Steatohepatitis

Steatohepatitis is a transitional phase of the disease from steatosis to cirrhosis. This pathology affects the cells of the liver tissue, expressing itself as an inflammatory process developing on the basis of fatty degeneration. The only good thing is that this process is still reversible (unlike liver cirrhosis).

ICD-10 code

Since the ICD-10 (International Classification of Diseases) code does not have a single designation, today the most common coding is K76.0 - fatty degeneration of the liver, not classified elsewhere.

Causes of steatohepatitis

To effectively treat the problem, it is necessary to have an understanding of both the disease itself and the sources that give rise to it.

This pathology is an inflammation in the liver tissues, which occurs against the background of the degeneration of liver fat cells. Doctors divide it into several types, which cause various pathologies. Causes of steatohepatitis.

1. Alcohol genesis. Almost every third person who abuses alcoholic beverages can be observed developing this deviation.
2. Metabolic genesis – pathology based on disturbances in metabolic processes.
   1. Excessive body weight.
   2. Protein deficiency.
   3. A deficiency of insulin in the body, causing diabetes.
   4. Rapid weight loss.
   5. Hunger strike.
   6. A disorder in lipid (fat) metabolism – dyslipidemia.
   7. Complete replacement of the patient's natural nutrition by parenteral administration of food (bypassing the digestive organs). This is mainly the intravenous route.
   8. Prolonged and repeated intravenous administration of glucose.
3. Drug trace of the disease. A number of drugs can cause poisoning with chemical compounds (intoxication), as well as fatty infiltration, which is caused by increased accumulation of lipid components in liver cells. Such consequences can be observed after taking certain drugs:
   1. Cytostatics that block the ability of cells to divide.
   2. Glucocorticoids that directly affect a person’s hormonal background.
   3. A number of antibiotic drugs.
   4. Nonsteroidal anti-inflammatory drugs (NSAIDs) used as analgesics, anti-inflammatory and antipyretic agents.
4. Surgical interventions performed on the organs of the gastrointestinal tract, especially in the case of partial removal of the small intestine, can also provoke this deviation.
5. Diverticulosis, a deviation resulting from the formation of a sac-like protrusion of the small intestine wall, can also be the cause of degeneration. In this case, an increased increase in the colony of pathogenic microorganisms is observed in the intestine.
6. Wilson-Konovalov pathology associated with changes in normal copper metabolism.
7. And a number of other factors. All sources are not yet fully known to modern medicine.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]

Symptoms of steatohepatitis

The symptoms of alcoholic or non-alcoholic steatohepatitis are almost identical. Developing against the background of long-term alcohol consumption, which leads to disruptions in metabolic processes (including lipid), the changes in question primarily affect the liver. After all, it is the "customs" of the body and ethyl alcohol entering the body is neutralized here. With regular attacks of alcohol, the organ ceases to cope with the purification of the body, and its cells begin to be damaged. They stop working, and fat gradually begins to accumulate on the surface. Little by little, the accumulation process leads to the occurrence of an inflammatory process and if it is not treated, then further progression can lead to a more severe disease - cirrhosis. This is an irreversible process in which the parenchymatous liver tissue is degenerated by fibrous connective structures, or stroma.

The non-alcoholic form develops in a similar way, but only the catalyst for the problem changes.

The main symptoms of steatohepatitis:

• In the area where the liver is located (under the right hypochondrium) a nagging pain begins to be felt.
• General weakness appears.
• Nausea.
• Weight loss is observed.
• Signs of diarrhea may appear.
• The skin takes on a yellowish tint.
• But one of the main indicators of pathology, both in alcoholic and non-alcoholic traces of the disease, is an increase in the size of the liver, which is easily determined even by palpation. When pressing on the diseased organ, the patient feels an increase in pain symptoms.

Non-alcoholic steatohepatitis

The name of the pathology type speaks for itself - non-alcoholic steatohepatitis, that is, the catalyst for the deviation from the norm was a source not associated with alcoholic beverages. It has another term - metabolic.

