
kovvu kaaleya vyaadhi

hepatic steatosis anie kooda piluvabade kovvu kaaleya vyaadhi (fld) anedi kaaleyamlo adanapu kovvu perige paristhiti. tarachugaa etuvanti lakshanaalu ledhaa takkuva lakshanaalu untaayi. appudappudu pottikadupu eguva kudi vaipuna alasata ledhaa noppi undavacchu. syrrosis, kaaleya cancer mariyu annanaala vairaslu vanti samasyalu undavacchu.
rendu rakaala kovvu kaaleya vyaadhulu unnaih naan-alcoholic fatty liver disease (naffled) mariyu alcoholic liver disease. naffled saadhaarana kovvu kaaleyam mariyu alcoholic kaani steatohepatitis (naash) thoo tayaaravutundi. praathamika pramaadaalalo madyam, type 2 diabetes mariyu oobakaayam unnaayi. itara pramaada karakalalo glucocarticoids mariyu hepatitis sii vanti konni mandulu unnaayi. naffled unna kondaru vyaktulu saadhaarana kovvu kaaleyaanni enduku abhivruddhi chestaro mariyu itarulu naashnu enduku abhivruddhi chestaro aspashtamgaa undhi. rooga nirdhaarana anedi rakta pareekshalu, vaidya imaging mariyu appudappudu kaaleya biopsy dwara maddatu ichhe vaidya charitrapai aadharapadi untundi.
naffled chikitsa saadhaaranamgaa baruvu taggadaaniki aahaaramlo maarpulu mariyu vyayamam dwara jarugutundi. teevramgaa prabhaavitamaina vaarilo, kaaleya marpidi oka empika kaavacchu. adhika madyapaanam chesevaarilo 90 saataaniki paiga kovvu kaaleyaanni abhivruddhi chestundagaa, 25 saatam mandhi marinta teevramaina madya hepatitisnu abhivruddhi chestaaru. naffled paaschaatya deshaalalo 30 saatam mandhi prajalanu mariyu asealo 10 saatam mandini prabhaavitam chestundi. naffled anedi united stateslo sumaru 10 saatam mandhi pillalanu prabhaavitam chestundi. idhi vruddhulalo mariyu purushulalo ekkuvagaa sambhavistundi.
sankethaalu mariyu lakshanaalu.
tarachugaa etuvanti lakshanaalu ledhaa takkuva lakshanaalu untaayi. appudappudu pottikadupu eguva kudi vaipuna alasata ledhaa noppi undavacchu.
samasyalu.
kovvu kaaleyam hepatic fibrosis, syrrosis ledhaa kaaleya cancerga abhivruddhi chendutundi. naffled baarina padina vyaktulalo, 10 samvatsaraala manugada raetu sumaru 80 saatam. fibrosis purogati raetu perugutunna vegamtho naashlo 7 samvatsaraalaku okati mariyu naffledlo 14 samvatsaraalaku okatigaa anchanaa veyabadindi. eee rogalakshanaalu mariyu jeevakriya anaarogyaala (diabetes rakam II, jeevakriya syndrome) madhya balamaina sambandham undhi. eee rogalakshanaalu oobakaayam laeni vyaktulanu kooda prabhaavitam cheyavachu, appudu vaariki ekkuva pramaadam untundi.
syrrotic alcoholic fld unnavaarilo 10 saatam kante takkuva mandiki hepatocellular carcinoma abhivruddhi chendutundi, idhi peddalalo atyanta saadhaarana praadhamika kaaleya cancer rakam, conny syrrosis laeni naash unnavaarilo 45 saatam varaku hepatocellular carcinomanu abhivruddhi cheyavachu.
eee paristhiti kovvu jeevakriyanu prabhaavitam chese itara vyaadhulatoe kooda mudipadi untundi.
kaaranaalu.
kovvu kaaleyam (efl) saadhaaranamgaa jeevakriya syndrome (madhumeham, adhika raktapotu, oobakaayam mariyu dyslipidemia) thoo mudipadi untundi, conny aneka kaaranaalalo edainaa oka kaaranam valla kooda kaavachuh
pathology.
kovvu maarpu anedi triglyzarides (tatastha kovvulu) yokka intracytoplasmatic perukupovadaanni suuchistumdi. praarambhamlo, hepatocytelu nucleus chuttoo chinna kovvu vacules (liposomelu) nuu pradarsistaayi (microvesicular kovvu maarpu). eee dasalo, kaaleya kanaalu kendramgaa unna kendrakaanni sthaanabhramsham cheyani bahula kovvu binduvulatoe nindi untaayi. chivari dasallo, vacules parimaanam perugutundi, nucleusnu sell yokka anchuku nettivestundi, idhi oka lakshana chihna valayam roopaanni istundi (macrovasicular kovvu maarpu). kanajaalam prosessing samayamlo kovvulu karigipotayi kabatti eee vesicles baga line cheyabadi, opticalga "khaalii" gaa untaayi. pedda vacules kalisipoyi kovvu tittulanu utpatti cheyavachu, ivi tirigi pondaleni gayalu. macrovasicular steatosis atyanta saadhaarana roopam mariyu idhi saadhaaranamgaa madyam, madhumeham, oobakaayam mariyu carticosteroidlatho mudipadi untundi. garbhadhaarana yokka teevramaina kovvu kaaleyam mariyu rays syndrome microvesicular kovvu maarpu valla kalige teevramaina kaaleya vyaadhiki udaaharanalu. kaaleyamlo kovvu baruvu dwara 5-10% nuu daatinappudu steatosis nirdhaarana jarugutundi.
