdominal volume due to fluid accumulation);
problems with memory and learning new information;
yellowness of the skin;
pain syndrome, which is practically not relieved by analgesics.

If fatty degeneration is complicated by necrosis of liver tissue, signs such as an unpleasant sweetish “liver” odor from the mouth, sudden weight loss, fever, nosebleeds, impaired heart rate and respiratory functions.

When the first symptoms indicating fatty liver degeneration appear, you must consult a general practitioner or hepatologist to undergo a full examination, clarify the diagnosis and prescribe a course of treatment. Fatty hepatosis is dangerous because in some cases it can quickly progress and lead to cirrhosis of the liver and other serious complications that can be fatal. That’s why it’s so important to start on time complex treatment, which, thanks to modern techniques and new generation drugs, gives good results.

Diagnosis of the disease

When visiting the clinic, the patient will be referred to an appointment with a therapist. The doctor will listen to the patient’s complaints, collect information about lifestyle, bad habits and concomitant diseases. When examining the patient, the abdomen is palpated, the area where the liver is located is tapped, and its boundaries are determined. To understand how to treat fatty liver, the doctor will prescribe a series of laboratory and instrumental studies.

(general, biochemistry, markers for hepatitis viruses);
urine and stool analysis;
Ultrasound of the abdominal organs;
CT or MRI of the liver.

If necessary, an FGDS FGS (endoscopic examination of the esophagus and stomach) is performed or a liver biopsy is performed. Additionally, if indicated, the patient is referred for consultation to narrow specialists: hepatologist, surgeon, gastroenterologist or oncologist.

Treatment of fatty liver

The treatment strategy for fatty liver largely depends on the causes of the disease. In addition to drug treatment, the patient is recommended to adjust his lifestyle: completely abandon bad habits(alcohol, smoking), change your diet and follow a certain diet limiting fats, carbohydrates and increased content proteins.

The essence of drug treatment for fatty liver is as follows:

elimination of provoking factors contributing to fatty liver;
normalization metabolic processes, removal of toxins and breakdown products;
regeneration and restoration of liver cells and normalization of its functions.

Medicines used in treatment processes are divided into several main groups:

Essential phospholipids (Essentiale Forte, Phosphogliv, Essliver Forte). Drugs in this group stabilize cell membranes and promote the restoration and regeneration of liver cells (hepatocytes).

Preparations based on herbal components (Gepabene, Hofitol, Silimar). These are powerful hepatoprotectors that help restore liver function, improve lipid metabolism and prevent further progression of hepatosis.
Medicines containing ursodeoxycholic acid (Ursofalk,). Provide immunomodulatory, choleretic and hypoglycemic effects. These are serious drugs with an extensive list of contraindications and side effects, so they can only be used as prescribed by a doctor and under his supervision.
Amino acid derivatives (Heptral, Glutargin, Gala-Merz). They exhibit regenerating and detoxifying properties and accelerate the recovery of liver cells. They are good for fatty liver degeneration caused by alcohol abuse.
Supplements (Ovesol, Galstena,). These products are created on the basis of plant extracts - oats, milk thistle, tamarisk, nightshade, capers, emblica and other natural ingredients. They work no worse synthetic drugs, contribute to the normalization of lipid metabolism, regeneration of liver cells and prevent their replacement by adipose tissue.

Preparations of animal origin (Heptral, Progepar) show good effectiveness in the treatment of fatty liver. They are produced on the basis of hydrolyzate isolated from pig liver or large cattle. But such medications can cause severe allergic reactions and other complications, so they should be taken only as prescribed by a doctor and taking into account possible contraindications.

In addition to medications, vitamin complexes will be beneficial; in particular, B vitamins, ascorbic acid, vitamin E, niacin, and folic acid will help support liver function.

Treatment of fatty liver with folk remedies

Add the basics drug treatment folk remedies, which include natural ingredients, decoctions and infusions of medicinal plants, will help

Sorrel. Sorrel is useful for fatty liver disease. The sour leaves of this plant help the formation and removal of bile, eliminate stagnation in the biliary system, restoration of liver function due to the normalization of lipid metabolism.
Turmeric. This oriental spice is very beneficial for the digestive tract. Shows pronounced antioxidant properties, reduces the level of glucose and cholesterol in the blood, ensures the production of bile and normalizes metabolic processes in liver tissue.
Milk thistle. Milk thistle meal is an excellent remedy for combating fatty liver. This medicinal plant is the basis of many hepatoprotective drugs (Karsila, Silymarin, Gepabene). You can buy milk thistle powder (meal) or oil at the pharmacy and take these products according to the instructions indicated on the package. A unique medicinal plant not only normalizes the functioning of the liver and promotes the restoration of its cells, but also restores the functioning of the gallbladder, exhibits choleretic effect and eliminates spasms that cause pain.
Cinnamon powder. It can be added to baked goods, tea or coffee. This remedy reduces the level of “bad” cholesterol in the blood and thereby prevents the accumulation of fat in liver cells.

In addition, at the pharmacy you can buy special herbal mixtures based on hawthorn, rose hips, nettle, yarrow and other herbs with choleretic and anti-inflammatory effects. It is recommended to brew them and drink them as tea. This will help improve performance digestive system, gallbladder and liver. Before starting treatment with folk remedies, discuss their use with your doctor.

Diet

The effectiveness of treatment for fatty liver largely depends on proper nutrition and compliance with special recommendations when preparing a diet. In case of fatty liver, diet is not just important - it plays a leading role in healing process and along with the increase motor activity, giving up bad habits and adjusting your lifestyle helps to cope with a dangerous pathology.

For fatty hepatosis, the doctor will prescribe it to the patient. Its essence is to limit fat as much as possible and increase the amount of protein (up to 120 g per day), vitamins and “slow” carbohydrates. Fatty, spicy, and spicy foods are completely excluded from the diet. fried foods, canned food, smoked meats, semi-finished products, limit the consumption of animal fats as much as possible.