This type of disease is most often found in women with curvaceous forms. It is excess kilograms (obesity) that provoke its development and progression. Hereditary predisposition can also provoke the disease.

The cause may also be organic: the patient has a history of hypothyroidism, protein metabolism disorders (it may be the result of improper "sitting" on various diets or outright starvation), diabetes. The source may also be the patient's love for fatty foods.

The essence of the pathological mechanism is a violation of the metabolic response to endogenous or exogenous insulin (insulin resistance). This disease is dangerous not only because of the high risk of developing cirrhosis, but also because of the increased likelihood of disorders in the cardiovascular system, since a failure in lipid metabolism provokes accelerated progression of atherosclerosis.

Mostly, a person suffering from fatty liver disease of non-alcoholic genesis, in its chronic course, may not even guess about his problem. In this case, the clinical picture is poorly expressed and does not cause a person much discomfort. In this situation, it can be recognized only during a preventive examination.

The situation is much more complicated when diagnosing inflammation of liver structures with small vesicular lipid inclusions. This pathology can cause low blood pressure, pre-fainting and fainting conditions, internal bleeding or the development of gallstone disease.

Alcoholic steatohepatitis

This type of pathology is usually diagnosed in every third person who has a special addiction to the "green snake". At the same time, it does not matter whether he drinks strong drinks or low-alcohol beer.

Ethyl alcohol is broken down almost completely in the liver. But if there is too much alcohol, the liver cells are unable to process it properly. A failure occurs, their cellular structure begins to break down, and painful symptoms appear. A person feels weight loss, yellowing of the skin appears, belching, loose stools, and heartburn are observed less often.

In laboratory studies, alcoholic steatohepatitis is manifested by an increase in the number of liver tests, a decrease in the level of hemoglobin and the development of leukocytosis.

Initially, therapy for this type of disease involves giving up alcohol, and then the patient is offered both medication and dietary nutrition.

[ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ]

Fatty steatohepatitis

The pathology in question, in addition to the above, has a number of other names: fatty liver or fatty liver dystrophy, caused by degeneration or dystrophy of cellular structures. After the appearance of biopsy in the sixties of the last century, this pathology was singled out as a separate disease.

The main characteristic of the pathology in question is the appearance of lipid deposits in the cellular or intercellular zone. The morphological parameter is the presence of triglycerides in the organ in question, more than one tenth of the dry mass. Doctors divide this pathology into certain stages of progression: 1.

Increased lipidity of liver cells. At the same time, the structure of hepatocytes and their work remained undisturbed, mesenchymal (stromal-vascular) reaction of cells is not observed. 2.

There is increased lipidity of hepatocytes, the first signs of cellular necrosis appear, and a mesenchymal (stromal-vascular) reaction of cells is present. 3.

Precirrhotic stage of development. Irreversible restructuring of the lobular structure of the organ is observed.

[ 14 ], [ 15 ], [ 16 ], [ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ]

Chronic steatohepatitis

The chronic nature of steatohepatitis develops on the basis of constant alcohol intoxication of the body and affects 20 to 30% of people suffering from alcohol dependence.

Almost completely, by oxidation with special enzymes, ethyl alcohol is metabolized in liver tissues. Excessive alcohol load on the body causes a malfunction of the organ, as a result of which a sluggish inflammatory process begins, which leads to deviations from the normal functioning of a number of liver functions.

Such a patient begins to complain of pain in the right hypochondrium, yellowing of the skin and dyspeptic disorders.

If timely treatment is not carried out, the chronic stage of the disease can sooner or later progress into cirrhotic manifestations, which no longer allow the restoration of the original integrity and functionality of the liver.

[ 22 ], [ 23 ], [ 24 ], [ 25 ]

Minimal activity steatohepatitis

Against the background of universal automation, modern people are increasingly beginning to suffer from hypodynamia, which develops against the background of a sedentary lifestyle: from floor to floor in an elevator, a trip to work in transport. Many of our compatriots imagine their rest only as time lying on the couch in front of the TV. Such an approach to life cannot but affect the condition of the whole organism and the work of internal organs, in particular.

