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Encyclopedia > Fatty liver
Fatty liver
Classification & external resources
ICD-10 K70., K76.0
ICD-9 571.0, 571.8
DiseasesDB 18844
eMedicine med/775 
MeSH C06.552.241
Different stages of liver damage

Fatty liver (also known as steatorrhoeic hepatosis or steatosis hepatis) is a reversible condition where large vacuoles of triglyceride fat accumulate in liver cells via the process of steatosis. Despite having multiple causes, fatty liver disease (FLD) can be considered a single disease that occurs worldwide in those with excessive alcohol intake and those who are obese (with or without effects of insulin resistance). The condition is also associated with other diseases that influence fat metabolism[1]. Morphologically it is difficult to distinguish alcoholic FLD from non alcoholic FLD and both show micro-vesicular and macrovesicular fatty changes at different stages. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ... Schematic of typical animal cell, showing subcellular components. ... Example of an unsaturated fat triglyceride. ... Hepatocytes make up 60-80% of the cytoplasmic mass of the liver. ... Histological section of a murine liver showing severe steatosis. ... This article is about the medical term. ... This article does not cite any references or sources. ... Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. ... A few of the metabolic pathways in a cell. ... This article or section is in need of attention from an expert on the subject. ...

Contents

Causes

Fatty liver is commonly associated with alcohol or metabolic syndrome (diabetes, hypertension and dyslipidemia) but can also be due to any one of many causes[2][3]: This article does not cite any references or sources. ... Metabolic syndrome is a combination of medical disorders that increase ones risk for cardiovascular disease and diabetes. ... This article is about the disease that features high blood sugar. ... For other forms of hypertension, see Hypertension (disambiguation). ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. ...

Metabolic
Abetalipoproteinemia, glycogen storage diseases, Weber-Christian disease, Wolmans disease, acute fatty liver of pregnancy, lipodystrophy
Nutritional
Malnutrition, total parenteral nutrition, severe weight loss, refeeding syndrome, jejuno-ileal bypass, gastric bypass, jejunal diverticulosis with bacterial overgrowth
Drugs and toxins
Amiodarone, methotrexate, diltiazem, highly active antiretroviral therapy, glucocorticoids, tamoxifen, environmental hepatotoxins (e.g. phosphorus, toxic mushroom)
Other
Inflammatory bowel disease, HIV

Abetalipoproteinemia is a rare genetic disorder (autosomal recessive) that interferes with the normal absorption of fat and fat soluble vitamins from food. ... Glycogen storage disease is any one of several inborn errors of metabolism that result from enzyme defects that affect the processing of glycogen synthesis or breakdown within muscles, liver, and other cell types. ... Weber-Christian disease is a skin disease characterized by relapsing fever and panniculitis. ... Wolman disease (also known as Wolman’s disease, Wolman’s syndrome, and acid lipase deficiency) is a rare severe lipid storage disease that is usually fatal at a very young age. ... Acute fatty liver of pregnancy is a rare life-threatening complication of pregnancy that occurs in the third trimester or the immediate period after delivery. ... In medicine, lipodystrophy is a condition characterized by abnormal or degernative conditions of the bodys fat tissue. ... Percentage of population affected by malnutrition by country, according to United Nations statistics. ... Total parenteral nutrition (TPN), is the practice of feeding a person intravenously, circumventing the gut. ... Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. ... Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished. ... Jejuno-ileal (JI) bypass is an obsolete bariatric surgery procedure. ... Roux-en-Y gastric bypass surgery, or simply gastric bypass surgery, is a procedure almost exclusively used in surgical weight loss applications to correct morbid obesity. ... Diverticulosis, otherwise known as diverticular disease, is the condition of having diverticula in the large colon which are outpocketings of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall. ... Bacterial overgrowth is when theres too much bacteria in a certain place. ... Amiodarone belongs to a class of drugs called Vaughan-Williams Class III antiarrhythmic agent. ... Methotrexate (rINN) (IPA: ), abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug used in treatment of cancer and autoimmune diseases. ... Diltiazem is a member of the group of drugs known as Benzothiapines , which are a class of calcium channel blockers, used in the treatment of hypertension, angina pectoris, and some types of arrhythmia. ... The term antiretroviral drugs is used to describe drugs used against HIV infection (HIV is an RNA retrovirus). ... The name glucocorticoid derives from early observations that these hormones were involved in glucose metabolism. ... Tamoxifen is an orally active selective estrogen receptor modulator (SERM) which is used in the treatment of breast cancer and is currently the worlds largest selling drug for this indication. ... A hepatotoxin (gr:, hepato = liver) is a chemical toxic substance which damages the liver. ... General Name, Symbol, Number phosphorus, P, 15 Chemical series nonmetals Group, Period, Block 15, 3, p Appearance waxy white/ red/ black/ colorless Standard atomic weight 30. ... For other uses, see Mushroom (disambiguation). ... In medicine, inflammatory bowel disease (IBD) is a group of inflammatory conditions of the large intestine and, in some cases, the small intestine. ... Species Human immunodeficiency virus 1 Human immunodeficiency virus 2 Human immunodeficiency virus (HIV) is a retrovirus that causes acquired immunodeficiency syndrome (AIDS, a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections). ...

