Fatty liver hepatitis – causes, symptoms & therapy

Fatty liver hepatitis is when less than 50% of the liver cells become fatty. If more than 50% of the liver cells are fatty, the liver is fatty . The fats are stored in the liver cells (hepatocytes) in the form of vacuoles. If the fatty liver becomes inflamed, steatohepatitis is present. In the fatty liver cells, there is a disruption in cell metabolism with cell death. Other immunological factors then lead to an inflammatory reaction.

causes

There are two different causes of fatty liver hepatitis. In alcoholic steatohepatitis, fatty liver hepatitis is caused by excessive alcohol consumption. Fatty liver hepatitis is likely to occur if men consume more than 40 grams of ethanol and women more than 20 grams of ethanol per day. The liver plays a crucial role in the breakdown of alcohol.If the body is fed alcohol, the liver primarily takes care of the breakdown and neglects other tasks such as its fat metabolism. The liver initially stores the fat so that it can then be used after the alcohol has been broken down. If alcohol continues to be consumed, the liver is unable to access its fat reserves and stores more and more fat.

Non-alcoholic steatohepatitis (NASH) is significantly less common than alcohol-induced fatty liver inflammation. The causes of NASH are usually metabolic diseases such as diabetes mellitus , obesity or elevated blood lipid levels . Rarer causes are copper storage disease ( Wilson’s disease ), surgical removal of the small intestine, tube feeding or chronic inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis .

Drugs such as corticosteroids or antiarrhythmics can also cause fatty liver inflammation. In rare cases, no clear cause can be identified or several causes occur together.

When to the doctor?

Fatty hepatitis is present when less than 50% of the liver cells are fatty. In many cases, such fatty liver hepatitis triggers various side effects that should always be examined by a doctor. The side effects mentioned include a feeling of fullness in the upper abdomen, loss of appetite, indigestion, nausea, vomiting and severe weight loss. If these symptoms occur individually or together, then a doctor should be consulted as soon as possible. Fatty liver hepatitis is a serious disease that should definitely be treated by a doctor.

Effective treatment can be achieved by taking appropriate medication in a targeted manner. The fat content in the liver can be adjusted and regulated very well. Of course, if you don’t get treatment from a doctor, there is a very high risk or an acute danger to life. If left untreated, the liver can become severely inflamed , leading to cirrhosis. If this clinical picture also remains without any treatment, liver cirrhosis can even lead to death. Appropriate treatment is immensely important, as this is the only way to guarantee full recovery.

symptoms and course

Typical symptoms of fatty liver hepatitis:

• pressure in the upper abdomen

• bloating

• indigestion

• loss of appetite

• nausea

• Vomit

• weight loss

With regard to the severity of the inflammation, two forms can be distinguished. Chronic persistent hepatitis is the milder form. It often remains symptom-free or only manifests itself in unspecific symptoms such as a feeling of pressure in the upper abdomen, a feeling of fullness or indigestion. Chronic active hepatitis occurs in 15 to 20 percent of all cases. This form of steatohepatitis causes more noticeable symptoms. Those affected suffer from loss of appetite, nausea, vomiting and weight loss. The skin turns yellow (jaundice). Fever can also occur.

With chronic active hepatitis, there is a risk that the inflammation will develop into cirrhosis of the liver . Liver cirrhosis is the end stage of many chronic liver diseases . In contrast to fatty liver, it is not reversible, since the fat cells convert into connective tissue, resulting in scarred areas. In advanced stages, liver cirrhosis leads to death.

Diagnose

In fatty liver hepatitis, the liver-specific enzymes in the blood are increased. Increased cholestasis parameters are shown in the blood, in particular gamma-GT is increased. The transaminases are also increased in the blood. There may be a slight increase in the leukocyte count . An increase in the C-reactive protein is also conceivable. C-reactive protein (CRP) is a non-specific marker of inflammation, meaning CRP increases when there is inflammation in the body. However, the inflammation cannot be precisely localized with the CRP.

Routine diagnostics also include an ultrasound examination . If necessary, the diagnosis is supplemented by probe ultrasound or magnetic resonance imaging . The histological confirmation of the diagnosis is made by means of a liver puncture with removal of a tissue sample. However, a distinction between alcohol-related fatty liver inflammation and non-alcoholic fatty liver inflammation cannot be made. This is done more on the basis of the blood values .

complications

In fatty liver hepatitis, there is usually inflammation in the liver. This can be life-threatening for those affected and in the worst case even lead to the death of the sinker. For this reason, medical treatment is always necessary for fatty liver hepatitis. As a rule, those affected suffer from strong pressure, which occurs primarily in the upper area of ​​the abdomen. There is also a loss of appetite and a feeling of fullness. Those affected also suffer from vomiting and nausea, and it is not uncommon for them to lose weight as a result.

Jaundice and fever also occur . It is not uncommon for fatty liver hepatitis to develop into cirrhosis of the liver. This can also lead to death since the damage caused by this disease is irreversible. Treatment for fatty liver hepatitis is usually through a healthy lifestyle and abstinence from alcohol. There are no further complications. Medications can also be used. In severe cases, a liver transplant is necessary for the person concerned to continue to survive. Fatty liver hepatitis may also reduce the patient’s life expectancy.

treatment and therapy

In alcoholic fatty liver hepatitis, alcohol is absolutely contraindicated. Absolute abstinence from alcohol is the most important pillar of therapy. As long as the liver cells have only become fatty and have not yet undergone cirrhotic remodeling, the organ can still regenerate. In the case of NASH, the underlying disease is treated first. Diet should be changed in patients with elevated blood lipid levels . If necessary, medication with lipid-lowering agents must be used.

Diabetes patients need better control. Chronic inflammatory bowel disease is usually treated with cortisone . They should also reduce their weight. The same applies to overweight patients. Weight reduction is often the decisive factor in the treatment of NASH. Some studies report that the administration of vitamin E and melatonin have a positive effect on the course of steatohepatitis.With progressive liver cirrhosis, liver transplantation is often the only remaining treatment. However, liver transplantation for fatty liver hepatitis has a significantly poorer prognosis than liver transplantation for other liver diseases. With other liver diseases, 89% of patients are still alive five years after the transplant. Five years after a transplant due to steatohepatitis, however, only 72% of the patients are still alive.

prevention

Alcohol-related fatty liver hepatitis can be easily prevented by abstaining from alcohol. The toxic limit of 40 grams of alcohol per day for men and 20 grams of alcohol for women should not be exceeded under any circumstances. Diet -related fatty liver hepatitis can be counteracted with a balanced diet and sufficient exercise. Diabetics should make sure that their blood sugar levels are well controlled.