Fatty and high-calorie food and a sedentary lifestyle, all this adds up to the appearance of additional kilograms. But fat cells begin to "settle" not only in the subcutaneous area, but also on the organs themselves. It is the lipid deposits in the cellular and intercellular zone of the kidney tissue that give impetus to the progression of the pathology in question.

Moderate steatohepatitis

Mild or moderate degree of disease development is observed in 10.6% of cases, the pathology in question manifests itself especially against the background of progressive steatosis, affecting hepatocytes of the perivenular zone and undergoing apoptotic changes.

The ongoing research and monitoring of numerous cases of the disease confirms the recent assumptions of doctors about steatohepatitis as a transitional bridge from steatosis to cirrhotic transformations.

At this stage of the disease, there are practically no pathological symptoms, which prevents early diagnosis. At this stage, the disease can only be detected accidentally during a preventive examination, so it should not be ignored.

Steatohepatitis in pregnancy

This pathology in a woman who is carrying her baby may be genetic (that is, a hereditary predisposition to this disease), or develop against the background of another liver disease, which the girl may have had before conception.

The problem can also be provoked by taking a number of medications (vitamin and mineral complexes). A number of multivitamins for pregnant women contain chemical compounds that the female body is unable to process in a state of increased stress (which is pregnancy).

There are frequent cases when, due to incompetence, the doctor himself prescribes increased doses of drugs to a pregnant woman.

It should not be forgotten that due to many incorrectly formed beliefs, some women and their relatives still believe that a pregnant woman should eat for two during this period, which cannot affect the overall weight of the expectant mother. Hence the pathological deposits in the liver tissue and, as a result, the development of the disease discussed in this article in the pregnant woman.

Diagnosis of steatohepatitis

The difficulty in diagnosing the disease in question is that, in most cases, it develops quite slowly and, for the time being, does not have a clear clinical picture, not manifesting itself in any way.

Mostly, the only sign may be pain during palpation, and for a specialist, this is also an increase in the size of the liver, compaction of its structure. Therefore, it is possible to detect the disease at an early stage only during a visit to the doctor during a routine check-up, or if a person comes with another problem.

If the patient already has reasons to worry, then there is no point in delaying an appointment with a specialist.

Diagnosis requires a comprehensive approach to the problem, since similar symptoms are characteristic of not one, but several diseases:

1. Clarification of the patient's complaints by a specialist:
   • What symptoms does discomfort manifest itself with?
   • How long ago did the attacks start?
   • What events preceded the next attack?
2. Study of anamnesis.
3. What infectious diseases did you suffer from?
4. What medications were used?
5. Is there a hereditary predisposition?
6. And others.
7. External (physical) examination.
   • The presence of a yellowed cornea and skin. Intensity of the shade.
   • The condition of the epidermis is assessed for scratches.
   • Obtaining a patient's weight index, which allows assessing the presence of obesity.
8. Palpation of the pathological area for liver enlargement and manifestation of pain symptoms.
   • Percussion and palpation of the abdomen to determine the size of the spleen and liver.
   • Degree of painfulness to touch.
9. Since alcohol can cause liver changes, the doctor may prescribe a special study, the result of which should be an answer to the question of whether or not a person has a passion for alcoholic beverages.
10. Ultrasound examination of the liver. Here the size parameters of the organ, morphological and organic changes affecting its tissues are assessed.
11. Laboratory tests are performed to assess the quantitative components of immunoglobulin A, cholesterol, triglycerides, alkaline phosphatase, bilirubin and other indicators. Based on the degree of deviation from the norm, we can talk about the presence of inflammation in this area.
    • Complete blood count.
    • Biochemical blood test.
    • Urine test.
12. If necessary, a tissue biopsy is performed to assess the level of pathological changes and, consequently, the duration of the inflammatory process.
13. Under certain circumstances, a CT scan may be ordered.
14. There may be a need for additional consultation with more specialized specialists. For example, a hepatologist, therapist, surgeon, etc.

