~tasha~
Age: 125
6645 days old here
Total Posts: 47628
Points: 0
Location:
United Kingdom, United Kingdom
Fatty Liver (STEATOSIS)
--------------------------
Liver is the commonest site for accumulation of fat because it plays central role in the fat metabolism.
Fatty Changes may be Mild and reversible or severe producing irreversible cell injury and cell death.
--Causes (Etiology)--
1. Excessive consumption of Alcohol
2. Starvation
3. Malnutrition
4. Obesity
5. Diabetes Mellitus
6. Chronic illness
7. Late Pregnancy
8. Hypoxia
9. Hepatotoxins
10. Drugs
11. Reyes Syndrome
--Pathogenesis--
Depends upon the Stage at which the individual etiologic agent acts in Normal fat transport and metabolism
--Lipid Source--
1. From Diet as Chylomicrons (Triglycerides and Phospholipids) and Free Fatty Acids
2. From Adipose Tissue as Free Fatty Acids
3. From Acetate of Liver Cells
Most of the Fatty Acids is esterified into Triglycerides by Alpha Glycerophosphate and small part of Free Fatty Acid is Changed into Cholesterol, Phospholipds, Ketone Bodies.
Lipoproptien is the Form of Lipid excreted by Hepatocytes.
Fatty Liver occurs on excessive accumulation of Triglycerides which can occur by
1. Increased entry of Free Fatty Acids into Liver.
2. Increased synthesis of Free Fatty Acids by Liver.
3. Decreased conversion into Ketone Bodies thus, increased formation of Triglycerides.
4. Increased alpha glyceroPhosphate causing increased esterification of fatty acids to Triglycerides.
5. Decreased synthesis of Lipo Amino Protien - decreased formation of Lipoprotien from Triglycerides.
6. Block in excretion of Lipoprotien from the Liver into Plasma.
--Pathological Changes--
Gross -
1. Enlarged with a tense, glistening capsule and rounded margins
2. Cut surface bulges slightly and is pale yellow to yellow.
3. Greasy to tuch
-Microscopically -
1. Numerous lipid vacuoles in the cytoplasm of Hepatocytes.
2. Initially small and present around the nucleas which progress.
3. May contain Lymphocytes, Macrophages, multinucleated giant cells.
Demonstration by Frozen section followed by fat stains like
1. Sudan Dyes - Sudan III, Sudan IV, Sudan Black.
2. OilRed O
3. Osmic Acid
--Clinical Features of Fatty Liver--
1. Often no symptoms or Signs
2. Vague Abdominal symptoms of nausea, vomiting and Diarrhoea.
3. Chronic Liver Disease.
--Investigations--
1. Elevated MCV - Heavy Drinking
2. Liver Biochemistry - Mild Abnormalities with elevation of Serum Amino Transferase enzyme.
3. Gamma GT levels - Sensitive test to determine whether patient is taking Alcohol
4. Changes in All Liver Biochemical Parameters -
- Severe Fatty infiltration
- Determined by USG, CT Scan, Liver Histology
--Management and Prognosis--
-General Management-
- Advise to Stop drinking.
- Delerium Tremens (Give Diazepam)
- Intravenous Thiamine to prevent Wernick-Korsakoff' s Encephalopathy
- Bed Rest
- Protein Rich diet and Vitamins supplement.
~tasha~
Age: 125
6645 days old here
Total Posts: 47628
Points: 0
Location:
United Kingdom, United Kingdom
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