Fatty liver degeneration - what is it? How to Treat Fatty Bone Marrow Degeneration

WE RECOMMEND – age-related process of replacement of hematopoietic tissue bone marrow to fat. In some cases, it begins earlier due to cancer or infectious diseases, uncontrolled drug therapy. This natural process can have complications. Among them are osteoporosis, anemia, disorder hormonal levels and stenosis spinal canal. In most cases specific therapy not required, but if complications threaten the patient's quality of life, it may be prescribed surgical intervention.

The main risk factor is age. Tissue degeneration begins to occur, including the bone marrow of the spine. This is natural, and if the patient is over seventy, often his bone marrow is half fat.

The process is initiated by myeloid cells. They are found in the bone marrow and create everything blood cells. They also form muscles and internal organs, such as the liver.

In some cases, degeneration occurs much earlier. The cause may be metabolic disorders, malignant neoplasms and metastasis, infections. Unfortunately, such changes can occur regardless of age.

An accelerated process of “obesity” of the vertebrae can occur due to the use of certain medications. These include non-steroidal anti-inflammatory drugs. This is especially bad considering that many people suffering from osteochondrosis mainly use NSAIDs - it turns out vicious circle degeneration of back tissues. You can also list blood pressure-lowering medications, cardiac medications, and antibiotics here.

How it develops

When blood circulation and metabolism of the spine are disrupted, osteochondrosis does not remain the only problem. Additional pathology There may be fatty degeneration of the bone marrow and ligaments that fix the back. The result of this pathological process may be further compression of the spinal cord. And if on spinal cord there is some kind of mechanical impact, a whole bunch of heavy neurological symptoms. Including partial and complete paralysis.

Due to the fact that the vertebral bodies do not have independent internal nerves and blood vessels, but feed through the endplates, fatty degeneration in them begins quickly. In addition to the vertebrae, the arteries also change. The path becomes more complicated nutrients to the vertebrae and discs. This is another reason why the nucleus pulposus loses its shock-absorbing properties.

Osteochondrosis and fatty degeneration lead to a decrease in the space between the vertebrae. To reduce spasms of the spinal ligaments, the body tries to get rid of calcium. This leads to a disease such as osteoporosis.

Prognosis and complications

Fatty bone marrow degeneration results in poor blood cell production. Anemia and decreased immunity are observed. Vascular tone decreases. The condition of not only the spine, but the entire human body. Fabrics internal organs they begin to “suffocate” without receiving enough oxygen.

Fatty degeneration of the vertebrae can lead to the development of diseases such as:

Simmond-Schien disease. Middle-aged females are usually affected. Begin hormonal changes because of which he suffers a large number of body tissues;
Anemia. The degeneration of the cells that create blood cells does not go away without a trace;
. Too much fat in bone prevents the body from producing collagen. Because of this, a person stops processing calcium correctly, and the vertebrae become fragile.

Blood clots worse, and as a result, traumatic effects can be fatal. Especially severe consequences may occur if such a symptom accompanies osteoporosis - dystrophy bone tissue. Bones break easily, and if a fracture occurs, internal bleeding may begin non-stop.

Treatment

Used as conservative curative measures, and operations. But unfortunately, they are largely only symptomatic. Degeneration of vertebral tissue due to aging is an irreversible process. But if complications, inflammatory processes, or pinched nerves occur, the following recommendations are suitable:

IN acute period When attacks are constantly tormenting, you need to give the patient complete rest. Eliminate both mental and physical stress factors;
Nonsteroidal anti-inflammatory drugs (Ibuprofen, Diclofenac);
Muscle relaxants to relieve painful muscle spasms (for example, Sirdalud);
Injection spinal blockades with novocaine;
Chondroprotectors are drugs that help regenerate cartilage tissue;
Physiotherapy (Magnet, Electrophoresis, Low frequency current, Shock wave therapy);
Physical therapy (after the acute period has ended);
Massage procedures, acupuncture.

Spinal dystrophy implies pathological changes consisting of... At the initial stage of the disease, it persists natural state intervertebral discs.

The main symptom of the disease is pain. Pain can occur both during inflammatory processes of the vertebrae and during abnormal changes in the case of degenerative-dystrophic conditions.

Symptoms of the disease

The presence of painful manifestations in different departments spinal column represents pathological changes in the musculoskeletal system and can lead to disability.

