Hepatosis

Hepatosis is a liver disease characterized by dystrophic changes in its parenchyma without a pronounced mesenchymal cellular reaction. Depending on the nature of the metabolic disorder, fatty and pigmentary (for example, congenital hyperbilirubinemia) hepatosis are distinguished.

Fatty hepatosis (fatty degeneration, fatty infiltration, liver steatosis) is characterized by fatty (sometimes with protein elements) degeneration of hepatocytes and a chronic course.

Etiology and pathogenesis: The main causes of the development of fatty hepatosis are alcoholism, less commonly obesity, diabetes mellitus, other endocrine disorders (Cushing's syndrome, myxedema, thyrotoxicosis, acromegaly), protein and vitamin deficiency, diseases of the digestive system accompanied by malabsorption (chronic pancreatitis, ulcerative colitis etc.), chronic intoxication with carbon tetrachloride, organophosphorus compounds, other toxic substances with hepatotropic effects, bacterial toxins, etc.

The pathogenesis of liver damage in these cases mainly comes down to disruption of lipid metabolism in hepatocytes and the formation of lipoproteins.

Symptoms and course: A low-symptomatic form is possible, in which the clinical picture is masked by manifestations of the underlying disease (thyrotoxicosis, diabetes mellitus, etc.), toxic damage to other organs or concomitant diseases of the gastrointestinal tract. In other cases, severe dyspeptic symptoms, general weakness, and dull pain in the right hypochondrium are observed; sometimes - mild jaundice.

The liver is moderately enlarged, with a smooth surface, painful on palpation. Splenomegaly is not typical. Aminotransferases in the blood serum are moderately or slightly increased, and the content of cholesterol and lipoproteins is often also increased.

The results of the bromsulfalein test are characteristic: a delay in the release of this drug by the liver is observed in most cases. Other laboratory tests are not very informative. The data of a puncture biopsy of the liver (fatty degeneration of hepatocytes) are of decisive importance in diagnosis.

The course is relatively favorable: in many cases recovery is possible, especially if the causes are eliminated and treated in a timely manner. However, hepatosis can sometimes transform into chronic hepatitis and cirrhosis.

Differential diagnosis: The absence of splenomegaly allows one to differentiate chronic hepatosis from hepatitis and cirrhosis. With cirrhosis, there are usually signs of portal hypertension and “liver signs”, which is not the case with hepatosis.

Hepatolenticular degeneration and hemochromatosis should also be taken into account. A liver biopsy is of great importance.

Treatment: Termination of the action of the etiological factor. Diet No5 with a high content of protein and lipotropic factors. Limiting fats. Lipotropic drugs, hepatoprotectors. For severe lipid metabolism disorders, use lipid-lowering agents.