Pathology

Fatty change represents the intra-cytoplasmic accumulation of triglyceride (neutral fats). At the beginning, the hepatocytes present small fat vacuoles (liposomes) around the nucleus - microvesicular fatty change. In this stage liver cells are filled with multiple fat droplets that do not displace centrally located nucleus. In the late stages, the size of the vacuoles increases pushing the nucleus to the periphery of the cell giving characteristic signet ring appearance - macrovesicular fatty change. These vesicles are well delineated and optically "empty" because fats dissolve during tissue processing. Large vacuoles may coalesce, producing fatty cysts - which are irreversible lesions. [1]. Macrovesicular steatosis is the most common form and is typically associated with alcohol, diabetes, obesity and corticosteroids. Acute fatty liver of pregnancy and Reye's syndrome are examples of severe liver disease caused by microvesicular fatty change[4]. The diagnosis of steatosis is made when fat in the liver exceeds 5–10% by weight[5][6][1]. It has been suggested that Cytoplast be merged into this article or section. ... A liposome is a spherical vesicle with a membrane composed of a phospholipid bilayer used to deliver drugs or genetic material into a cell. ... HeLa cells stained for DNA with the Blue Hoechst dye. ... Histological section of a murine liver showing severe steatosis. ... Seal as impression A seal is an impression, usually in wax or embossed on the paper itself, or other item attached to a legal instrument used to authenticate it in place of, or in addition to, a signature. ... A cyst (soft c, rhymes with list) is a closed sac having a distinct membrane and develosion on the nearby tissue. ... Histological section of a murine liver showing severe steatosis. ... This article does not cite any references or sources. ... This article is about the disease that features high blood sugar. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... Acute fatty liver of pregnancy is a rare life-threatening complication of pregnancy that occurs in the third trimester or the immediate period after delivery. ... Reyes syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver. ...

Mechanism leading to hepatic steatosis
Mechanism leading to hepatic steatosis

Defects in fat metabolism is responsible for pathogenesis of FLD which may be due to imbalance in energy consumption and its combustion resulting in lipid storage or can be a consequence of peripheral resistance to insulin, whereby the transport of fatty acids from adipose tissue to the liver is increased[7][1]. Impairment or inhibition of receptor molecules (PPAR-α, PPAR-γ and SREBP1) that control the enzymes responsible for the oxidation and synthesis of fatty acids appears to contribute towards fat accumulation. In addition alcoholism is known to damage mitochondria and other cellular structure further impairing cellular energy mechanism. On the other hand non alcoholic FLD may begin as excess of unmetabolised energy in liver cells. Hepatic steatosis is considered reversible and to some extent nonprogressive if there is cessation or removal of underlying cause. Image File history File links Size of this preview: 513 × 599 pixelsFull resolution (2178 × 2543 pixel, file size: 797 KB, MIME type: image/jpeg) Mechanism behind lipid accumulation in liver cells. ... Image File history File links Size of this preview: 513 × 599 pixelsFull resolution (2178 × 2543 pixel, file size: 797 KB, MIME type: image/jpeg) Mechanism behind lipid accumulation in liver cells. ... This article or section is in need of attention from an expert on the subject. ... Pathogenesis is the mechanism by which a certain etiological factor causes disease (pathos = disease, genesis = development). ... In cell biology, peroxisome proliferator-activated receptors (PPARs) are a group of nuclear receptor isoforms that exist across biology. ... In cell biology, peroxisome proliferator-activated receptors (PPARs) are a group of nuclear receptor isoforms that exist across biology. ... SREBP Beginning with the discovery of the sterol regulatory element binding proteins (SREBPs) in 1993, a productive combination of biochemistry, molecular biology and genetics, has brought to light the complex mechanisms by which animal cells maintain the proper levels of intracellular lipid (fats and oils) in the face of widely...