For example, fatty degeneration of the bone marrow of the spine is formed during the gradual replacement normal consistency fatty tissue.

Degenerative-dystrophic conditions are an irreversible process of metabolic disorders in bone tissue. Thus, it becomes clear that pain in the back muscles, which is often attributed to fatigue or salt deposits, must be sought in the deterioration of the performance of the vertebrae themselves.

Common causes of the disease include:

incorrect distribution of the load on the spine;
natural aging;
changes in hormonal levels;
injuries and bruises;
passive lifestyle;
genetic factors.

Types of abnormal changes

Deviations in work may occur different areas back muscles, it can be like dystrophy thoracic spine and lumbosacral. The cervical spine also experiences no less stress.

There may be no pain for a long time, but gradually the patient begins to feel discomfort caused by pain syndrome, weakness and muscle strain.

At sedentary in life there are often suspicions of dystrophy lumbar region spine, but in most cases similar problem provoked

The main component of hematopoiesis is bone marrow, which is located directly in the bones. At pathological changes the body may also experience degeneration of the bone marrow of the spine, for example, in diseases such as osteochondrosis, cartilaginous nodes.

In case of inflammatory processes or improper metabolism, it is possible to replace healthy bone tissue with a layer of fat. Then they talk about fatty degeneration of the vertebral bodies of the bone marrow. This can significantly worsen the composition of the blood.

Treatment methods

Absolute cure of changes occurring in skeletal system, impossible. Modern medical techniques involve only a temporary suspension of the development of pathology and elimination painful sensations at the patient.

Therapeutic treatment consists of taking those included in the group of analgesics, or using local drugs – .

For elimination pain also influence. Doctors advise eating foods rich in B vitamins.

Each case is individual, so in no case should you self-medicate by purchasing from pharmacies. medications without a doctor's prescription! All medications are prescribed only by a physician after diagnosis.

IN in some cases surgical intervention is used. Thus, with fatty degeneration of the bone marrow of the spine, severe inflammatory process, which often leads to urgent assistance surgical care, after which the patient will have a long course of rehabilitation.

How to prevent disease

Main preventative ways maintaining the patient in normal conditions with dystrophy of the lumbosacral region are a decrease excess weight and moderate but regular physical activity. To do this you need to eat right and exercise.

Excellent help and... For dystrophy cervical region are used to fix the cervical vertebrae, which relax the muscles and reduce the load on them.

Bone marrow is the mass that occupies those spaces in the bone cavity that are not filled with bone tissue. He is the most important body hematopoiesis, constantly creates new blood cells, which replace dead ones. Bone marrow plays an important role in the formation and maintenance of immunity.

Problems that arise in the bone marrow inevitably affect hematopoiesis, blood composition, the state of blood circulation, blood vessels, and soon the entire body. When bone marrow functions are impaired, the number of leukocytes, platelets, and red blood cells in the blood decreases. The composition of the blood changes, and therefore the nutrition of the organs, that is, their functions also suffer. Due to changes in the composition of the blood, the nature of its movement through the vessels also changes, which also causes many unpleasant consequences.

Degenerative processes begin sooner or later in any organism. Similar processes also occur in the bone marrow. To a certain extent they are normal physiological processes, of course, if they start at due date. During degenerative-dystrophic processes, normal (myeloid) bone marrow tissue is gradually replaced by connective and adipose tissue. Moreover, it is fat replacement that predominates.

With age, such processes increase and accelerate. Thus, by the age of 65, approximately half of a person’s bone marrow is replaced by adipose tissue. At an older age fat cells can occupy half of its volume. Fatty bone marrow degeneration is the focus of medical science today. An earlier and more intense process of such replacement of one tissue by another causes the development of various diseases.

Where do fat cells come from?

When scientists studied the precursor cells of fat, the first “suspects” were bone marrow myeloid cells. These cells give rise to blood cells (except lymphocytes), cells from which muscles are formed, liver cells, and can also be the progenitors of fat. Thus, perhaps due to the low “specialization” of myeloid cells in the bone marrow, they are significantly replaced by fat cells.

Pathological replacement of myeloid tissue with adipose tissue can occur due to a violation metabolic processes in the body, bone marrow lesions by metastases, infectious processes, especially chronic ones.

What diseases are accompanied by fatty degeneration of the bone marrow?

