Elderly fatty liver

　　Many diseases can be accompanied by senile fatty liver. To facilitate clinical diagnosis and treatment, it is mainly divided into alcoholic fatty liver and non-alcoholic fatty liver.
　　Firstly, Alcoholic fatty liver
　　Long-term and excessive alcohol consumption has serious harm to the human digestive, nervous, and circulatory systems, especially its direct toxic effect on the liver, which is closely related to the amount, time, and method of drinking. Prospective studies by some scholars have shown that fatty liver can be formed in some people after 10 to 12 days of consuming 150g to 200g of ethanol per day; another statistical show that more than 160g of alcohol is consumed daily, 42% of people will have alcoholic fatty liver, 32% will have alcoholic hepatitis, and 14% will have alcoholic cirrhosis within 10 years. Alcohol stimulates the secretion of catecholamines by the adrenal glands, causing an increase in fat mobilization in peripheral tissues, which is considered one of the factors that exacerbate fatty liver. At the same time, due to reduced food demand and digestive absorption disorders in alcoholics, the toxic effect of alcohol can be exacerbated.
　　Secondly, Non-alcoholic fatty liver
　　1. Obesity-related fatty liver: Obesity is defined as body weight exceeding 20% to 25% of the standard. The incidence of fatty liver in severe obesity patients ranges from 61% to 94%. Obesity patients have excessive peripheral fat tissue, an increase in the release of unesterified fatty acids, a faster rate of fat accumulation in the liver than fat decomposition, and in addition, obesity patients often consume low-protein and high-carbohydrate foods, leading to a protein-calorie imbalance, all of which can lead to the occurrence of fatty liver.
　　2. Nutritional deficiency fatty liver: Mainly caused by insufficient caloric supply and low protein intake or malabsorption, etc. During hunger, the increase in serum free fatty acids can lead to the formation of fatty liver; Bypass surgery and gastric partitioning surgery are surgical methods for controlling obesity, and their postoperative complications include liver fatty degeneration.
　　3. Diabetic fatty liver: About 50% of diabetic patients have fatty liver. Type 1 diabetics develop fat decomposition due to insulin deficiency, a decrease in the ability to clear plasma lipoproteins, leading to the formation of fatty liver; Type 2 diabetics are mainly caused by obesity due to excessive intake of carbohydrates.
　　4. Drug and toxic fatty liver: Drugs that cause fatty liver include tetracycline, adrenal cortical hormones, and antitumor drugs, etc. Common toxic substances that cause fatty liver include carbon tetrachloride (CCl4), phosphorus, isopropyl alcohol, trichloroethylene, arsenic, lead, mercury, and others. The aforementioned drugs and toxic substances can cause varying degrees of liver damage.
　　5. Other: Primary liver diseases, such as viral hepatitis, inflammatory bowel disease, and others.

　　A small number of elderly fatty liver patients may have splenomegaly, and may have portal hypertension (such as ascites, edema, upper gastrointestinal bleeding) and acute encephalopathy. As fatty liver continues to develop, it may produce severe conditions such as liver cirrhosis, so elderly patients need to pay attention to it.

　　The following conditions may suggest the possibility of fatty liver in elderly patients, including similar symptoms to chronic hepatitis but can be excluded from the diagnosis of chronic hepatitis: liver area pain or discomfort, anorexia, nausea, vomiting, abdominal distension, diarrhea, impotence, nosebleed, spider veins, and gynecomastia in males, and may have obesity, alcohol consumption, and medication history.

　　The patient's physical signs may include liver enlargement, with the edge feeling blunt, smooth, soft, or tough, but the spleen is not large, accompanied by weight loss or increased weight due to generalized lipid deposition.

　　Since simple fatty liver often has no specific clinical symptoms, or its symptoms are often similar to other liver diseases, especially chronic liver disease, it is necessary to confirm the diagnosis through laboratory, imaging, and pathological tissue examination. A complete diagnosis should include etiology, pathology, and typing, etc.