Severe fatty liver is accompanied by inflammation, a situation that is referred to as steatohepatitis. Progression to alcoholic steatohepatitis (ASH) or non-alcoholic steatohepatitis (NASH) depend on persistence or severity of inciting cause. Pathological lesions in both conditions are similar. However, the extent of inflammatory response varies widely and does not always correlate with degree of fat accumulation. Steatosis (retention of lipid) and onset of steatohepatitis may represent successive stages in FLD progression[8]. An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... Steatohepatitis is a type of liver disease, characterized by inflammation of the liver with concurrent fat accumulation in liver (steato, meaning fat, hepatitis, meaning inflammation of the liver). ... Steatohepatitis is a type of liver disease, characterized by inflammation of the liver with concurrent fat accumulation in liver (steato, meaning fat, hepatitis, meaning inflammation of the liver). ... As its name signifies, Non-alcoholic steatohepatitis (NASH) or Nonalcoholic Fatty Liver Disease (NAFLD) is fatty inflammation of the liver when this is not due to excessive alcohol use. ... Pathology (in ancient Greek pathos = pain/pation and logos = word) is the study of diseases. ... Histological section of a murine liver showing severe steatosis. ... Some common lipids. ...


Liver with extensive inflammation and high degree of steatosis often progresses to more severe forms of the disease[9]. Hepatocyte ballooning and hepatocyte necrosis of varying degree are often present at this stage. Liver cell death and inflammatory responses lead to the activation of stellate cells which play a pivotal role in hepatic fibrosis. The extent of fibrosis varies widely. Perisinusoidal fibrosis is most common, especially in adults, and predominates in zone 3 around the terminal hepatic veins[10]. Hepatocytes make up 60-80% of the cytoplasmic mass of the liver. ... Necrosis (in Greek Νεκρός = Dead) is the name given to accidental death of cells and living tissue. ... Hepatic stellate cells, also known as Ito cells, are pericytes found in the perisinusoidal space (a small area between the sinusoids and hepatocytes) of the liver. ... Fibrosis is the formation or development of excess fibrous connective tissue in an organ or tissue as a reparative or reactive process, as opposed to a formation of fibrous tissue as a normal constituent of an organ or tissue. ... A sinusoid is a small blood vessel similar to a capillary but with a fenestrated endothelium. ... A hepatic lobule is a small division of the liver defined at the histological scale. ... Superior vena cava, inferior vena cava (IVC), azygos vein and their tributaries. ...


The progression to cirrhosis may be influenced by the amount of fat and degree of steatohepatitis and by a variety of other sensitizing factors. In alcoholic FLD the transition to cirrhosis related to continued alcohol consumption is well documented but the process involved in non-alcoholic FLD is less clear.