Simmonds-Sheehan syndrome,
Hypoplastic and aplastic anemia,
Osteoporosis.

This is a list of diseases in which a link has been established between bone marrow degeneration and symptoms or causes of the disease.

Simmonds-Sheehan syndrome

Another name for this disease is hypothalamic-pituitary cachexia. It most often affects women aged 30-40 years. Initially pathological process occurs in the adenohypophysis and hypothalamus. Further, the secretion of hormones, including growth hormone, is disrupted. This causes degenerative-dystrophic and atrophic processes in tissues and organs and a wide variety of symptoms.

Hypoplastic and aplastic anemia

This group of anemias develops as a result of inhibition of hematopoiesis, which, in turn, is caused by the replacement of myeloid tissue in the bone marrow with fatty tissue. The reasons for this may be toxic or infectious and viral effects.

Among the substances that negatively affect the condition of the bone marrow are arsenic, benzene, and some medications. This is one of the arguments that you should not self-medicate; any medicine should be prescribed by a doctor. He does this taking into account the possible consequences.

Medicines that may cause or accelerate bone marrow degeneration:

Cytostatic agents,
Nonsteroidal anti-inflammatory drugs, e.g. acetylsalicylic acid, analgin,
Sleeping pills (barbiturates),
Means to reduce blood pressure eg captopril,
Thyrostatics,
Anti-tuberculosis drugs,
Sulfonamides,
Some antibiotics, in particular chloramphenicol,
Antiarrhythmic drugs.

The main manifestation of hypoplastic and aplastic anemia is thrombocytopenia, manifested hemorrhagic syndrome. Bleeding, bleeding of the skin and mucous membranes, hemorrhagic rashes - these are the most frequent symptoms this type of anemia.

Osteoporosis

Until recently, it was believed that a large amount of adipose tissue protects the body from osteoporosis, since it helps compensate for missing hormones. However latest research found that this is not entirely true. Excess fat cells interfere with the body's production of collagen and calcium absorption. This leads to weakening of bone tissue, to degenerative processes in it, that is, to bone fragility - the main manifestation of osteoporosis.

Liver steatosis - synonyms: fatty hepatosis, fatty liver, fatty infiltration, lipodystrophy - is a liver disease that is characterized by focal or dispersed deposition of fat in the liver cells. It is considered a common pathology, often causing no symptoms. In some cases, it manifests itself as an inflammatory process with further development cirrhosis and signs of liver failure.

ICD-10 code

K76.0 Fatty liver degeneration, not elsewhere classified

Causes of fatty liver

A small number of fat cells are present in the liver tissue of everyone healthy people. Their share is approximately 5%. We speak of fatty degeneration if this percentage is more than 10. With advanced pathology, the amount of fat can be 50 percent or more.

Why does this happen? There can be many reasons, and here are some of them.

Long-term liver intoxication:

due to excessive intake of alcoholic beverages (so-called alcoholic steatosis);
due to long-term use medications, for example hormonal drugs, chemotherapy drugs, antibiotics, anti-tuberculosis drugs.

Disturbed metabolic processes:

hyperfunction of the adrenal cortex;
thyroid diseases;
diabetes;
obesity.

Poor nutrition:

excessive passion for fat and sweet food, That is heavy load on the liver;
chronic form inflammatory process in the pancreas or intestines;
irregular nutrition, long-term strict diets, insufficient intake of proteins, vitamins and minerals;
rare and small meals;
regular overeating.

Insufficient oxygen supply to body tissues, which can be observed in pathologies respiratory tract or cardiovascular diseases.

The pathogenesis of the development of the disease can occur in different ways. So, etiological reasons there may be two diseases.

Firstly, fats can accumulate in the liver with increased intake into the body:

due to excess fat in food;
due to excess carbohydrates in food (carbohydrates stimulate the formation fatty acids);
due to increased consumption of glucose reserves in the liver, which causes the body to remove fat reserves from the depot and store them in the liver tissues;
due to underoxidation of fats, which can occur with metabolic disorders, anemia;
due to increased output somatotropin, which happens in diseases of the pituitary gland, with traumatic brain injuries, or in patients with diabetes.

