How does the liver get fat ? - The process is called 'steatosis' which means abnormal deposition of fat inside a cell. Small vacuoles of triglycerides are formed in the hepatocytes (liver cells) which may also accompany inflammation of liver or as commonly known hepatitis. This fatty deposition occurs when the energy or fat metabolism is disturbed or imbalanced so as to not break down fat properly. It can also be caused due to the fat metabolism hormone receptor being impaired or inhibited. Alcohol is metabolized by alcohol dehydrogenase (ADH) into highly toxic acetaldehyde, then further metabolized by aldehyde dehydrogenase (ALDH) into acetic acid which is oxidized into Carbon Dioxide (CO2) and water. Alcohol harms the mitochondria and other cellular processes. The mitochondria is the power house of the cell which generates energy and orchestrates metabolism inside the cell thereby the energy metabolism gets impaired. fat vacuoles are small in the early stages which do not cause any displacement of the cell's nucleus position, later stages the fat vacuoles contain more fat and grows larger in size causing obvious pushing of the nucleus to the periphery of the cell thus disrupting it. However as the disease progresses the fat vacuoles can coalesce to form fat cysts which are more irreversible lesions and can damage the liver cells for good.
Complications of AFLD - When the liver is laden with fatty tissue or even fat cysts it can also get inflammed to an extent where hepatitis can ocur. This condition is more severe and harmful to the body. In this stage the hepatocyte can balloon up or undergo necrosis (die). As the hepatocytes necrose and the liver scars the blood vessles in hte liver become narrow leading to increased pressure in hte blood entering the liver (portal hypertension). The veins need to develop collaterally and thus form a network of collateral portal veins which are fragile and can easily rupture causing bleeding or varices. Varices can lead emergency situation of internal bleeding. The increased blood pressure creates backlog of the blood which the veins try and match up with the collateral system but it doesn't prove enough. This leads to excess body fluids retention in the abdominal area in the peritonial cavity (abdominal wall cavity) and is termed as 'Ascites'. Ascites puts pressure on the diaphragm making breathing laboured. The later stages of alcoholic fatty liver disease leads to toxic substances ammonia as protein isn't metabolized well and can cause disorientation and loss of brain activity leading to sudden death.
Therapy and Care - The liver has main functions of detoxification, fat metabolism and protein metabolism which suffers during any liver disease. Therefore the diet that is administered should make sure the protein, fat and other substances are calculated as per the disease stage after liver function test. The medium chain fatty acids bypass liver and enter directly to be metabolized in the intestine therefore these are good substitutes for fat in the diet. Easily digested peptides and amino acids in the diet should be given rather than the usual protein foods. Protein and fat percentage in the diet should be as low as possible depending upon the stage of the disease and can be modified as the therapy and healing progresses. Liver is the only regenerative organ of our body and it needs ample of simple sugar to do so in order to heal itself back to original health therefore glucose is the best remedy as well as soft fruits and organic home made fruit jellies. Since the ascites is due to water backlog the fluid administration should be measured as per urine quantity daily and fluid drainage done at the health care center or hospital. Excess fluids can also become fatal. the liver is highly susceptible to any kind of infection or toxicity in this disease therefore a complete avoidance of processed, canned or outside food should be the mantra. fat soluble vitamins like A,D and E cannot be administered as their normal doses as they are stored in the liver but can be given in reduced amounts. Potassium and sodium content needs to be measured as it influences the water retention and blood pressure. The liver is in dire need of antioxidants like Vitamin B, C and minerals to heal the stress it suffers and more of fruits that are easily digested and chewed (preferentially soft) should be eaten in merrily. Complete abstinence of alcohol and drugs like paracetamol should be observed. The patient should be under thorough medical care and observation with a total bed rest for couple of months.
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