Sweets, pastries, confectionery (especially with cream), sweet carbonated drinks, and strong coffee are prohibited. Avoid fatty sauces (mayonnaise), margarine, sausages, lard, high-fat dairy products (whole milk, cream, sour cream, cheese). But low-fat fermented milk drinks (kefir, fermented baked milk, yogurt, yogurt) can and should be included in the daily menu.

Preference should be given to dietary meat (chicken, rabbit, turkey) and low-fat fish. It is recommended to include more in your diet fresh vegetables and fruits, greens. As a side dish you should serve stewed vegetables, mashed potatoes, porridge (buckwheat, oatmeal, millet, rice). Alcohol should be completely excluded!

It is recommended to adhere to fractional meals. This means that food must be taken in small portions, 5-6 times a day, preferably at the same time. Dishes should be steamed, stewed, boiled or baked. It is better to completely avoid cooking methods such as frying. It is recommended to serve ready-made dishes not too hot; they will be better digested when warm.

Do not forget about maintaining a drinking regime. You need to drink at least 1.5 liters of liquid per day. This volume includes clean drinking water, juices, compotes, fruit drinks, green and herbal teas. To avoid the appearance of edema, it is better to drink the main amount of liquid in the first half of the day. Following these recommendations will help cope with the disease and support liver function.

Fatty liver disease, also called fatty liver disease, occurs as a result of the accumulation of adipose tissue in its cells. As a result, the liver can no longer function normally and eliminate toxic substances.

Stages of the disease

Based on the degree of damage to liver cells and the accumulation of simple fats in them, three stages of the disease are distinguished. With fatty hepatosis of the first degree, foci of accumulation of cells with a high concentration of fat are formed. When, due to an increase in the area of these accumulations, connective tissue begins to grow between the cells, we can say that the pathological process has moved to stage II. Fatty liver III degree characterized by a significant accumulation of fat cells and the appearance of pronounced bands of connective tissue ending with strands of fibroblasts.

Causes of the disease

The transformation of normal cells into fat cells can happen for various reasons. This is caused by pathologies associated with lipid metabolism disorders: obesity, type 2 diabetes mellitus, hypertriglyceridemia. Exposure of the liver to toxins can also eventually lead to the development of fatty liver disease. The liver is assigned to function as a kind of filter: it neutralizes toxic and foreign substances in the body. But if toxic effects the impact on the organ becomes permanent (for example, with regular alcohol intake), at some point it will no longer be able to cope with it. The likelihood of developing fatty hepatosis is quite high in people living in areas with increased radiation. In addition, it leads to the disease poor nutrition(irregular food intake, lack of protein in the diet, fasting), as a result of which lipid metabolism is disrupted. Fatty liver degeneration can also result from long reception antibiotics. Endocrine diseases lead to a pathological process in the liver due to excessive or, on the contrary, insufficient action of certain hormones.

Fatty liver: symptoms

As cells become affected, symptoms begin to appear. They become most pronounced on Stage III illnesses when treatment is no longer possible. In this case, only one thing can help a person - a liver transplant. So, the main symptoms of fatty hepatosis are: heaviness in the abdomen from above (in the area where the liver is located), dysbacteriosis, decreased visual acuity, dullness of the skin, nausea, vomiting. These symptoms appear in the acute form of the disease, while the chronic form proceeds without any pronounced symptoms.

Fatty liver: treatment

The basis of treatment is adherence to a special diet aimed at limiting the intake of fat as much as possible. Due to this, it is possible to ensure that the fat that has already accumulated will begin to be actively used, which will rid the liver of it. From the diet you need to exclude fatty fish and meat, meat broths, beans and beans, mushrooms, tomatoes, onions and garlic (fresh), radishes, sour cream and cottage cheese with a high percentage of fat, canned food, smoked foods, carbonated drinks. Coffee should be replaced with unsweetened tea. Compliance with such a diet is mandatory, it is the basis of all treatment!

Fatty liver degeneration is chronic disease organ. In this case, degeneration of gland cells is observed. This pathology occurs quite often and requires compulsory treatment. The liver is the most important unpaired organ. The gland performs a large number of different functions. In particular, digestive, protective, cleansing. Up to one hundred liters of blood passes through the liver every day. During this period, it is cleared of heavy metals, toxins, poisons. And all harmful substances settle in the organ and are eliminated after some time. Consequently, the full functioning of the entire organism depends on the health of the organ.

Fatty liver and its causes

In medicine, fatty degeneration can be called steatosis, hepatosis, lipoidosis, steatohepatosis. The disease does not develop due to an inflammatory process. The main change is large cluster adipose tissue in an organ, which is overgrown with a capsule. These capsules subsequently develop into cysts. If you don't start timely treatment, cysts can rupture, causing serious complications.

Fatty degeneration, most often, begins to develop at a more mature age of 45-50 years. The main cause of pathology is considered to be metabolic disorders. Violations occur against the background of various factors. Liver hepatosis in most men develops due to excessive alcohol consumption. In this case, alcoholic fatty degeneration is diagnosed. A dangerous and frequent complication of the pathology is liver cirrhosis.

Liver damage also occurs due to excessive consumption of energy drinks, drugs, and cigarettes. Many people believe that fatty degeneration appears only in people with overweight bodies. This opinion is fundamentally wrong. Liver hepatosis is often detected in thin people. This phenomenon is explained by protein deficiency in the human body. In this regard, fatty degeneration is typical for vegetarians. People who are addicted to various diets also suffer from this disease. Extreme sudden weight loss gives heavy load on the liver, which begins to accumulate fatty tissue.

Accompanied by the following chronic diseases:

Atherosclerosis;
Diabetes;
Chronic hepatitis;
Viral hepatitis C;
Dysfunction of the endocrine system;
Hormonal disorders;
Pancreatitis.