Secondly, in some cases the fat does not leave the liver:

with a deficiency of transport proteins that help remove excess fat (in chronic alcoholics, with a lack of protein in the body);
with a hereditary predisposition to insufficient protein synthesis;
in case of chronic damage by toxic substances (alcoholics, drug addicts, in the presence of malignant diseases).

Symptoms of fatty liver

The problem is that the disease does not reveal itself for a long time. For example, on initial stages when fat just begins to accumulate in the liver tissue, external signs fatty degeneration is not observed.

At the second stage of development of the pathology, the fatty “dots” become larger, they tend to merge, which leads to the death of the hepatocytes themselves. Only from this moment the first signs of the disease begin to appear:

feeling of weakness;
sometimes – attacks of nausea;
a feeling of heaviness in the area of the liver projection;
increased gas formation;
the appearance of disgust towards fatty foods;
heaviness in the stomach;
pain in the right hypochondrium for no apparent reason.

At the third stage, which is considered a harbinger of cirrhosis, the process of destruction of liver tissue begins. Instead it grows connective tissue, which leads to deterioration of liver function and impaired bile excretion. During this period, the following symptoms may be observed:

yellowing of the eye sclera;
yellowing skin;
attacks of not only nausea, but also vomiting;
the appearance of a skin rash.

In addition, it is observed general decline immunity, which can provoke the addition of infectious and colds.

Acute fatty liver degeneration in pregnant women

Acute fatty liver degeneration in pregnant women is one of the most serious complications that can arise during pregnancy. Fortunately, this disease occurs very rarely.

The following conditions in a pregnant woman can lead to the development of the disease:

a state of uncontrollable vomiting;
hepatosis with cholestasis;
gestosis with hepatic-renal syndrome;
acute form fatty liver disease.

The first symptoms of the pathology appear in the period from 30 to 38 weeks of gestation, in in rare cases- earlier. Initially, there is a feeling of weakness, lethargy, with recurring nausea and vomiting, and abdominal pain. After some time, heartburn sets in, the esophagus area becomes painful, especially when swallowing - this is due to the formation of ulcers on the surface of the esophageal tube.

At the next stage, jaundice appears, the vomit becomes Brown color. There is often an accumulation of fluid in abdominal cavity, anemia.

In this situation, the doctor must orient himself in time and distinguish the onset of the development of acute fatty degeneration from infectious diseases digestive system. Accurate diagnosis largely determines the further outcome of the disease, because not only the health is at stake, but also the life of the expectant mother and her child.

Forms

As the disease progresses, various structural tissue changes occur in the liver. This allows us to conditionally divide the pathology into several forms of progression:

Focal disseminated liver dystrophy is a pathology in which points of fat are located gradually on different areas liver organ. Usually this form does not differ in any symptoms.
Severe disseminated fatty degeneration of the liver is a form of the disease when there are quite a lot of fatty inclusions and they are located throughout the entire organ. The first signs of the disease may appear.
Zonal dystrophy is a form of dystrophy in which spots of fat can be found in certain lobes (zones) of the liver.
Diffuse fatty degeneration of the liver is a pathology when the entire hepatic lobe is uniformly filled with fat. The symptoms of this form are already quite pronounced.
Alcoholic fatty liver disease can occur in a rare special form called Ziewe syndrome. This form has the following characteristics:
- symptoms appear abruptly and are pronounced;
- a blood test indicates an increase in bilirubin (a yellow bile substance formed from red blood cells);
- blood cholesterol levels increase;
- the amount of triglycerides (fatty products that damage small capillaries) increases;
- the amount of hemoglobin drops noticeably (due to massive destruction of red blood cells due to an increasing deficiency of tocopherol, which forms and accumulates in hepatocytes).

Also, depending on the form, there are acute and chronic dystrophies.

With chronic fatty liver degeneration, tiny droplets of fat accumulate in the cytoplasm of liver cells, which gradually combine into larger droplets or into a large vacuole that completely fills the cytoplasm and displaces the nucleus to the cell edge. When most of the liver tissue is affected, a diagnosis of “fatty hepatosis” is made. This condition is characterized by the fact that liver cells filled with big amount fat, burst with the formation of fatty cysts.
Acute fatty liver disease is characterized by a sharp development, rapidly increasing symptoms, often turning into cirrhosis or other complex liver pathologies. This disease is usually a consequence of severe hepatitis, deep intoxication of the body (for example, mushroom or chloroform poisoning), and alcoholism. Symptoms acute form always sharply expressed: an increase in the size of the liver, large fluctuations in temperature in one direction or another, convulsive and delusional states, bleeding. The patient's condition is usually serious and requires immediate specialized medical care.