　　Elderly alcoholic fatty liver is prone to develop into alcoholic hepatitis and liver cirrhosis, and can also lead to liver failure; non-alcoholic fatty liver is divided into 4 stages, namely fatty liver, fatty liver hepatitis, fatty liver hepatitis with fibrosis, and liver cirrhosis, so fatty liver can threaten people's health, and good prevention can prevent the occurrence of fatty liver.

　　1. First-level prevention

　　Avoid long-term and excessive alcohol consumption, have a reasonable diet, control weight, use or avoid corticosteroids, tetracyclines, and other drugs, and avoid contact with yellow phosphorus, carbon tetrachloride, and other substances.

　　2. Second-level prevention

　　Implement blood biochemistry and liver B-ultrasound examinations for high-risk populations.

　　3. Third-level prevention

　　Patients with fatty liver hepatitis or alcoholic hepatitis should rest in bed, actively treat liver protection, and avoid developing liver cirrhosis, severe hepatitis, hepatic encephalopathy, and hepatorenal syndrome, etc.

　　Risk factors and intervention measures: if nausea, vomiting, fever, jaundice, ascites, and significantly increased ALT and AST are found, and hepatitis or liver cirrhosis develops, immediately rest in bed, remove the cause, and take liver-protecting drugs; pay attention to the supplementation of sugar, protein, calories, and vitamins to prevent liver failure; if there are mental abnormalities, drowsiness, and concurrent hepatic encephalopathy, anti-hepatic coma treatment should be given on the basis of the above treatment.

　　Older patients with fatty liver often have no obvious symptoms, and the diagnosis is mainly confirmed through liver function and B-ultrasound examination results. The main examination items include the following types:
　　I. Laboratory examination
　　Plasma globulin is often increased, and increased bilirubin is mostly seen in fatty liver with cholestasis; alanine aminotransferase (ALT) and aspartate aminotransferase (AST), cholinesterase, and alkaline phosphatase are slightly increased; in alcoholic liver disease, the increase of AST is more obvious than that of ALT, and it is considered to be a relatively specific indicator for diagnosing alcoholic liver disease; there may be increased blood lipids, mainly increased cholesterol; some patients may have prolonged prothrombin time.

　　I. Imaging examination

　　1. Ultrasound shows

　　(1) A 'bright' liver with dot-like hyperechoic liver parenchyma.

　　(2) the attenuation of deep echo waves while the change in the size of the liver is minimal.

　　(3) enhanced contrast between liver and kidney.

　　(4) unclear luminal structure.

　　2. CT accuracy is better than ultrasound, mainly manifested as the general or localized reduction of liver parenchymal density, and the enhancement of the portal vein echo.

　　3. MRI (Magnetic Resonance Imaging) with proton spectroscopic imaging system can clearly distinguish the differences in signals between water and fat, and has a promising application prospect, but its price is expensive.

　　4. 99mTc radionuclide scan can help distinguish between localized fatty liver and intrapulmonary space-occupying lesions.

　　Second, liver biopsy

　　It is an important method for diagnosis, especially for localized fatty liver. Under the guidance of ultrasound, aspiration of liver tissue biopsy is accurate and safe.

　　A reasonable diet for elderly fatty liver patients should be high in protein, moderate in calories, and low in carbohydrates; overweight individuals should achieve a negative energy balance state of energy consumption on the basis of ensuring the basic needs of the body's protein and various nutrients; nutritional fatty liver should follow a diet high in protein, sufficient amounts of carbohydrates and fats..

　　Generally speaking, fatty liver is a reversible disease, and early diagnosis and timely treatment can often restore normal function. In addition to excluding the cause, Tai Chi, Qigong, aerobics, and maintaining moderate physical activity can consume a certain amount of fat, achieve weight loss and reduce blood lipid levels, and can significantly change the liver tissue, which is beneficial to the recovery of the disease. The main methods of treating fatty liver are as follows:

　　First, routine treatment

　　1. Eliminate the cause

　　Different methods should be adopted for different causes. Alcoholic fatty liver patients should abstain from alcohol; nutritional fatty liver needs reasonable nutritional reinforcement; obesity-related fatty liver should control weight and focus on weight loss; after controlling blood sugar in diabetic fatty liver, the condition of fatty liver can be improved; stop using drugs that cause fatty liver.