Other factors can also lead to fatty degeneration. Thus, poor nutrition and low amounts of vitamins consumed negatively affect all organs of the digestive system. develops against the background of frequent intoxication, poisoning, and damage to the body by chemicals. Pesticides that enter the body along with vegetables and fruits damage the liver. Even some medications provoke obesity of the gland. These include antibiotics and hormonal agents. Synthetic hormones with high level Estrogen content causes not only dystrophy, but also polycystic gland disease.

Heart and bronchial diseases cause oxygen deficiency. And oxygen deficiency can also serve as a factor in fatty degeneration. Frequent excess of lipids into the gland is considered dangerous. Lipids settle in the liver, fat droplets accumulate and grow. Small amounts of these components are not dangerous. In this case, hepatocytes have time to process and remove them. The progression of an increase in fat cells leads to the next stage of fatty degeneration - inflammatory hepatitis. Then liver failure and cirrhosis occur.

Symptoms of fatty liver disease

The initial stage of fatty liver is asymptomatic. Therefore, it is extremely difficult to recognize the disease in a timely manner. After all, few people regularly undergo routine medical examinations. The disease can be classified according to several criteria. So, the main one is the classification by stages. The first stage of fatty degeneration is characterized by a small number of fat molecules that do not have a significant effect on the liver. But the pathogenic process has already started.

At the second stage fat components almost completely fill the liver cells. There is a risk of developing an inflammatory process. The last third stage is irreversible. The liver cannot perform its functions due to tissue necrosis. In connection with this classification, the signs completely depend on the stage of the disease. The first symptoms begin to appear already in the second stage. The following manifestations are worth noting:

Pain in the right hypochondrium;
Feeling of bitterness in the mouth;
Frequent belching;
Loss of body weight;
Flatulence;
Nausea, vomiting;
Enlarged liver;
Yellow coating on the tongue;
Constipation or diarrhea.

The last stage of the disease manifests itself very clearly. The patient complains of sleep disturbances. There is drowsiness during the day and insomnia at night. Fatigue increases, memory deteriorates, and jaundice appears. Due to the accumulation of free fluid, the abdomen increases in size. The patient becomes irritable and prone to depression. To relieve pain, you need to use more serious drugs, because simple analgesics do not help. Sometimes itching of the skin may occur.

Necrosis in fatty liver is considered very characteristic and typical. Added to all previous symptoms bad smell sweat, mouth, nosebleeds, anorexia, cardiac dysfunction, rapid breathing, increased body temperature. When the very first minor signs of the disease appear, you should immediately seek help from a specialist. It is strictly forbidden to prescribe therapy yourself. Such actions can lead to complications and death. After all, the disease develops in the shortest possible time.

Treatment methods

Before prescribing treatment, it is necessary to diagnose the abdominal organs. So, the specialist begins collecting anamnesis by interviewing the patient, examining, and palpating the liver. Palpation may reveal an enlarged organ. Next, the patient must pass a series of tests and undergo instrumental examinations. A blood test will show some changes in your blood counts. Ultrasound diagnostics, MRI, CT will allow you to fully assess the condition of the organ and identify the stage of the disease. Only after this the most correct treatment is prescribed.

First of all, the factor that provoked fatty liver degeneration is excluded. So, in the case of alcoholism, a consultation with a narcologist is prescribed. If obesity occurs against the background of diabetes mellitus, the endocrinologist should reconsider the methods of treating the disease. It is very important during and after therapy to follow a diet and daily physical activity.

For patients with increased body weight, it is recommended to reduce it. This will automatically reduce the load on the gland and remove excess fat. But losing weight should be slow and gradual. After all, rapid weight loss provokes inflammation of the organ. In combination, the doctor prescribes some medications that normalize and restore the normal process of fat metabolism in the liver. For mild cases of the disease, therapy is prescribed aimed at antioxidant protection, restoration of cell membranes, hepatocytes.

Thus, hepatoprotectors are used to normalize liver functions. High efficiency The following medications differ:

Essentiale;
Karsil;
Galstena;
Sibektan;
Ursosan;
Antral.

The leading position is occupied by the drug Heptral. This drug is complex. It consists of two natural components - methionine and adenosine. Thus, Heptral takes an active part in restoring liver cell membranes, prevents fat oxidation, and stimulates the production of essential protein in the liver. A very useful remedy for alcoholic damage to the gland. Its effectiveness is observed not only at the stage of fatty degeneration, but also hepatitis and cirrhosis.

Traditional medicine against fatty hepatosis

Very often, representatives of traditional medicine recommend resorting to traditional therapy. A large number of herbs and plants have positive effect on the condition of the liver. Everyone knows that the majority natural preparations for the treatment of the liver are made on the basis of milk thistle. In this regard, several herbal preparations have been developed for the treatment of fatty degeneration of the organ.

Milk thistle has a choleretic effect and reduces cell insulin resistance. This prevents the development of fibrosis and cirrhosis. Fatty liver disease can be treated with the following herbal tea:

Plantain leaves;
Milk thistle seeds;
Roots of marsh calamus;
Horsetail;
A series.

All ingredients are taken in the amount of 1 teaspoon. The mixture is poured into a glass of boiling water. It is advisable that it is not just water, but dill infusion. Cover the product with a lid and leave for 40-50 minutes. After this, the preparation is filtered, and a little more dill infusion is added to it, up to 200 ml. Take 50 g of this folk remedy a few minutes before meals. The number of doses per day should be 4-5 times. The course of therapy is quite long - up to 5 months.

Oats have a rich complex of vitamins, which are also often used to treat the liver. For fatty degeneration, it is customary to use a decoction of whole oat grains, oat jelly, and a decoction of oat flour with the addition of honey. This plant promotes the rapid breakdown of fats. Sometimes pumpkin is used in the treatment of hepatosis. This is because the vegetable is rich in minerals and vitamins that restore organ cells.