[ 26 ], [ 27 ], [ 28 ], [ 29 ], [ 30 ], [ 31 ]

Treatment of steatohepatitis

First, you need to determine the source of the changes. If the catalyst for the problem is alcohol, then the first thing you need to do is give up "bad" drinks.

At the same time, it is necessary to eliminate toxic effects on the body, increase sensitivity to insulin, strengthen the immune system, stabilize and normalize lipid and other types of metabolism, and restore the body's hepatoprotective capabilities.

The attending physician recommends his patient constant moderate physical activity: walking, swimming, dancing, fitness, etc. If necessary, you should normalize your weight.

With this pathology, the patient must definitely review his diet. Usually, the doctor prescribes "Table No. 5" for such a patient. Dietary nutrition should now become a lifelong habit. When returning to the "old life" (for example, drinking alcohol or eating unauthorized food), the disease tends to return and manifest itself with renewed vigor.

Pharmacological therapy is also carried out. To improve insulin sensitivity, biguanides are prescribed: metfogamma, bagomet, siofor, metformin-acri, glucophage, avandamet and others.

The hypoglycemic drug metformin - acri is prescribed strictly individually for each patient, but not more than 3 g daily, divided into several doses.

Contraindications to the drug include a history of diabetic ketoacidosis or diabetic precoma, coma, dysfunction of the heart, liver, respiratory organs and kidneys, acute cerebrovascular accident, as well as in the case of hypersensitivity to the components of the drug.

To reduce the activity of aminotransferases and protect against the destruction of hepatocytes, the doctor prescribes drugs based on ursocholic acid: ursofalk, ursochol, urdoksa, ursodeoxycholic acid, ursosan. Ursodeoxycholic acid capsules are taken orally in a daily dose, which is calculated as 10 - 15 mg per kilogram of the patient's weight. The drug is swallowed before bedtime, without chewing, with a sufficient amount of water. Contraindications to the use of this drug include radiolucent gallstones, increased intolerance by the human body to one or more components of the drug, atrophy of the gallbladder function and inflammation occurring in it and in the bile ducts, pancreatitis, as well as severe liver and / or kidney dysfunction.

Hepatotropic drugs that normalize phospholipid levels: Cholenzym, Allochol, Tivortin, Enerliv, Atoxil, Polysorb, Phosphogliv, Livolin Forte, Essentiale Forte, Sirin, Ribavirin, Hepatomax and others.

Essentiale forte is prescribed in a starting dosage for adult patients and adolescents over 12 years of age, two capsules three times a day. At the same time, maintenance therapy involves the introduction of one capsule three times a day. The medicine is used directly during meals, without chewing, together with a small amount of water. The duration of therapy is at least three months. The drug is not prescribed if hypersensitivity of the body to its components is detected.

Drugs that control cholesterol levels in atherosclerosis are statins. These may be: pravastatin, cerivastatin, fluvastatin, atorvastatin, simvastatin, rosuvastatin, lovastatin and others.

Fluvastatin is prescribed as a starting dose of 20 mg once a day (in the evening). If necessary, or if therapeutic effectiveness is not achieved, the doctor may double the dosage.

Administration of the drug is contraindicated in the active phase of liver disease, hypersensitivity to the components of the drug or persistent growth of accumulation of serum transaminases of unknown etiology, as well as during lactation and pregnancy.

The basis of therapy is diet, but if it does not bring significant results, the doctor can introduce lipotropic drugs into the treatment protocol, which allow normalizing metabolic processes and protect the liver from damage. These are silibinin, carsil, legalon, orgitox, legalon, selgon.

The hepatoprotector Karsil is prescribed before meals together with a sufficient amount of water. The duration of therapy is about three months.

In case of mild and moderate liver damage, the drug is administered in a dosage of one to two pills three times a day; in case of more severe damage, four pills, which corresponds to 420 mg of the drug, three times a day.

The prophylactic dose is two to three tablets per day.

Contraindications include increased intolerance to the components of the drug and the acute stage of poisoning of various etiologies.

