Fatty Liver.

Synonym.—Steatosis of the Liver.

Definition.—The term fatty liver may be applied to two conditions,—fatty infiltration and fatty degeneration. In fatty infiltration, there is an increased amount of fat in the normal cells, and is supposed to result from some constituent of the food, such as fat, or from carbohydrates. In fatty degeneration of the liver, the protoplasm or albuminates of the liver-cells are replaced by fat and the liver substance destroyed.

In infiltration, the fat varies, and in the normal liver is from three to five per cent, increasing after a full meal, particularly when the food is rich in the carbohydrates.

Etiology.—Aside from the physiological fatty liver, due to milk diet in infants, and the ingestion of a large quantity of carbohydrates, fatty liver is due to excessive use of alcohol and beer. Insufficient exercise, especially in hearty eaters, favors the accumulation of fat, owing to imperfect oxidation of the fatty particles ingested. Also imperfect oxidation due to tuberculosis of the lungs, pernicious anemia, and chlorosis.

It may be due to certain poisons, among which may be mentioned phosphorus, arsenic, copper, antimony, mercury, the aluminum salts, iodoform, carbolic acid, the mineral acids, and ptomains from fish, oysters, etc. It may occur as the result of the infectious diseases, especially such as are followed or attended by long-continued pus formation, as puerperal fever, erysipelas, etc.; the poison arising from acute yellow atrophy; as a result of general obesity, the liver acting as a receptacle to the excess of fat.

Pathology.—In fatty infiltration, the liver is increased in size, sometimes weighing from twelve to fifteen pounds, yet of such low specific gravity as to float in water. It is smooth, with rounded edges, and of a light-yellow color. On section, it is dry, and leaves the knife oily. The protoplasm of the cell is crowded to one side by the oil-drops.

In fatty degeneration, the liver is smaller than normal, is smooth, of a light-yellow color, soft and easily torn. On section, the cells are found degenerated, and a yellowish-gray, or mottled, friable, oily substance, is presented to the eye,

Symptoms.—There are no characteristic symptoms attending this condition. Ascites and splenic enlargement are rare, and, when present, are due to complication. Jaundice is usually absent, for in advanced cases the bile is but little lessened in quantity.

The stools are light-colored, however, and constipation may alternate with diarrhea. When the liver is very much enlarged, there will be gastro-intestinal disturbances, with loss of appetite, flatulence, nausea, and sometimes vomiting; diarrhea, 'alternating with constipation, occurs, and the stools contain mucus.

There is a sense of fullness in the right hypochondrium, and the liver, on palpation, is found large, smooth, soft, and doughy, and extending several inches below the costal ridge.

Course and Complications.—The disease runs a chronic course, depending largely upon the complications existing, which often include fatty degeneration of the kidneys and heart. Where the kidneys are involved, the urine is scanty, high-colored, and contains albumin, fat, or oil-casts, and crystals of cholesterin. When fatty degeneration of the heart complicates the disease, the pulse is irregular and feeble, and frequent attacks of vertigo and syncope occur. Later, edema of the extremities and general anasarca take place.

Diagnosis.—The enlargement of the liver, it being smooth, with rounded edges, and soft and doughy, would suggest its true character, especially if the patient has freely indulged in beer and alcohol, and been a high liver or eaten largely of the carbohydrates, and followed a sedentary life. The history of infectious diseases, or acute yellow atrophy, would also suggest fatty liver.

The absence of jaundice, ascites, and splenic enlargement, would also render the diagnosis more positive.

Prognosis.—This depends upon the condition. Fatty infiltration is not to be regarded as very serious; but fatty degeneration is a more grave lesion, especially when due to acute yellow atrophy or the more grave infectious, diseases.

Treatment.—This will be largely hygienic and dietary. The patient should take plenty of well-regulated exercise in the open air. He should abstain from alcohol, beer, and sweet wines. Fatty, farinaceous, and starchy foods are to be avoided, and the patient should take sparingly of fluids.

The diet should consist of albuminoid substances, such as lean meats, fish, vegetables, and fruits. Plain broths may be used sparingly. The saline alkaline waters may be used freely. Gastric complications will be treated as they arise, and will call for hydrastis, nux vomica, rhus tox., ipecac, etc.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.