The following collection is also highly effective: wormwood, sage, string, raspberry leaves, yarrow, chamomile, birch leaves. All components are mixed in equal quantities. The product is poured with boiling water in a ratio of 1:2. After this, the drink is infused for three hours, filtered, and drunk throughout the day, like regular tea.

Diet

It is very important to follow a diet during treatment. The diet should be rich in vitamins and minerals. On initial stage fatty degeneration, simple adherence to a diet is enough for complete. Specialists install table No. 5. In this case, fat consumption is limited, but it is important to consume enough animal protein. So, the following foods are included in the diet:

Dietary types of meat;
Lean fish;
Oatmeal, buckwheat, wheat groats;
Dairy and fermented milk products;
Fresh vegetables and fruits;
Dried fruits;
Compotes, jelly, herbal tea.

It is very important to consume a sufficient amount of purified non-carbonated water throughout the day. It is good for the liver to eat carrots, beets, pumpkin, fresh cucumbers, cauliflower, parsley, zucchini. Prunes, bananas, and apples have healing properties for the organ. The dishes must be prepared steamed or baked and boiled. You need to exclude alcohol, large amounts of salt, vinegar, marinades, spices, preserves, fatty meat, coffee, meat broths, radishes, garlic, legumes, and mushrooms from your diet. Proper nutrition in combination with an active lifestyle and exercise will help to very quickly restore all liver functions and prevent the development of complications of fatty degeneration.

Lecture 4. Fatty degeneration

1. Types of fats in the body

Fats found in the body of animals and humans are designated by a general, collective term - lipids, which have two varieties:

a) neutral fats;

b) lipoids (fat-like substances).

Neutral fats form the basis of fat depots, deposited in the subcutaneous tissue, mesentery, omentum, under the serous covering of the abdominal wall, under the epicardium, near the kidneys and in other places.

Neutral fats are called labile (or consumable), since their quantity is variable, they provide the body's energy reserves. Lipoids are distinguished by chemical composition: These include phosphotides, sterols and sterides, sphingolipoids and waxes. Lipoids are part of cytoplasmic fat, where they are associated with proteins and form complex unstable fat-protein complexes (lipoproteins). They, together with proteins, are building materials and integral part cellular structures, therefore they are relatively stable and change little quantitatively.

In cells and tissues, fats are found in the form of drops and grains. These drops and grains do not dissolve in water (unlike glycogen) and in acetic acid (unlike proteins), they are soluble in alcohol, ether, xylene, chloroform, therefore, to identify fats, material fixed in formaldehyde is used, and sections are prepared in freezing microtome.

To prove the presence of fat in tissues and organs, special stains and reactions are used. The most commonly used are Sudan III and Sharlach, which color the fat droplets orange-red. When exposed to osmic acid, the droplets turn black. Nile blue sulfate (nilblue sulfate) colors neutral fats red and fatty acids dark blue.

2. Mesenchymal and parenchymal fatty degenerations

When fat metabolism is disturbed, pathological anatomy considers separately the changes occurring in fatty tissue and in the parenchyma of internal organs.

Disorders of the metabolism of neutral fat in adipose tissue

A. Reducing fat

A general decrease in fat content in fiber may result from overexploitation of animals, with chronic infectious diseases, tumors, endocrine disorders, etc.

The amount of fat in the fiber is reduced, it is saturated with serous fluid (serous atrophy of fat). In this case, the fiber sometimes acquires a gelatinous character (mucosal dystrophy) and a yellowish-gray color. Such conditions of the body are referred to as exhaustion, or cachexia.

Macroscopy reveals that the fat cells are wrinkled due to loss or complete disappearance of fat. The reduction in fat in fiber may be local. In the subcutaneous fat layer, fat cells sometimes disintegrate: during inflammation, injury, or due to improper use of medications administered subcutaneously.

B. Increase in fat

Obesity is characterized by excessive deposition of fat into tissue throughout the body: subcutaneously, intermuscularly, in the mesenteries and omentums, in the interstitium parenchymal organs. General obesity is caused for various reasons: overfeeding, especially in combination with weakening muscle activity, endocrine disorders, etc. In this case, excess fat deposits are observed not only in fat depots, but also in the liver, kidneys, muscle, connective tissue and in the interstitium of other organs. Pericardial obesity is of particular importance when it spreads to the myocardium, since atrophic and dystrophic changes in muscle fibers occur.

Local excess fat deposition (lipomatosis) is observed in organs and tissues undergoing atrophy (kidneys, individual lymph nodes, areas of skeletal muscle, etc.).

Disorders of cytoplasmic fat metabolism in certain tissues and organs

Fatty degeneration

The reasons may be: general obesity, protein starvation, infections and intoxications, heart and lung diseases, chronic anemia, local circulatory disorders, vitamin deficiencies, etc.

The accumulation of fat in cells occurs mainly through infiltration, i.e. penetration from the outside - from various fat depots. The second way is also considered possible - decomposition; at the same time, inside the cytoplasm, the breakdown of fat-protein complexes occurs and the release of fatty substances, collecting in drops.

With a weak degree of fatty degeneration, drops are detected in limited areas of the hepatic lobules, but as the process intensifies, obesity spreads to the entire lobule. Usually, small droplets of fat appear first, occupying almost the entire cytoplasm. The nucleus moves to the periphery of the cell and is compressed.

The liver cells then resemble fat cells. With pronounced dystrophy, the beam arrangement of liver cells is disrupted (discomplexation). If the harmful principle acts very strongly, dystrophy can turn into necrobiosis and necrosis. Liver cells either die in designated areas or spread to entire lobules. Sometimes a significant or large part of the entire liver parenchyma dies (toxic liver degeneration).