Diagnosis of fatty liver

Collection of complaints, questioning of the patient regarding the symptoms of the disease.
Questioning the patient about his lifestyle, availability bad habits, about other concomitant diseases.
Examination of the patient, palpating the abdomen and liver area, tapping the area where the liver and spleen are located.

Conducting laboratory tests:

complete blood count (erythrocytopenia, hemoglobinemia, thrombocytopenia, anemia, leukocytosis);
blood biochemistry (assessment of the functional capacity of the pancreas, gall bladder);
analysis of the consequences of alcoholism (immunoglobulin levels, measurement of average erythrocyte volume, transferrin level, etc.);
assessment of marker content for viral liver pathologies;
general research urine;
stool analysis.

Carrying out instrumental diagnostic procedures:

Ultrasound scanning of the abdominal organs, assessment of the external borders and general condition liver organ;
esophagogastroduodenoscopy method – endoscopic examination state of the digestive system;
liver puncture for biopsy and further histological examination(removal of a liver tissue sample for analysis);
method computed tomography– obtaining layer-by-layer x-rays liver;
magnetic resonance imaging method;
elastography method - ultrasound analysis to assess the depth of hepatic fibrosis;
retrograde cholangiography method - a procedure for obtaining x-ray images after insertion contrast agent into the biliary system (usually prescribed for cholestasis).

Additional consultations with specialists medical profile– this could be a gastroenterologist, narcologist, surgeon, etc.

Treatment of fatty liver

There is no special treatment regimen as such for fatty liver. Therapeutic measures provide for the exclusion of provoking factors and stabilization of metabolic processes, restoration of liver tissue and elimination of toxic effects on hepatocytes. In combination with drug treatment the patient is explained the need for management healthy image life and proper nutrition.

Treatment of the disease with drugs is carried out with drugs such as membrane stabilizers and antioxidants. Drugs for fatty liver disease can be divided into several groups:

Products consisting of essential phospholipids, for example, drugs based on phosphatidiethanolcholine, which can create protection for liver cells. Such medications include Essentiale, Hepabos, Essliver, etc.
Products that belong to sulfoamino acids (Heptral, Dibikor, etc.);
Funds based herbal ingredients(Karsil, Liv 52, artichoke extract, etc.).

Heptral is prescribed by injection in an amount of 400 to 800 mg per day for 14-20 days. Then switch to 2-4 tablets per day.

Essentiale is taken 600 mg three times a day. The course of treatment should be at least 2-3 months. After 20-30 days of treatment, the dosage is slightly reduced to 300 mg three times a day.

Alpha lipoic acid (Alpha lipon) is administered intravenously in amounts up to 900 mg per day for a month. After 2 weeks from the start of treatment, the infusion can be replaced with oral administration 600 mg/day.

An artichoke-based remedy, Chofitol, has a choleretic and hepatoprotective effect and normalizes metabolism. Hofitol is prescribed 3 tablets three times a day before meals. Duration of therapy is up to 1 month.

Liv 52 is taken 1-2 tsp. twice a day, or in tablet form - 2-3 tablets up to 4 times a day half an hour before meals.

Besides medicines, to reduce liver toxicity is prescribed vitamin supplements, such as vitamin E, ascorbic acid, niacin and vitamin B².

From funds traditional medicine can be successfully used:

cinnamon powder and sticks – help reduce the amount of glucose and cholesterol in the blood, prevent the accumulation of fat in the liver;
turmeric is an excellent antioxidant, enhances bile production, lowers blood glucose levels;
milk thistle – eliminates spasms in gallbladder, removes toxic substances, restores hepatocytes. You can also take pharmaceutical drugs with milk thistle – this is the plant’s oil, or the ready-made preparation Gepabene (prescribe 1 capsule three times a day);
sorrel – helps remove bile and stabilizes its production. Reduces fat content in the liver.

Nutrition for fatty liver

One of the factors in the development of fatty liver is sedentary lifestyle life combined with overeating. Therefore, it is very important to monitor your diet and maintain normal weight. If the patient is obese, then he is recommended to follow a diet (but not strict) with a weight loss of approximately 0.5 kg per week. Moderate physical activity is encouraged: exercise on an exercise bike, swimming, walking.