If necessary, antibiotics are prescribed to stop the proliferation and further development of pathogenic intestinal microflora.

Cytoprotectors, pharmacological compounds that "put" protection on the body's cells, are also often used. These are sucralfate, misoprostol, venter, sucrafil, cytotec, alsucrale, sukrama.

Misoprostol is administered orally at a dose of 0.2 g four times a day, the last dose immediately before bedtime. If necessary, the dosage can be changed, but this decision remains with the attending physician.

Contraindications include individual intolerance of the human body to one or more components of the drug, including other prostaglandins and their analogues.

Standard of medical care for steatohepatitis

What can be said about the measures that should be taken when diagnosing the disease discussed in this article. First of all, relatives and friends should support the person both morally and physically.

The first thing that is necessary is to adhere to the diet prescribed by the doctor - "Table No. 5". It will not be at all superfluous and even welcomed if the whole family supports the sufferer in terms of nutrition.

Most often, this disorder in the liver is benign, progressing quite slowly. But there are cases of degeneration into cirrhosis and liver failure. This should not be allowed under any circumstances. And the first stage of this path is stopping the inflammatory process progressing in the body.

In this case, it is necessary not only to establish the source of the pathology, but also accompanying diseases that can affect the course of therapy, which consists of three main areas:

• Diet therapy.
• Drug treatment.
• Moderate physical activity – therapeutic exercise.

If possible, in parallel with this pathology, it is necessary to stop the disease that can slow down the effectiveness of the course of treatment or become a catalyst for its relapse.

• That is, the standard of medical care:
• Examination of the patient.
• Studying his medical history.
• Correct diagnosis and the reasons for its occurrence.
• Complex therapy that allows to relieve both the main problem and, if possible, the accompanying pathology.
• Strict adherence to dietary recommendations.

Diet for steatohepatitis

It is quite difficult to imagine modern medicine without the use of numerous diets developed by specialists to relieve a particular disease. Modern diet therapy is a fairly tangible lever of influence on painful areas. With the help of the correct use and combination of various food products, it becomes possible to significantly improve the patient's condition, as well as significantly reduce the duration of treatment and rehabilitation therapy.

In the case of our problem, the doctor prescribes "Diet No. 5", the main feature of which is the exclusion of various smoked, fried, spicy and fatty foods from the diet. On the contrary, the amount of products rich in vitamins, useful minerals and microelements should increase.

If the patient is overweight, then his daily menu should be calculated in such a way that the body receives a sufficient amount of necessary substances, while gradually getting rid of extra pounds. It is also necessary to ensure that the weight is not lost too quickly - this is also unacceptable.

The diet is selected individually, taking into account the severity of the clinical picture, the burdened anamnesis and the individual characteristics of the person. Therefore, this appointment is the direct prerogative of a qualified specialist.

The daily diet should be hypocaloric and calculated as 25 mg per kilogram of the patient's weight.

Products allowed to be included in the diet:

• Non-sweet bakery products: cookies, bread made from rye or wheat flour.
• Not very strong coffee (preferably with added milk) or tea.
• Green tea.
• Sugar.
• It is permissible to consume a small amount of butter (no more than 50 g daily).
• Various vegetable and fruit juices, fresh juices, compotes, punches, fruit drinks.
• Sour cream, hard cheeses and cottage cheese (low fat).
• Vegetable broths and vegetable soups based on them, you can add pasta and various cereals.
• Jam and jellies.
• Vegetable oil (no more than 50 g daily).
• Various cereals.
• Low-fat milk and dairy products.
• Sweet fruits and berries, sour fruits should be avoided.
• Meat products from lean cuts: rabbit, chicken, turkey, beef, etc. Poultry meat should be cooked and eaten without the skin.
• Herbal teas and tinctures.
• Fresh and cooked vegetables.
• Natural honey.
• Various greens.
• Egg (preferably just the white) – no more than one per day.
• River fish.

Dishes should be prepared using boiled, steamed or baked products.