Macroscopically, it is found that with diffuse obesity, the liver is enlarged in size, yellowish in color, and clayey in appearance; its consistency is doughy. When making a cut, a fat deposit is visible on the knife blade, and droplets of fat often appear on the surface of the cut. If at the same time there is venous congestion of the liver, variegation is noticeable on its surface and on the section. The periphery of the lobules is yellowish, and the center is red - this is the dilated central vein. The pattern of the parenchyma becomes similar to the cut of nutmeg (“nutmeg liver”).

Microscopy shows that there are deposits of small and large fat droplets in the interstitium, in the epithelium of convoluted tubules, loops of Henle and collecting ducts. In severe fatty degeneration, necrobiosis and necrosis of the renal tubular epithelium can occur. The cortical layer is thickened, gray-yellow or ocher-yellow in color. The medulla is red or yellowish-gray. The consistency of the kidney is flabby. The cut surface is greasy and sticky.

Sometimes the changes are diffuse in nature, the heart muscle becomes flabby and clayey. Microscopy reveals a large number of small fat droplets in all muscle fibers.

More often, the dystrophic process has focal character when changes occur only in a group of muscle fibers located near small veins. In such cases, stripes and spots of gray-yellow color are visible in the myocardium. The pattern resembles the skin of a tiger (“tiger heart”).

With the increase in the process of fatty degeneration in muscle cells Nuclei may die by lysis or pyknosis.

Outcomes and significance of fat metabolism disorders

The outcomes of fatty degeneration depend on to a large extent from the cause that caused it. With minor metabolic disturbances, it may occur full recovery functions and structures of affected cells. Sometimes even with very significant obesity, cells remain viable. Once the conditions that caused obesity have passed, the fat droplets undergo assimilation, and the cells return to their normal state.

With a deep and long-term disruption of lipid metabolism, fatty degeneration progresses, which leads to cell death and disintegration.

Damage to parenchymal elements results in a weakening of their function, and sometimes its complete cessation. For example, in infectious diseases, death often occurs due to the decline and cessation of heart activity associated with fatty degeneration of the heart muscle. IN in rare cases A rupture of the altered heart wall may occur.

Fatty degeneration of the muscle fibers of the walls blood vessels may lead to wall rupture.

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Liver dystrophy is a comatose state caused by profound depression of liver function. The occurrence of hepatic coma is associated with the presence of various diseases in chronic form that damage the liver.

The liver is a very important organ that plays a significant role in the processes of fat metabolism. Fats contained in food entering the human body, entering the intestines, under the influence of enzymes they are broken down and enter the circulatory system. Together with the bloodstream, they are transferred to the liver, where they are transformed into various substances necessary for the functioning of the body, such as triglycerides, phospholipids, cholesterol.

If excessive levels of triglyceride in the liver occur, fatty infiltration liver. Fatty liver disease is often characterized by more than ten times the normal amount of triglycerides in the liver. The mass of these substances in the liver can account for more than half the mass of the liver, while in the liver of a person not susceptible to this disease they are usually no more than five percent. This condition is caused by a number of factors, including: consumption of foods high in fatty acids, high intensity of those processes occurring in the liver that lead to the formation of a large amount of triglycerides, disruption of the transport function of triglycerides from the liver to adipose tissue. In a healthy body, triglycerides typically accumulate in adipose tissue as fat.

The nature of fatty deposits in the liver determines the classification of fatty liver into the following two types. Based on the size of fat droplets in the liver, there are small-droplet and large-droplet degeneration.

ICD-10 code

K76.0 Fatty liver degeneration, not elsewhere classified

Causes of liver dystrophy

The causes of liver dystrophy mainly boil down to the fact that this disease develops against the background of a significant decrease in the ability of liver cells to exhibit an appropriate reaction caused by their interaction with insulin. Insulin is a hubbub responsible for the delivery of glucose contained in the blood and tissue fluid to the cells. Due to the development of immunity of liver cells to the effects of insulin, a deficiency of glucose appears, which is extremely important for their normal functioning, and liver cells begin to die. In place of the damaged cells, over time, it grows adipose tissue. This tissue does not have the properties of specific liver tissue, which ultimately leads to a significant decrease in the efficiency of the normal functioning of this organ, one of the most important in the human body.

The lack of proper response of liver cells to insulin exposure may be one of the manifestations of congenital hereditary pathology, and in addition, it often becomes a consequence of metabolic disorders in the patient’s body. Insulin resistance can also occur as a result of improper immune aggression against the hormone insulin.

The causes of liver dystrophy also lie in such factors associated with the lifestyle and diet of a person as overconsumption eating foods high in fats of plant and animal origin, as well as low levels of physical activity.

Symptoms of liver dystrophy

Symptoms of liver dystrophy in most cases are extremely mild. As a rule, patients with this disease do not express complaints about any disturbing phenomena associated with its presence. The development of the pathological process is characterized by slow progress and invisibility clinical manifestations. However, as the disease progresses, dull painful sensations in the area of the right hypochondrium, nausea, vomiting, and stool disturbances may occur. In a small number of cases, liver dystrophy may occur severe pain in the abdomen, loss of body weight, itching and jaundice of the skin.

Symptoms of liver dystrophy in the toxic type of the disease and with massive necrosis are characterized by the occurrence of hyperplasia of the lymph nodes and spleen located next to the portal vein. Manifestations of liver dystrophy are also multiple hemorrhages that can appear in the skin, mucous membranes and serous membranes. There are necrotic phenomena and dystrophic changes that occur in tissues, also affecting the myocardium of the heart and pancreas.

Against the background of toxic chronic liver dystrophy in the chronic form of this disease, when its relapses occur, postnecrotic cirrhosis of the liver can progress. As the disease progresses further, there is a possibility fatal outcome caused by liver failure or hepatorenal syndrome.

