Difference between revisions of "Steatosis"
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# | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Non-alcoholic fatty liver disease1.jpg | |||
| Width = | |||
| Caption = Steatosis. Elastic [[Masson's trichrome stain]]. | |||
| Synonyms = fatty liver | |||
| Micro = fatty change (macrovesicular or microvesicular and periportal or centrilobular), negative for ballooning degeneration, negative for significant inflammation - esp. [[neutrophils]] | |||
| Subtypes = macrovesicular steatosis (periportal, centrilobular), microvesicular steatosis | |||
| LMDDx = [[steatohepatitis]] (ASH, MASH), [[drug-induced liver injury]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = yellow colour, greasy/slippery feeling, enlarged | |||
| Grossing = | |||
| Staging = | |||
| Site = [[liver]] - see ''[[medical liver disease]]'' | |||
| Assdx = [[obesity]], [[alcoholism]] | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = very common | |||
| Bloodwork = | |||
| Rads = may be estimated by proton density fat fraction (PDFF) | |||
| Endoscopy = | |||
| Prognosis = dependent on underlying cause | |||
| Other = | |||
| ClinDDx = [[ASH]], [[MASH]], [[drug-induced liver injury]] | |||
| Tx = dependent on underlying cause | |||
}} | |||
'''Steatosis''', also '''fatty liver''', is a fatty change in the [[liver]] associated with a number of underlying (medical) causes. | |||
==General== | |||
===Classification=== | |||
Can be divided into: | |||
#Macrovesicular steatosis. | |||
#*Common. | |||
#Microvesicular steatosis. | |||
#*Rare. | |||
#*Potentially life threatening.<ref name=pmid15503661>{{Cite journal | last1 = Jolly | first1 = RA. | last2 = Ciurlionis | first2 = R. | last3 = Morfitt | first3 = D. | last4 = Helgren | first4 = M. | last5 = Patterson | first5 = R. | last6 = Ulrich | first6 = RG. | last7 = Waring | first7 = JF. | title = Microvesicular steatosis induced by a short chain fatty acid: effects on mitochondrial function and correlation with gene expression. | journal = Toxicol Pathol | volume = 32 Suppl 2 | issue = | pages = 19-25 | month = | year = | doi = | PMID = 15503661 | URL = http://tpx.sagepub.com/cgi/pmidlookup?view=long&pmid=15503661 }}</ref> | |||
Note: | |||
*It is considered technically incorrect to say the liver, in steatosis/steatohepatitis, contains ''adipocytes''; they are ''lipid-laden hepatocytes'',<ref>Guindi, M. September 2009.</ref> despite that: | |||
**Histologically, these cells look like adipocytes. | |||
**Lipid-laden hepatocytes have gene activations suggestive of adipogenic-like transformation.<ref>URL: [http://www.jci.org/articles/view/20513/version/1 http://www.jci.org/articles/view/20513/version/1]. Accessed on: 23 September 2009.</ref> | |||
===Etiology=== | |||
====Microvesicular steatosis==== | |||
Microvesicular steatosis DDx:<ref name=pmid2177300>{{cite journal |author=Hautekeete ML, Degott C, Benhamou JP |title=Microvesicular steatosis of the liver |journal=Acta Clin Belg |volume=45 |issue=5 |pages=311–26 |year=1990 |pmid=2177300 |doi= |url=}}</ref> | |||
*Acute fatty liver of pregnancy, | |||
*Reye's syndrome. | |||
*Drug toxicity: | |||
**Sodium valproate toxicity. | |||
**High-dose tetracycline toxicity. | |||
*Jamaican vomiting sickness. | |||
*Congenital defects of urea cycle enzymes. | |||
Less common causes: | |||
*[[Alcoholism]]. | |||
*Hepatitis D. | |||
*Weird stuff: | |||
**Congenital defects of fatty acid beta oxidation. | |||
**Cholesterol ester storage disease. | |||
**Wolman disease and Alpers syndrome. | |||
The classic causes of microvesicular steatosis are:<ref>[http://www.mailman.srv.ualberta.ca/pipermail/patho-l/1996-June/001788.html http://www.mailman.srv.ualberta.ca/pipermail/patho-l/1996-June/001788.html]</ref> | |||
*Fatty liver of pregnancy. | |||
*Aspirin (Reye's syndrome). | |||
*Tetracycline. | |||
It was once thought that all other causes of fatty liver produce macrovesicular steatosis. | |||
====Macrovesicular steatosis==== | |||
Can sometimes be divided into ''centrilobular'' predominant and ''periportal'' predominant.<ref name=pcddx_steatosis>Steatosis. pathconsultddx.com. URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970840-3 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970840-3]. Accessed on: 2 Sep 2009.</ref> | |||
