Understand the causes of hepatic steatosis and how to reverse the problem

The hepatic steatosis is characterized by an accumulation of fat in liver cells, also called fatty infiltration or fatty liver disease. It is very common and can be divided into alcohol (when there is abuse in alcohol consumption) or non – alcoholic (when there is no significant alcohol intake history).

The steatohepatitis Nonalcoholic can be caused by viral hepatitis, diabetes , insulin resistance, overweight or obesity , high cholesterol or triglycerides and drugs such as steroids, estrogen, amiodarone, antiretroviral drugs, diltiazem and tamoxifen. There are also cases related to some surgeries for obesity, malnutrition or rapid weight loss – these lead to a metabolic stress with fat accumulation in the liver. The most frequent cause is obesity or even being overweight.

The non-alcoholic fatty liver reaches about 20% of the general population and about 60% of obese people. Over 70% of patients with steatosis are obese, and the higher the overweight, the higher the risk. The steatosis is more common in women, probably by action of estrogen.

initial or mild steatosis is when there is little fat deposition in the liver, if this fat persists for a long time or there is a greater accumulation of fat, can cause damage to liver cells, with inflammation, which called steatohepatitis. That is, after several years of steatosis can occur “hepatitis” by excess fat. The steatohepatitis is a much more disturbing framework steatosis, it can progress to liver cirrhosis in approximately 20% of cases, which is the most feared complication of hepatic steatosis.

Both steatosis as steatohepatitis has no symptoms and are often discovered by an abdominal ultrasound routine or research altered laboratory tests for the liver. The doctor may suspect hepatic steatosis by clinical history, physical examination of the patient, detecting enlarged liver, or increased waist circumference by fat accumulation.Some patients with hepatic steatosis complain of fatigue and heaviness or discomfort in the abdomen upper right, but there is no evidence that these symptoms are related to fat accumulation in the liver, for patients with advanced degrees of steatosis usually have no symptoms.

Ultrasonography usually indicates the degree of hepatic steatosis, as follows:

liver - Photo: Getty Images
When the ultrasound or CT scan showed steatosis you need to do additional tests to evaluate the presence of inflammation
  • Grade 1 or light: when there is little accumulation of fat
  • Grade 2: when there is a moderate accumulation of fat in the liver
  • Grade 3: When there is a great accumulation of fat in the liver.

This graduation is not very accurate because the assessment is subjective, depends on the equipment and the experience of the doctor who does the exam, but it helps in assessing the intensity of fat and follow-up to see if there was improvement with treatment. It is not possible to differentiate cases of steatosis from steatohepatitis, or other causes of hepatitis by imaging. The ultrasound can be seen fat well, but it does not have sufficient sensitivity to rule out or confirm the presence of inflammation in the liver, not knowing the degree of liver injury.

When the ultrasound or CT scan showed steatosis we need to do additional tests to evaluate the presence of inflammation and identify the cause of steatosis, metabolic disorders should be investigated, such as obesity, glucose intolerance, high cholesterol or triglycerides, as well as evaluating consumption alcohol. Other etiologies for liver disease should be excluded when evaluating a patient with suspected steatosis, such as viral hepatitis, drug use.

Fat does not mean inflammation

The degree of steatosis on ultrasound is not proportional to the severity of the condition, the patient may have steatosis grade 1 and have lots of inflammation or have grade 3 and not present liver inflammation. The presence of inflammation is more important than the amount of fat being investigated through blood tests for assessment of the liver, which are liver enzymes (AST and ALT or AST and ALT) and other liver disease markers as gamma GT. Steatosis is the most common cause of elevated liver enzymes in routine blood tests, usually at steatohepatitis no greater increase therein.

The diagnosis of steatohepatitis is made by histological examination of a liver fragment removed by liver biopsy. This procedure is usually only indicated in patients with elevated liver enzymes with increased risk of steatohepatitis and liver fibrosis as a result of inflammation.

The steatosis and steatohepatitis are reversible disease, provided they have not yet caused fibrosis in the liver. The association of hepatic steatosis with hepatitis B or C, cholestasis, metabolic or autoimmune diseases may facilitate the evolution to cirrhosis.It is therefore very important to identify the steatosis and treatment.

This is the cause, not itself steatosis

There are yet a specific treatment for steatosis. Thus, treatment focuses on the issue, namely, diabetes, high cholesterol and triglyceride levels, obesity. This includes use of medication, when necessary, and a change in lifestyle, with weight loss, nutritional education and physical activities, in addition to regular medical care.

Generally , the most effective measure for controlling steatosis is weight loss, a reduction of 7% in body weight can bring good results. To this one must have a reduced calorie diet, avoiding fried foods, fats and sweets and increase the intake of fruits, vegetables and lean meats. However, it should be gradually lose weight much faster loss can aggravate steatosis. Persons with body mass index (BMI) do not show large benefits in weight loss, because the cause steatosis is not overweight. In patients with morbid obesity, bariatric surgery may be an option.

Some medications have been used with some benefit. Vitamin E at a dosage of 400 to 800 IU per day is indicated for patients with steatohepatitis and liver fibrosis signals, proven by biopsy of the liver. hypoglycemic drugs, used to treat diabetes, such as metformin, pioglitazone and rosiglitazone, have been used commonly in patients with high blood glucose levels. Orlistat (Xenical) can be used as drugs help to control body weight, does not act directly on the steatosis. Some studies have shown benefits of omega 3 in the cases of steatosis, but not of steatohepatitis.

Other drugs have been tested with mixed results, including: ursacol (ursodeoxycholic acid), N-acetylcysteine, folic acid, silymarin.

Therefore, despite the steatosis is a benign disease in most cases, if left untreated can evolve unfavorably. Therefore, all patients with diagnosis of hepatic steatosis and especially steatohepatitis should start treatment to reverse this accumulation of fat.

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