Fatty liver

Fatty liver is a syndrome that occurs due to the progression of fatty degeneration in liver cells. The course of this disease is characterized by the occurrence of a process of pathological accumulation of fatty deposits in the liver cells that look like fat droplets. The cause of the development of this disease affecting the liver in many cases is pathological processes occurring in the biliary and intestinal tract. Risk factors for the development of fatty liver are also the presence of severe obesity in the patient, type 2 diabetes mellitus, malabsorption and maldigestive syndromes, and regular abuse of alcoholic beverages. The development of fatty liver can result from the use of a number of medications, such as corticosteroids, tetracyclines, estrogens, as well as non-steroidal anti-inflammatory drugs. In addition, fatty liver can accompany the course of various viral hepatitis that occurs in a chronic form, in particular hepatitis C.

Toxic liver dystrophy

Toxic liver dystrophy has as its manifestations massive progressive necrotic processes affecting liver tissue. The disease, as a rule, is acute in nature, and in some cases it can be present in the body in a chronic form, causing liver failure as the pathology progresses.

The cause of massive liver necrosis is mainly due to exposure to toxic substances contained in food products, including in mushrooms that cause poisoning with arsenic, phosphorus compounds, etc. These intoxications are exogenous in nature. Endogenous intoxications can also provoke toxic liver dystrophy. These include toxicosis that occurs in women during the period when they are bearing a child, thyrotoxicosis. The cause of toxic liver dystrophy is often a disease viral hepatitis, at which this disease develops as one of the manifestations of its lightning-fast form.

Toxic liver dystrophy causes changes in the body that are characteristic of each specific stage of the pathological progress of this disease. First, the size of the liver increases, this organ acquires either a flabby or dense consistency, and it becomes characterized by a jaundiced tint. As the disease progresses, the liver shrinks in size, and its capsular membrane becomes wrinkled. The liver tissue changes its color to grayish and takes on the appearance of a clayey mass. In later stages, after the third week of illness, the process of liver reduction in size continues and it acquires a reddish tint. The hepatic reticular stroma is exposed, in which dilated and engorged sinusoids are noted. Hepatocytes remain preserved only in the peripheral areas of the lobules. The above phenomena indicate the transition of hepatic dystrophy to the stage of red dystrophy.

The presence of toxic liver dystrophy that has progressed to chronic stage is an extremely rare clinical case, but is associated with the likelihood of death of the patient due to progressive liver failure.

Acute liver dystrophy

Acute liver dystrophy primarily appears as a complication that develops against the background of an unfavorable course of Botkin's disease. Cases of the appearance of this disease in an autonomous form, as medical statistics show, are extremely rare.

To date, medical research in the field of studying the mechanisms of development of degenerative phenomena in the liver has not led to a clear answer to the question of the cause of acute hepatic dystrophy. At present, the mechanisms of pathological progress of this disease are still not fully understood. serious illness affecting the liver, and it remains unclear whether there is a correlation with the strength (virulence) of the virus, or whether there is an effect of some other factors.

The presence of brucellosis, relapsing fever, syphilis, as well as pregnancy and its artificial termination can lead to an aggravated course of parenchymal hepatitis. All this determines high probability degeneration of hepatitis into a severe form of liver dystrophy.

Acute liver dystrophy at the initial stage recreates a clinical picture similar to the onset of Botkin's disease, which is associated with a significant deterioration in the patient's general condition. In this case, the nervous system is mainly affected, which manifests itself in the appearance of various disorders brain activity. Patients begin to become delirious, rush around the bed, have convulsions and vomiting. In some cases, the appearance of such conditions became the justification for the need to hospitalize the patient in a psychiatric clinic. On the other hand, a different, opposite reaction of the central nervous system to the development of the pathological process is possible. Apathy and depression may appear, a significant decrease in the vital tone of the body, and increased drowsiness may appear. Up to the onset of unconsciousness and hepatic coma.

Alcoholic liver dystrophy

Alcoholic liver dystrophy is a disease caused by overuse alcoholic beverages for a long period of time exceeding 10-12 years. Alcohol, in excessive quantities entering the human body, has an extremely negative, hepatotoxic effect.

The appearance of alcoholic hepatic degeneration may be a sign that there is fatty liver degeneration or steatosis, cirrhosis, alcoholic hepatitis. In the vast majority of cases, as the most early stage As the pathological process progresses in the liver, steatosis develops due to alcohol abuse. After the regular intake of alcohol into the patient’s body ceases, pathological changes due to steatosis developing in the liver return to normal within 2 to 4 weeks. Often during the course of the disease there may be no significant symptoms.

Alcoholic liver dystrophy has the same symptoms that characterize chronic alcohol intoxication. Diagnosed due to detection of increased size parotid glands, the presence of Dupuytren's contracture, palmar erythema. The presence of this disease in the patient’s body is also indicated by the results of laboratory tests and liver biopsy.

Therapeutic measures for alcoholic liver dystrophy consist primarily of the patient’s absolute cessation of alcohol consumption. A course of treatment with corticosteroids and essential phospholipids is prescribed. If the disease is terminal, a liver transplant may be indicated.

Diffuse liver dystrophy

Diffuse liver dystrophy is a pathological process that develops in the parenchyma, which is the main tissue from which this organ is formed. In specific liver cells, hepatocytes, processes take place aimed at detoxifying toxic substances entering the body. Hepatocytes take part in the digestive processes, their role in this case is reduced to the secretion of bile, which contains a number of enzymes that break down fats in the gastrointestinal tract. Liver cells provide neutralization harmful substances by transforming them into those that do not pose a threat to the normal functioning of the body, and which are subsequently excreted along with bile.

Diffuse liver dystrophy occurs as a result of the fact that liver cells are not always able to process the poison entering the body. It happens that they cannot cope with the scale of intoxication, and ultimately the poisoning leads to their death. Over time, the cells destroyed in this way are replaced by fibrous connective tissue. The more significant the degree of such liver damage, the more it negatively affects its ability to perform its functions.

