Description of the problem:

My father is suffering from early fatty liver, but since his gallbladder has been removed, the common treatments may not be very effective, can you please provide the treatment for fatty liver in my father's case, thanks!

Ans:

In a healthy person, the total fat in the liver is about 2-5% of the weight, including phospholipids, triglycerides, fatty acids, cholesterol, and cholesteryl esters. Fatty liver can be diagnosed when the weight of fat accumulated in the liver exceeds 5% of the total weight of the liver. According to the amount of fat accumulated in the liver, fatty liver can be categorized into light (5-10%), medium (10-25%) and heavy (>30%) degrees.

Fatty liver can be a stand-alone disease, but is more commonly a pathologic process of systemic disorders in the liver. Liver steatosis is present in varying degrees in about 1 0% of the general population.

At present, the treatment of fatty liver is still based on the removal of the cause of the disease, in the adjustment of diet, at the same time, can choose the appropriate lipid-lowering drugs, and supplemented with symptomatic treatment. Early diagnosis, early treatment can effectively control the further development of fatty liver, and can make the condition reversed.

I. Dietary therapy

Adjusting diet is an important part of the treatment of fatty liver. In principle, fresh vegetables, lean meat (mainly beef and mutton) and diet rich in lipophilic substances (choline, methionine) should be consumed to reduce weight by 10-20%. However, it should be noted that the diets of patients with fatty liver should still contain moderate amounts of fat, and attention should be paid to controlling the intake of sugar. Because, when consuming non-fat food, the body can still synthesize lipoic acid from sugar and amino acid precursors, and excessive intake of sugar can increase insulin secretion, prompting the conversion of sugar into fat. In addition, it should also be based on different causes, different conditions to determine the composition of the diet.

(a) Obesity fatty liver

Under the premise of ensuring the normal intake of nutrients, we should appropriately reduce the intake of fat, sugar and total calories, fat should use vegetable oil and limit the intake of high cholesterol foods, such as can adhere to a year can be reduced by 10-20kg, the liver fat deposition subsides. Diet control and weight loss measures must be appropriate, excessive dietary restrictions can also lead to steatohepatitis and hepatic fibrosis, and electrolyte disorders, hyperuricemia and ketoacidosis and other adverse consequences. Studies at home and abroad have shown that the faster the initial weight loss, the greater the chance of weight rebound and cardiac, cerebral and vascular cirrhosis and liver fibrosis, and the more difficult to maintain the weight after weight loss. Therefore, the goal of diet therapy for these patients should be to control the degree of weight loss at the primary stage within 10-15%, with a daily intake of 1,200-1,800 kilocalories for about one year. For those who do not have a significant effect can be changed to a low-calorie diet therapy, the daily intake of 600-1200 kcal is appropriate.

(ii) Alcoholic fatty liver disease

In patients with simple alcoholic fatty liver disease, abstinence from alcohol may be the special tool. At the same time, intake of high protein, high calorie, high vitamin diet to correct malnutrition. Fat intake should not exceed 15%-20% of total calories and reduce the intake of polyunsaturated fatty acids, which can induce and exacerbate liver tissue damage through lipid peroxidation.

(C) Malnutrition fatty liver

This disease is most common in patients with insufficient nutritional intake or digestive and absorption disorders and chronic wasting disease. Dietary therapy should be based on high protein, high calorie, high vitamin and low fiber diet, and compound amino acid preparations should be added to those with serious conditions.

(D) diabetic fatty liver Diet therapy plays an important role in the treatment of diabetic patients. For type I and II diabetic fatty liver patients should be given a low-calorie, low-fat, high-fiber diet, sugar can account for about 60% of the total calories. The daily protein intake of patients with combined kidney disease should be limited to Ig/kg or less to reduce the burden on the kidneys.

(E) Hyperlipidemic fatty liver

These patients can be cured simply by diet therapy. The diet should be low in sugar, fat, cholesterol and fiber. Try to eat more mushrooms, fungus, celery and hawthorn, etc., in order to achieve the purpose of lowering blood ester and reducing fat deposition in the liver.

(6) Post-hepatitis fatty liver

This condition is common in the recovery of acute viral hepatitis and chronic hepatitis patients, mostly due to excessive calorie intake and excessive restriction of activities leading to weight gain, which in turn leads to fat deposition in the liver. Diet should appropriately reduce the intake of fat, sugar and total calories and increase moderate physical activity.

Second, drug treatment

(a) lipid-lowering drugs

Because fatty liver and hyperlipidemia are closely related, lipid-lowering drugs have long been used to treat fatty liver with some effect, such as: choline, methionine, niacin and its derivatives, inositol, cholestyramine, Antomin (chlorphenbutyl ester), benzabephet (must be lowered), elastase, beauty, and so on. (Bilirubin), elastase, methotrexate, etc. There are also many new drugs, such as ciprofibrate, fenofibrate (lipofectamine, pralidoxime), gemfibrozil, acipimox (leuprolide), clomiphene, biclofibrate, etofibrate (ezetimibe), lovastatin, simvastatin, etc., which have the effect of lowering serum triglyceride, cholesterol, VLDL, LDL, and elevating HDL, and thus are effective in fatty liver. However, the efficacy of most of the various types of lipid-removing drugs is still not very accurate, and some of them have large side effects. Improper application may aggravate hepatic fat deposition, and even lead to hepatic insufficiency or deterioration of the patient's liver function, so they should be applied under the guidance of physicians. The treatment of fatty liver focuses on diet control, weight reduction, supplemented by a small amount of drug therapy.

(2) Hepatoprotective drugs

In recent years, some of the drugs that have the effect of both protecting hepatocytes and correcting hepatocyte fat metabolism are being actively researched, and some of them have already been applied in the clinic, such as: prostaglandin E (PGE), hepatic health, malotilate, taurine, mercaptopropionylglycine and so on, can be tried.

(3) Traditional Chinese medicine

Many traditional Chinese medicines such as Salvia divinorum, Rhizoma Ligustici Chuanxiong, cassia seeds, hawthorn, zedoary, etc. are effective for fatty liver, and they can be used to alleviate the symptoms by forming a prescription according to the principle of traditional Chinese medicine diagnosis and treatment. For example, for patients with liver depression and Qi stagnation type, Chai Hu Shu Hepatosan can be added and reduced; for Qi and blood stasis type, Chuan Xie Tang can be added and reduced; for phlegm and turbidity type, Si Rei San combined with Phlegm Conducting Tang can be added and reduced. In addition, some single prescription such as fat drink (hawthorn, diarrhea, chaihu), fat tablets (atractylodes macrocephala, chenpi, half-summer, danshen), platinum pills (alum, tulip gold, etc.) can also lower fat, commercially available weight loss drinks have weight loss and lowering of ester effect, you can choose to choose or in the guidance of the doctor to choose.