Diet for fatty liver is not just important - it plays a leading role in the effectiveness of treatment for patients. IN medical institutions usually prescribed diet table No. 5, with the consumption of protein foods up to 120 g per day, limiting animal fat, as well as a sufficient amount of liver-healthy foods - cottage cheese, cereals (oatmeal, buckwheat, millet, wild rice). Welcome plant food– fruits and vegetables, herbs, all types of cabbage.

Instead of meat products It is recommended to eat fish and seafood. It is advisable to avoid fried foods - steam, boil or bake dishes, with minimum quantity butter(it is better to replace with vegetable).

We must not forget about drinking regime: in the absence of contraindications, you should drink at least 2 liters of water per day, mainly in the first half of the day.

It is necessary to limit or exclude fatty dairy products: whole milk, sour cream, cheeses. Low-fat kefir, fermented baked milk, and yogurt are allowed for consumption.

Should be taken regularly preventive examinations, especially if suspicious symptoms are present, such as weakness, discomfort in the right hypochondrium, nausea and loss of appetite. If a person notices signs of jaundice, he should immediately visit a doctor. For fatty liver disease, timely diagnosis and treatment is very important.

People at risk should be especially careful about liver health:

persons who drink alcohol;
patients who have recovered from viral infections infectious diseases liver;
patients who have chronic diseases that require constant reception any medications;
people working in hazardous enterprises;
persons who have hereditary predisposition to liver diseases;
people who adhere to strict diets with limited proteins or those on “starvation” diets;
in the presence of helminths in the body.

You cannot ignore the symptoms of liver disease - even if everything is fine with the organ, it is better to double-check this and consult a doctor.

Forecast

The course of the disease largely depends on its origin. If there is no inflammatory process and the hepatocytes are not damaged, then the pathology in most cases does not worsen. However, if there are signs of hepatitis, then sooner or later the dystrophy develops into cirrhosis of the liver. This complication most often occurs in old age, with severe metabolic disorders, obvious obesity, and diabetes mellitus.

With timely treatment and following all doctor’s recommendations, fatty liver can be reversible. Over time, the patient will be able to return to a normal lifestyle. But in advanced situations or when doctor’s orders are ignored (continued consumption of alcoholic beverages, errors in diet, constant intoxication of the body), life expectancy can be significantly reduced. As the disease progresses, liver cirrhosis develops and the person becomes disabled.

Description:

Fatty is the death of working liver tissue (parenchyma) and its replacement with adipose tissue. As the parenchyma decreases, the functions of the liver gradually fade away. A decrease in liver function entails changes in metabolism.

Symptoms:

Patients with fatty hepatosis usually have no complaints. The course of the disease is mild and slowly progressing. Over time, constants appear dull pain in the right hypochondrium, there may be stool disturbances.
Very rarely there is marked fatty clinical picture: severe pain in the abdomen, jaundice, weight loss, .

Causes:

The main reason is the insusceptibility of liver cells to the action of the hormone insulin (insulin resistance). One of the functions of insulin is to transport glucose into cells from the blood and tissue fluid. With insulin resistance, liver cells do not receive the glucose they need and die, being replaced by unpretentious, but useless, fat cells.
Insulin resistance can be genetically programmed, appear as a result of metabolic disorders, be caused by erroneous immune aggression to insulin and other factors. Modern medicine learned to safely and effectively cope with insulin resistance, with the help of medications, dosed physical activity and proper nutrition.
Associated factors influencing the replacement of liver tissue with fat: (alcohol, professional, etc.), increased fat content in food, sedentary lifestyle.

Treatment:

For treatment the following is prescribed:

A diet with increased content proteins, limiting fats, especially refractory ones of animal origin. Multivitamins and “hepatoprotector” drugs (that protect the liver) are prescribed - heptral, phosphogliv, essentiale, etc. Sufficient physical activity. It should be noted that treatment of fatty hepatosis is usually long-term, at least 2-3 months, with subsequent monitoring of abdominal ultrasound and biochemical blood parameters. However, in the absence of changes in lifestyle, with persistent increased body weight, if the diet is not followed, treatment of fatty hepatosis may be ineffective and after treatment, fatty hepatosis returns again.