Products prohibited for inclusion in the diet:

• You should limit or completely eliminate products made from rich dough. These are pancakes, cakes, crepes, fried pies, and so on.
• Strong broths: meat, mushroom, fish.
• Chocolate, cocoa and coffee.
• Root vegetables that are difficult for the digestive system: radishes and horseradish.
• Fatty fish.
• Pickled vegetables.
• Animal and cooking fats.
• From greens: spinach, sorrel, green onions.
• Lard and fatty meat.
• Hot sauces and seasonings.
• Mustard and horseradish.
• Sour varieties of fruits and berries.
• Smoked meats.
• Canned meat and fish.
• Creams.
• Strong tea.
• Eggs (especially the yolk), hard-boiled or scrambled (fried).
• Ice cream, especially those based on palm oil.
• Alcohol and carbonated drinks.
• Very cold and too hot food.

[ 32 ], [ 33 ], [ 34 ], [ 35 ]

Prevention of steatohepatitis

No one will argue that it is better to prevent any disease than to fight its consequences later. Therefore, in organizing your life, it is necessary to follow a number of simple rules and the probability of occurrence and development of the disease in question will be significantly reduced, tending to zero.

• It is necessary to monitor your weight, it should be close to the norm. Obesity has a negative effect on the functioning of all systems and organs of the human body.
• You shouldn't thoughtlessly go on various diets: starvation or sudden weight loss will also not be beneficial.
• You shouldn't get carried away with drinking alcoholic beverages.
• Take medications with extreme caution, having carefully read the instructions that come with them.
• It is necessary to be very careful about the products that are consumed. If the human diet is close to, and when treating pathology fully complies with, the dietary "Table No. 5", then "provocations" from the nutritional side should not be expected. This restriction especially concerns fatty and improperly processed food.
• It is necessary to undergo timely treatment for diseases such as diabetes mellitus, viral infections, and correction of dyslipidemic disorders.
• Regular preventive examination is necessary.

Prognosis of steatohepatitis

The consequences of a disease can be predicted only by knowing its clinical picture, severity of the disease and individual characteristics of the victim's body. If we are talking about the alcoholic type of the problem under consideration, then, in the presence of large-vesicular deposits in cellular tissues, we can talk about an increase in the probability of degeneration into cirrhosis. While the non-alcoholic process, characterized by a low rate of development, gives a similar result in 15-18% of cases. At the same time, this degeneration is stretched out in time and can last up to ten years.

The result of the forecast also depends on the activity of the person in the organization and adherence to preventive recommendations.

[ 36 ], [ 37 ], [ 38 ]

Steatohepatitis and the army

The disease in question is not a reason for exemption from service in the Armed Forces. But modern doctors know that hepatitis can be caused not only by an infection, but also by a metabolic disorder in the human body, as in the case of a metabolic disorder, fatty degeneration develops and, as a consequence, steatohepatitis.

Therefore, these two diseases quite often go hand in hand, and if chronic hepatitis is proven in the conscript’s medical history, this is precisely the fact that gives grounds for not recruiting such young people to serve in the Army.

You can get acquainted with this list in more detail in the “Regulations about the military-medical examination in the Health Forces of Ukraine. Ministry of Defense of Ukraine; Order, Regulations, Perelik [...] dated 08/14/2008 No. 402” by following the link rada.gov.ua

Life is wonderful and some representatives of human society try to take the most out of it: abundant fatty food, alcohol, even to the store in the neighboring house - by car. If rest - then a restaurant and lying on the couch or on a trestle bed on the beach. And then they begin to wonder - steatohepatitis - what is it and where did it come from. There is a well-known proverb: "Take care of your honor from a young age." In light of the problem discussed in this article, it should be changed: "Take care of your health from a young age." A correct active lifestyle, healthy nutrition, a balanced combination of physical activity and rest will protect you from many health problems. Regular preventive examinations should not be ignored. This will allow, if the pathology already exists, to recognize it at an early stage. In this case, it will be much easier to stop the problem and without serious consequences.