As a rule, the development of diffuse pathological progress in the liver is accompanied by a similar process that also affects the pancreas, since the functions of these two organs are closely related to each other.

Focal liver dystrophy

Focal liver dystrophy presents certain difficulties in diagnosing this disease due to the fact that although there is a deterioration in the functioning of the liver, it is extremely difficult to detect these pathological changes through laboratory tests.

Based on the reasons that cause focal hepatic dystrophy, each individual case is characterized by the presence of various objective and subjective symptoms and manifestations of this disease in each individual patient.

Focal liver dystrophy, which occurs in particular as a consequence of regular intoxication large doses alcohol, manifests itself in such phenomena as the appearance of shortness of breath, loss of appetite, etc. in some cases, patients note the occurrence of discomfort and heaviness in the area of the right hypochondrium. Such symptoms are characterized by an increase in their intensity during movement.

Often, detection of fatty liver infiltration becomes possible only with magnetic resonance imaging (MRI) and computed tomography. Data diagnostic techniques represent the most effective way to detect in a patient focal dystrophy liver.

Granular liver dystrophy

Granular liver dystrophy is the most common type of protein dystrophic pathology. With this disease, the colloidal properties of the cell cytoplasm are disrupted, in which the appearance of grain-like protein is observed.

The reasons causing the appearance of this liver disease are: lack of adequate feeding in infancy, and in later age periods - the consequences of intoxication, the presence of infections, disruption of the functioning of the circulatory system and lymph flow, as well as exposure to factors that can provoke tissue hypoxia.

As granular liver dystrophy develops, changes in protein cellular metabolism occur. With the progress of the pathological process of granular dystrophy, the cytoplasm acquires a swollen and cloudy appearance, as a result of which this liver lesion is also characterized as cloudy swelling. The liver affected by this disease acquires a flabby consistency, and its blood supply is disrupted.

In the process of establishing a differentiated diagnosis, granular dystrophy must be separated from physiological processes protein synthesis in cells in which granularity appears in the protein.

Granular liver dystrophy is predominantly a reversible process, however, due to severe course The disease has the possibility of its degeneration into such forms as hyaline-droplet or gyropic dystrophy, as well as necrosis.

Protein liver dystrophy

Protein dystrophy of the liver occurs as a result of a violation of protein metabolic processes and can be represented by amyloidosis, hyalinosis and granular dystrophy.

A characteristic feature of amyloidosis is that in the presence of this disease, a special protein amyloid substance is deposited in the tissues.

Hyalinosis is a type of protein dystrophy, which often occurs as a concomitant disease against the background of atherosclerosis. This pathology is characterized primarily by local localization; in particular, it can appear in the wall of a vessel during the formation of a blood clot. Hyalinosis tends to form translucent protein structures similar to cartilaginous hyaline tissue.

Protein dystrophy of the liver also takes on the form of granular dystrophy, which means the appearance of drop-shaped and granular protein formations in the cellular protoplasm. Combining into a single whole, these formations tend to completely fill the entire internal cellular space. With granular liver dystrophy, the protein cellular structures become denser and the normal functioning of the cells is disrupted. Granular dystrophy is fraught with the occurrence pathological changes necrotic in nature and leads to cell death.

Hydropic liver dystrophy

Hydropic liver dystrophy, also known as hydropic dystrophy, has the following feature: vacuoles containing cytoplasmic fluid appear in the cell. In the presence of this type of hepatic dystrophy, the parenchyma cells are characterized by increased sizes, the nucleus in them acquires a peripheral localization, and in some cases its shrinkage or vacuolization is observed.

As pathological changes develop, the cell becomes filled with fluid and its ultrastructures decompose. The cell becomes like a container filled with water, and is essentially one continuous vacuole with a bubble-shaped nucleus placed in it. Similar phenomenon, which is a sign that characterizes liquefaction necrosis, is called balloon dystrophy.

Hydropic liver dystrophy can only be detected by examination using a microscope, since the appearance of tissues and organs is not characterized by visual changes.

The prognosis in the presence of this disease seems unfavorable due to the fact that with hydropic dystrophy of the liver, the functioning of this organ is significantly impaired. A negative prognostic factor is also that the outcome of this disease is focal or total cell necrosis.

Yellow liver dystrophy

Acute yellow liver dystrophy can occur during pregnancy as one of the associated complications. It is caused by the condition acute intoxication, in which this disease is an aggravating factor in the development of infection processes in the body.

Jaundice in a woman during the period during which she is carrying a child, as well as in the presence of other liver pathologies in addition to liver dystrophy, such as cholecystitis and the presence of liver stones, can also be present in the form of an autonomous disease provoked by autointoxication of the body. This condition is known as pregnancy-related toxicosis.

Yellow liver dystrophy is one of the most serious toxicosis of pregnancy. The disease is caused by severe intoxication with the products of metabolic processes occurring during pregnancy, which differ in characteristics other than those of the metabolism that takes place in the normal state of the body. Pathological progress at the beginning of its development is characterized by the appearance of jaundice, which is preceded by a period of severe, often very prolonged vomiting. As time passes, the condition worsens due to the fact that skin and sclera acquire a pronounced icteric appearance, clouding of consciousness occurs, states of delirium and overexcitement nervous system. There is the possibility of multiple subcutaneous hemorrhages, in the composition of urine, the amount of which tends to significantly reduce, the presence of cyrosine and lecithin is detected, and in addition there is a decrease liver dullness. Due to further deterioration of the patient's general condition, there is a possibility of death within a few days.

Parenchymal liver dystrophy

Parenchymal liver dystrophy is based on the development of the associated pathological process of changes in chemical, physical and morphological characteristics inherent in cellular proteins. The essence of such disturbances in the functioning of cells is the process of hydration to which the cytoplasm undergoes as a result of coagulation, denaturation, or, on the contrary, the phenomenon of colliquation taking place in the cell. In cases in which protein-lipid bonds are disrupted, membrane cellular structures are characterized by the occurrence of destructive processes in them. The consequences of such changes are the development of necrotic processes of a coagulation - dry, or colliquation - wet nature.

