Fatty Liver (STEATOSIS)

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Fatty Liver (STEATOSIS) By. Dr. Apurva Tamhane (B.H.M.S., C.C.H.,

C.G.O.)

 

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 touch

 

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.

 

 

 

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