Centrilobular predominant (zone III) - ''DOA'':<ref name=pcddx_steatosis/> | |||
*[[Diabetes mellitus]]. | |||
*[[Obesity]], metabolic dysfunction-associated steatohepatitis ([[MASH]]). | |||
*[[Alcoholic liver disease]], alcoholic steatohepatitis (ASH). | |||
Periportal predominant (zone I) - ''TAPES'':<ref name=pcddx_steatosis/> | |||
*Total parenteral nutrition (TPN). | |||
*[[AIDS]]. | |||
*Phosphorus poisoning. | |||
*Exogenous steroids. | |||
*[[Starvation]].<ref name=pmid10600264>{{Cite journal | last1 = Nagy | first1 = I. | last2 = Németh | first2 = J. | last3 = Lászik | first3 = Z. | title = Effect of L-aminocarnitine, an inhibitor of mitochondrial fatty acid oxidation, on the exocrine pancreas and liver in fasted rats. | journal = Pharmacol Res | volume = 41 | issue = 1 | pages = 9-17 | month = Jan | year = 2000 | doi = 10.1006/phrs.1999.0565 | PMID = 10600264 }}</ref> | |||
Notes: | |||
*[[HCV]] genotype 3 is reported to cause periportal steatosis.<ref name=pmid16614743>Yoon EJ, Hu KQ. Hepatitis C virus (HCV) infection and hepatic steatosis. Int J Med Sci. 2006;3(2):53-6. Epub 2006 Apr 1. PMID 16614743. Avialable at: [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1415843 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1415843]. Accessed on: September 9, 2009.</ref> | |||
*Donor livers with more ''macrovescicular steatosis'' = worse outcome. | |||
**More than 30% means the liver is undesirable for [[Liver transplantation pathology|transplantation]].<ref>STC. 6 December 2010.</ref> | |||
==Gross== | |||
*Yellow colour. | |||
*Greasy/slippery feeling. | |||
*Enlarged. | |||
Note: | |||
*May be estimated on MRI by proton density fat fraction (PDFF).<ref name=pmid23382291>{{Cite journal | last1 = Tang | first1 = A. | last2 = Tan | first2 = J. | last3 = Sun | first3 = M. | last4 = Hamilton | first4 = G. | last5 = Bydder | first5 = M. | last6 = Wolfson | first6 = T. | last7 = Gamst | first7 = AC. | last8 = Middleton | first8 = M. | last9 = Brunt | first9 = EM. | title = Nonalcoholic fatty liver disease: MR imaging of liver proton density fat fraction to assess hepatic steatosis. | journal = Radiology | volume = 267 | issue = 2 | pages = 422-31 | month = May | year = 2013 | doi = 10.1148/radiol.12120896 | PMID = 23382291 }}</ref> | |||
==Microscopic== | |||
Features - macrovesicular steatosis. | |||
*One large vacuoles - similar to mature adipose tissue. | |||
*Nucleus is eccentric. | |||
Features - microvesicular steatosis. | |||
*Multiple small (clear) cytoplasmic vacuoles - similar to brown fat, as seen in a [[hibernoma]]. | |||
*Nucleus is central.<ref>STC. 6 December 2010.</ref> | |||
===Grading=== | |||
Quantity of fat is usually given as a percentage and graded ''mild'', ''moderate'', or ''marked''. | |||
*Mild <33%, moderate >33% & <66%, marked >66%.<ref>Guindi, M. September 17, 2009.</ref> | |||
===Images=== | |||
<gallery> | |||
Image:Periportal_hepatosteatosis_intermed_mag.jpg | Periportal steatosis. (WC/Nephron) | |||
Image:Non-alcoholic_fatty_liver_disease1.jpg | Centrilobular steatosis. (WC/Nephron) | |||
</gallery> | |||
==See also== | |||
*[[Steatohepatitis]]. | |||
*[[Medical liver disease]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Liver pathology]] |
Latest revision as of 19:22, 16 May 2024
Steatosis | |
---|---|
Diagnosis in short | |
![]() Steatosis. Elastic Masson's trichrome stain. | |
| |
Synonyms | fatty liver |
| |
LM | fatty change (macrovesicular or microvesicular and periportal or centrilobular), negative for ballooning degeneration, negative for significant inflammation - esp. neutrophils |
Subtypes | macrovesicular steatosis (periportal, centrilobular), microvesicular steatosis |
LM DDx | steatohepatitis (ASH, MASH), drug-induced liver injury |
Gross | yellow colour, greasy/slippery feeling, enlarged |
Site | liver - see medical liver disease |
| |
Associated Dx | obesity, alcoholism |
Prevalence | very common |
Radiology | may be estimated by proton density fat fraction (PDFF) |
Prognosis | dependent on underlying cause |
Clin. DDx | ASH, MASH, drug-induced liver injury |
Treatment | dependent on underlying cause |
Steatosis, also fatty liver, is a fatty change in the liver associated with a number of underlying (medical) causes.