Diagnosis

Flow chart for diagnosis, modified from[3]
 
 
 
Elevated liver enzyme
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Serology to exclude viral hepatitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Imaging study showing
fatty infiltrate
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assess alcohol intake
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Less than 2 drinks per dayǂ
 
More than 2 drinks per dayǂ
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non alcoholic fatty liver disease likely
 
Alcoholic fatty liver disease likely
 
 
ǂ Criteria for nonalcoholic fatty liver disease:
consumption of ethanol less than 20g/day for woman and 30g/day for man[11]

Most individuals are asymptomatic and are usually discovered incidentally because of abnormal liver function tests or hepatomegaly noted in unrelated medical condition. Elevated liver biochemistry is found in 50% of patients with simple steatosis[12]. The serum ALT level usually is greater than the AST level in non-alcoholic variant and the opposite in alcoholic FLD. Alanine transaminase or ALT is an enzyme (EC 2. ... AST is a three-letter abbreviation that stands for a number of different things. ...


Imaging studies are often obtained during evaluation process. Ultrasonography reveals a "bright" liver with increased echogenicity. A fatty liver has lower density than spleen on CT scan and fat appears bright in T1 weighted MRI. No radiological modality is however able to distinguish simple steatosis from advanced NASH. Histological diagnosis by liver biopsy is sought when assessment of severity is indicated. Medical ultrasonography is an ultrasound-based imaging diagnostic technique used to visualize internal organs, their size, structure and their pathological lesions. ... Echogenicity (misspelled sometimes as echogenecity) is the ability to create an echo, i. ... For other uses, see Density (disambiguation). ... The spleen is an organ located in the abdomen, where it functions in the destruction of old red blood cells and holding a reservoir of blood. ... CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ... Non-alcoholic fatty liver disease (NAFLD) is fatty inflammation of the liver when this is not due to excessive alcohol use. ... A thin section of lung tissue stained with hematoxylin and eosin. ... A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ...


Treatment and prevention

The treatment of fatty liver depends on what is causing it, and generally, treating the underlying cause will reverse the process of steatosis if implemented at early stage.


Complication

Up to 10% of cirrhotic alcoholic FLD will develop hepatocellular carcinoma. Overall incidence of liver cancer in non-alcoholic FLD has not been assessed yet but the association is well established[13]. Hepatocellular carcinoma (HCC, also called hepatoma) is a primary malignancy (cancer) of the liver. ...


Epidemiology

FLD is prevalent among 10%- 24% of general population in various countries[2]. However among obese individuals the condition is observed in up to 75% of people, 35% of whom, despite no evidence of excessive alcohol consumption, will lead to non alcoholic FLD[14]. It is the commonest cause of abnormal liver function test in the US[2]. African Americans and Mexican Americans have higher frequencies of unexplained serum aminotransferase elevations than those reported in whites but prevalence of FLD among different racial groups is not known. Non-alcoholic fatty liver disease (NAFLD) is fatty inflammation of the liver when this is not due to excessive alcohol use. ... Liver function tests (LFTs or LFs), are groups of clinical biochemistry laboratory blood assays designed to give a doctor or other health professional information about the state of a patients liver. ... United States may refer to: Places: United States of America SS United States, the fastest ocean liner ever built. ... In biochemistry, a transaminase or an aminotransferase is an enzyme that catalyzes a type of reaction between an amino acid and an α-keto acid. ...


See also

Histological section of a murine liver showing severe steatosis. ... Steatohepatitis is a type of liver disease, characterized by inflammation of the liver with concurrent fat accumulation in liver (steato, meaning fat, hepatitis, meaning inflammation of the liver). ... Non-alcoholic fatty liver disease (NAFLD) is fatty inflammation of the liver when this is not due to excessive alcohol use. ... Metabolic syndrome is a combination of medical disorders that increase ones risk for cardiovascular disease and diabetes. ... Cirrhosis of the liver is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrotic scar tissue as well as regenerative nodules, leading to progressive loss of liver function. ... Pâté de foie gras (right) with pickled pear. ... Focal fatty liver (FFL) is localised or patchy process of lipid accumulation in the liver. ...