Parenchymal liver dystrophy is classified according to its types as:

Hyaline-drip
Hydropic
Horny dystrophy.

Granular dystrophy, which is characterized by the appearance of protein grains in the parenchyma cells, can also be classified as parenchymal liver dystrophy. This type of hepatic dystrophy is characterized by an increase in the volume of the organ affected by this disease, its acquisition of a flabby consistency and dull appearance on the cut. The last given feature determines that granular liver dystrophy is also called dull or cloudy swelling.

Diagnosis of liver dystrophy

Diagnosis of liver dystrophy is associated with a number of difficulties arising due to the fact that, traditional methods laboratory tests in this case often turn out to be unfounded, even though with this disease affecting the liver, the inevitable deterioration in the functioning of this organ becomes obvious.

The clinical picture of dystrophic liver pathology, as a rule, is asymptomatic, therefore the main sign suggesting the presence of this disease in the body is an increase in the size of the liver. Since the echogenicity of the liver tissue during ultrasound examination does not differ to any significant extent from normal indicators, sometimes even with a tendency to increase, this prevents accurate and unambiguous differentiation with cirrhosis or liver fibrosis. Using ultrasound, it becomes possible to identify areas that have increased echogenic characteristics, while areas of low absorption coefficient are determined using computed tomography. CT and magnetic resonance imaging are one of the most effective methods for recognizing dystrophic pathology in the liver. They are most effective for determining focal fatty infiltration of the liver.

Diagnosis of liver dystrophy also involves histological examination biopsy samples in order to establish the presence of an excessive amount of fatty formations in this organ.

Treatment of liver dystrophy

Since in such a matter as the treatment of liver dystrophy great importance has the formulation of an accurate differential diagnosis and, based on this, the appointment of certain therapeutic measures In order to exclude hepatitis, which is the most severe stage of this disease, during diagnosis, a liver biopsy is usually prescribed. Today, unfortunately, there is no such non-invasive technique that would make it possible to diagnose hepatitis with a high degree of accuracy, or to reliably determine the degree and prescribe appropriate treatment for fatty liver of non-alcoholic origin.

Before sending a patient for a biopsy and prescribing treatment for liver dystrophy, including treatment for fatty liver, the recommendations of medical specialists boil down to the fact that the patient needs, first of all, to change his lifestyle. Since this liver lesion is characterized by increased insulin-resistant characteristics, such changes in the patient’s lifestyle mean a number of measures aimed, first of all, at eliminating or minimizing the effect of such negative factor. Adherence to a special diet and nutrition regimen is prescribed, in conjunction with an increase in the amount of physical activity.

The diet involves reducing the total calorie content of the daily diet, minimizing the consumption of those foods that contain fructose in large quantities, as well as those with a high content of fatty acids.

Exercises are useful to improve the absorption of insulin and its more effective action. physical exercise, which also help get rid of excess fatty tissue in the internal organs and help reduce negative phenomena caused by fatty liver degeneration.

Diet for liver dystrophy

Diet for liver dystrophy is one of the important factors in the fight against this disease and successful healing.

The diet allows the consumption of foods containing... large quantities vitamins, fiber, pectin, and carbohydrates. Fat content in food daily ration should not exceed 70 grams. This diet also involves the exclusion of cholesterol-containing foods and minimal consumption of table salt.

It is recommended to eat only boiled or steamed foods. Although fried food is on the list of categorical prohibitions for dystrophic liver pathology, you can cook meat and fish dishes in the oven. As for fish, it should be noted that it is recommended to avoid especially fatty varieties.

As for drinks, cocoa and coffee, soft carbonated drinks are excluded from the diet.

Diet for liver dystrophy - an approximate list of dishes acceptable and recommended for consumption is given below.

First courses can be represented by borscht, soups from cereals, vegetables, and also dairy.

For the second course, you can eat boiled or steamed meat or lean fish.

Any vegetables can be used as side dishes, again boiled or steamed, vegetable salads from boiled onions, cabbage, carrots.

Positive preventive factors for maintaining the activity of the whole organism in high vitality and preventing the occurrence of pathological phenomena in internal organs, in particular in the liver, is a meaningful, systematic approach to establishing the entire life routine, organizing correct mode nutrition with the presence in a balanced diet of all the beneficial substances and elements necessary for the body, and with the limitation of overly hot and fried foods, smoked foods, and canned foods.

It is also important in such an issue as the prevention of liver dystrophy to control body weight and maintain your body mass index within the optimum range.

Regular exercise stress in the form of sports - walking, jogging, swimming, etc. close to optimal weight body helps to eliminate overstrain of the liver functions, as well as the vital activity of the whole organism.

Prognosis of liver dystrophy

The prognosis for liver dystrophy, if the disease is not burdened by the presence of all kinds of accompanying complications, is favorable. Patients in most cases retain their ability to work.

Liver dystrophy with pronounced characteristics of the pathological process leads to a decrease in resistance to infections entering the body, can cause worse tolerance to anesthesia and surgical interventions, and contribute to a longer postoperative recovery period.

If the progressive trends in the influence of factors leading to hepatotoxicity persist: metabolic disorders or hyperlidemia, there is a possibility of further aggravation of the development of inflammation, leading to the development of micronodular cirrhosis and NASH.

The prognosis of liver dystrophy with the use of dietary restrictions and the cessation of bad habits when applied to patients with fatty liver degeneration was characterized by a tendency for them to maintain working capacity and a satisfactory state of the body. However, from time to time, such observed patients complained of a significant loss of strength and vitality, especially during periods associated with long-term work requiring significant stress.

A negative prognostic factor was that in some patients the disease degenerated into cirrhosis.