　　2. Rational diet

　　A reasonable diet should be high in protein, moderate in calories, and low in carbohydrates. On the basis of ensuring the basic needs of the body's protein and various nutrients, overweight individuals should achieve a negative energy balance state of energy consumption. Nutritional liver fatty liver should follow a diet high in protein, sufficient amounts of carbohydrates and fats.

　　3. Drugs

　　(1) Eseentiale: Contains natural choline phosphatidylcholine, unsaturated fatty acids, and various vitamins, which can improve the metabolism of fats in the liver, increase lipoprotein synthesis, reduce fat infiltration in liver cells, reduce inflammatory response, promote cell regeneration, reduce the formation of scar tissue, and benefit bile stability, prevent the formation of gallstones, and promote the absorption of fat-soluble vitamins. Dosage: 2 to 4 vials per dose, once a day, intravenous injection or infusion, a course of 2 to 4 weeks; soft capsule, 1 to 2 capsules per dose, 3 times a day.

　　(2) Thiopurone (Kesilei): A novel metabolic improvement detoxifier with strong effects in preventing liver injury caused by carbon tetrachloride, ethanol, and D-galactose, preventing the accumulation of triglycerides, protecting the mitochondrial structure, improving its function, administered intravenously at a dose of 0.1g to 0.2g, a course of 2 to 4 weeks.

　　(3) Glutathione (Atomoxetine): Can combine with the toxic metabolic products of ethanol in the liver, such as acetaldehyde and oxygen free radicals, thereby inhibiting the production of peroxides and the accumulation of triglycerides in liver cells, preventing the transformation, necrosis, and fibrosis of liver cells, and preventing liver fibrosis. Dosage: 1-2 times/d, each 0.6g, intramuscular or intravenous injection.

　　(4) Choline: It is a component of lecithin and plays an important role in promoting the synthesis of phospholipids, accelerating the transport of fats in the liver, and the formation of lipoproteins. Oxidized choline: 0.1-1.0g/time, 3 times/d, oral; Compound choline: 2ml/time, 1-2 times/d, intramuscular injection. The above drugs are suitable for malnutrition-induced fatty liver, and are ineffective for other types of fatty liver.

　　(5) B vitamins: Have a protective effect on liver cells.

　　(6) Bear bile powder: Mainly contains bile acids including ursodeoxycholic acid, cholic acid, and deoxycholic acid, etc., which can reduce plasma cholesterol levels, promote the decomposition and metabolism of fats and fatty acids in the body, and is used for the treatment of hyperlipidemia and fatty liver patients. Common dosage: 0.4g-1.2g, 1-2 times/d, taken with warm water.

　　(7) Monascus Extract (Zhibituo): The main ingredients are Monascus and other natural drugs, which have the effects of preventing the occurrence of hyperlipidemia, reducing cholesterol, triglycerides, and low-density lipoprotein. Common dosage: 3 tablets (10.5g)/time, 3 times/d, oral, course of treatment 4-8 weeks.

　　Secondly, Optimal Treatment Plan

　　1. Non-alcoholic Fatty Liver

　　(1) Rational nutrition, weight control, and discontinuation of drugs that cause fatty liver.

　　(2) Oral administration of Ganodecorin and B vitamins, or intravenous administration of Ganodecorin can also be used for treatment.

　　2. Alcoholic Fatty Liver

　　(1) The primary treatment is to strictly abstain from alcohol and adopt a diet high in protein and vitamins.

　　(2) Drug treatment for concurrent alcoholic hepatitis: ① 0.2g of Thiopurine (Kaisilei) added to 250ml of 5% glucose solution for intravenous infusion, course of treatment 2-4 weeks. ② 1.2g of Glutathione (Atomoxetine) added to 250ml of 5% or 10% glucose solution for intravenous infusion, course of treatment 2-4 weeks.