Reference

  1. ^ a b c Reddy JK, Rao MS (2006). "Lipid metabolism and liver inflammation. II. Fatty liver disease and fatty acid oxidation". Am. J. Physiol. Gastrointest. Liver Physiol. 290 (5): G852-8. DOI:10.1152/ajpgi.00521.2005. PMID 16603729. 
  2. ^ a b c Angulo P (2002). "Nonalcoholic fatty liver disease". N. Engl. J. Med. 346 (16): 1221-31. DOI:10.1056/NEJMra011775. PMID 11961152. 
  3. ^ a b Bayard M, Holt J, Boroughs E (2006). "Nonalcoholic fatty liver disease". American family physician 73 (11): 1961-8. PMID 16770927. 
  4. ^ Goldman, Lee (2003). Cecil Textbook of Medicine -- 2-Volume Set, Text with Continually Updated Online Reference. Philadelphia: W.B. Saunders Company. ISBN 0721645631. 
  5. ^ Adams LA, Lymp JF, St Sauver J, Sanderson SO, Lindor KD, Feldstein A, Angulo P (2005). "The natural history of nonalcoholic fatty liver disease: a population-based cohort study". Gastroenterology 129 (1): 113-21. PMID 16012941. 
  6. ^ Crabb DW, Galli A, Fischer M, You M (2004). "Molecular mechanisms of alcoholic fatty liver: role of peroxisome proliferator-activated receptor alpha". Alcohol 34 (1): 35-8. DOI:10.1016/j.alcohol.2004.07.005. PMID 15670663. 
  7. ^ Medina J, Fernández-Salazar LI, García-Buey L, Moreno-Otero R (2004). "Approach to the pathogenesis and treatment of nonalcoholic steatohepatitis". Diabetes Care 27 (8): 2057-66. PMID 15277442. 
  8. ^ Day CP, James OF (1998). "Steatohepatitis: a tale of two "hits"?". Gastroenterology 114 (4): 842-5. PMID 9547102. 
  9. ^ Gramlich T, Kleiner DE, McCullough AJ, Matteoni CA, Boparai N, Younossi ZM (2004). "Pathologic features associated with fibrosis in nonalcoholic fatty liver disease". Hum. Pathol. 35 (2): 196-9. PMID 14991537. 
  10. ^ Zafrani ES (2004). "Non-alcoholic fatty liver disease: an emerging pathological spectrum". Virchows Arch. 444 (1): 3-12. DOI:10.1007/s00428-003-0943-7. PMID 14685853. 
  11. ^ Adams LA, Angulo P, Lindor KD (2005). "Nonalcoholic fatty liver disease". CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 172 (7): 899-905. DOI:10.1503/cmaj.045232. PMID 15795412. 
  12. ^ Sleisenger, Marvin (2006). Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Philadelphia: W.B. Saunders Company. ISBN 1416002456. 
  13. ^ Qian Y, Fan JG (2005). "Obesity, fatty liver and liver cancer". HBPD INT 4 (2): 173-7. PMID 15908310. 
  14. ^ Hamaguchi M, Kojima T, Takeda N, Nakagawa T, Taniguchi H, Fujii K, Omatsu T, Nakajima T, Sarui H, Shimazaki M, Kato T, Okuda J, Ida K (2005). "The metabolic syndrome as a predictor of nonalcoholic fatty liver disease". Ann. Intern. Med. 143 (10): 722-8. PMID 16287793. 

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links


  Results from FactBites:
 
Dr Sandra Cabot's Liver Doctor - Love your Liver and Live Longer (2730 words)
Indeed a fatty liver becomes a warehouse for fat and if it is allowed to progress for many years, the liver may finally become just a "bag of fat" with dire consequences for your health and longevity.
In the USA the incidence of fatty liver is 15 to 20% of the general population and is much higher than this in obese individuals.
Liver enzymes are normally contained within the liver cells, and only when the cells are damaged and/or inflamed, do the enzymes leak into the blood stream.
Researchers estimate significant fatty liver disease in children (930 words)
The team found that in 23% of those children with fatty liver, the liver injury was severe enough to produce steatohepatitis, an inflammation caused by fat buildup in the liver.
The researchers noted that fatty liver disease is most prevalent among children and adolescents of Hispanic origin adding that the odds of a Hispanic child having fatty liver disease is five times higher than that for a fl child.
Schwimmer stated that fatty liver disease is usually diagnosed through biopsy tissue samples and that presented the first obstacle of determining the rate of the disease in a pediatric population.
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