General
Classification
Can be divided into:
- Macrovesicular steatosis.
- Common.
- Microvesicular steatosis.
- Rare.
- Potentially life threatening.[1]
Note:
- It is considered technically incorrect to say the liver, in steatosis/steatohepatitis, contains adipocytes; they are lipid-laden hepatocytes,[2] despite that:
- Histologically, these cells look like adipocytes.
- Lipid-laden hepatocytes have gene activations suggestive of adipogenic-like transformation.[3]
Etiology
Microvesicular steatosis
Microvesicular steatosis DDx:[4]
- Acute fatty liver of pregnancy,
- Reye's syndrome.
- Drug toxicity:
- Sodium valproate toxicity.
- High-dose tetracycline toxicity.
- Jamaican vomiting sickness.
- Congenital defects of urea cycle enzymes.
Less common causes:
- Alcoholism.
- Hepatitis D.
- Weird stuff:
- Congenital defects of fatty acid beta oxidation.
- Cholesterol ester storage disease.
- Wolman disease and Alpers syndrome.
The classic causes of microvesicular steatosis are:[5]
- Fatty liver of pregnancy.
- Aspirin (Reye's syndrome).
- Tetracycline.
It was once thought that all other causes of fatty liver produce macrovesicular steatosis.
Macrovesicular steatosis
Can sometimes be divided into centrilobular predominant and periportal predominant.[6]
Centrilobular predominant (zone III) - DOA:[6]
- Diabetes mellitus.
- Obesity, metabolic dysfunction-associated steatohepatitis (MASH).
- Alcoholic liver disease, alcoholic steatohepatitis (ASH).
Periportal predominant (zone I) - TAPES:[6]
- Total parenteral nutrition (TPN).
- AIDS.
- Phosphorus poisoning.
- Exogenous steroids.
- Starvation.[7]
Notes:
- HCV genotype 3 is reported to cause periportal steatosis.[8]
- Donor livers with more macrovescicular steatosis = worse outcome.
- More than 30% means the liver is undesirable for transplantation.[9]
Gross
- Yellow colour.
- Greasy/slippery feeling.
- Enlarged.
Note:
- May be estimated on MRI by proton density fat fraction (PDFF).[10]
Microscopic
Features - macrovesicular steatosis.
- One large vacuoles - similar to mature adipose tissue.
- Nucleus is eccentric.
Features - microvesicular steatosis.
- Multiple small (clear) cytoplasmic vacuoles - similar to brown fat, as seen in a hibernoma.
- Nucleus is central.[11]
Grading
Quantity of fat is usually given as a percentage and graded mild, moderate, or marked.
- Mild <33%, moderate >33% & <66%, marked >66%.[12]
Images
See also
References
- ↑ Jolly, RA.; Ciurlionis, R.; Morfitt, D.; Helgren, M.; Patterson, R.; Ulrich, RG.; Waring, JF.. "Microvesicular steatosis induced by a short chain fatty acid: effects on mitochondrial function and correlation with gene expression.". Toxicol Pathol 32 Suppl 2: 19-25. PMID 15503661.
- ↑ Guindi, M. September 2009.
- ↑ URL: http://www.jci.org/articles/view/20513/version/1. Accessed on: 23 September 2009.
- ↑ Hautekeete ML, Degott C, Benhamou JP (1990). "Microvesicular steatosis of the liver". Acta Clin Belg 45 (5): 311–26. PMID 2177300.
- ↑ http://www.mailman.srv.ualberta.ca/pipermail/patho-l/1996-June/001788.html
- ↑ 6.0 6.1 6.2 Steatosis. pathconsultddx.com. URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970840-3. Accessed on: 2 Sep 2009.
- ↑ Nagy, I.; Németh, J.; Lászik, Z. (Jan 2000). "Effect of L-aminocarnitine, an inhibitor of mitochondrial fatty acid oxidation, on the exocrine pancreas and liver in fasted rats.". Pharmacol Res 41 (1): 9-17. doi:10.1006/phrs.1999.0565. PMID 10600264.
- ↑ Yoon EJ, Hu KQ. Hepatitis C virus (HCV) infection and hepatic steatosis. Int J Med Sci. 2006;3(2):53-6. Epub 2006 Apr 1. PMID 16614743. Avialable at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1415843. Accessed on: September 9, 2009.
- ↑ STC. 6 December 2010.
- ↑ Tang, A.; Tan, J.; Sun, M.; Hamilton, G.; Bydder, M.; Wolfson, T.; Gamst, AC.; Middleton, M. et al. (May 2013). "Nonalcoholic fatty liver disease: MR imaging of liver proton density fat fraction to assess hepatic steatosis.". Radiology 267 (2): 422-31. doi:10.1148/radiol.12120896. PMID 23382291.
- ↑ STC. 6 December 2010.
- ↑ Guindi, M. September 17, 2009.