kovvu aamla gvakriyalo lopaalu fld yokka vyaadhikaarakaaniki kaaranamavutaayi, idhi shakti viniyogam mariyu daani dahanamlo asamatulyata kaaranamgaa undavacchu, phalitamgaa lipid nilva kaavacchu ledhaa insulinku paridheeya nirodhakata yokka paryavasanamga undavacchu, dheeni dwara kovvu aamlaala ravana kovvu kanajaalam nundi kaaleyaaniki perugutundi.
kovvu aamlaala aakseekarana mariyu samshlaeshanhaku kaaranamayye enjaimlanu niyantrinche grahaka anuvula (ppar-α, ppar-γ mariyu srebp1) balaheenata ledhaa nirodham kovvu perukupovadaniki dohadam chestundi. adanamgaa, madya viniyoga rugmata mitochondria mariyu itara cellular nirmaanaalanu debbateestundi, cellular shakti yantraamgaanni marinta balaheenaparustundi. marovaipu, alcoholic kaani fld kaaleya kanaalalo metabolized shakti adhikamgaa undatam praarambhamavutundi. hepatic steatosis anedi tirigi maarchagaligedigaa pariganinchabadutundi mariyu antarleena kaaranaanni tagginchinatlayithe ledhaa tolaginchinatlayithe kontavaraku purogati laenidigaa pariganinchabadutundi.
teevramaina kovvu kaaleyam konnisaarlu vaaputo koodi untundi, eee paristhitini steatohepatitis anie pilustaaru. alcoholic steatohepatitis (buudida) ledhaa naan-alcoholic steatohepatitis (naash) kuu purogati prerepinche kaaranam yokka pattudala ledhaa teevratapai aadharapadi untundi. rendu paristhitulalo rogalakshana gayalu okela untaayi. ayithe, shotha pratispandana yokka paridhi vistrutamgaa maarutuu untundi mariyu ellappuduu kovvu perukupoye sthaayitho sambandham kaligi undadu. steatosis (lipid nilupudala) mariyu steatohepatitis prarambham fld purogatilo varusa dasalanu suuchimchavachchu.
vistrutamaina vaapu mariyu adhika sthaayi steatosis thoo kuudina kaaleya vyaadhi tarachugaa vyaadhi yokka marinta teevramaina roopaalaku purogamistundi. hepatocyte beluning mariyu vividha sthaayila necrosis tarachugaa eee dasalo untaayi. kaaleya kanaala maranam mariyu shotha pratispandanalu hepatic stellet kanaala kriyaaseelataku daariteestaayi, ivi hepatic fibrosislo keelaka paatra poeshistaayi. fibrosis yokka paridhi vistrutamgaa maarutuu untundi. perisinasoidal fibrosis chaalaa saadhaaranam, mukhyamgaa peddalalo, mariyu terminal hepatic sirala chuttoo john 3loe prabalamgaa untundi.
syrrosis purogati kovvu parimaanam mariyu steatohepatitis sthaayi mariyu vividha itara sunnitamaina kaarakaala dwara prabhaavitamavutundi. alcoholic efldlo, nirantara madyam viniyogaaniki sambandhinchina sirrosisku parivartana baga namodu cheyabadindi, ayithe alcoholic kaani efldlo palgone prakriya antha spashtamgaa ledhu.
rooga nirdhaarana.
chaalaa mandhi vyaktulu lakshanarahitamgaa untaaru mariyu saadhaaranamgaa asaadhaarana kaaleya paniteeru pareekshalu ledhaa sambandham laeni vaidya paristhitulalo gurtinchabadina hepatomegali kaaranamgaa yaadrucchikamgaa kanugonabadataru. saadhaarana steatosis unna rogulalo 50 saatam mandhi unnata kaaleya enjaimlu kanipistaayi. seeram alanine transominess (alt) sthaayi saadhaaranamgaa naan alcoholic variantlo aspertate transominess (esty) sthaayi kante ekkuvagaa untundi mariyu alcoholic efldlo dheeniki viruddhamgaa untundi (esty alt 2:1 kante ekkuva). saadhaarana rakta pareekshalu kaaleya fibrosis sthaayini anchanaa veyadam dwara vyaadhi yokka parimaanaanni nirnayinchadaaniki sahaayapadavachhu. udaaharanaku, rakta pareekshala phalitaala nundi lekkinchina aust-tuu-plateletla nishpatti suuchika (apri score) mariyu aneka itara skorlu, kaaleya fibrosis yokka sthaayini gurtinchagalavu mariyu bhavishyattulo kaaleya cancer erpadutundani anchanaa veyagalavu.
imaging adhyayanalu tarachugaa moolyaankanam prakriya samayamlo pondabadataayi. ultrasonography perigina ecogenesitytho kuudina "prakaasavantamaina" kaaleyaanni velladistundi. kovvu kaaleyaanni nirdhaarinchadamlo vaidya imaging sahaayapadutundi; kovvu kaaleyaalu computed tomography (siti) loe spleens kante takkuva saandratanu kaligi untaayi, mariyu tii1-baruvunna ayaskanta pratidhvani chitraalalo (ms) kovvu prakaasavantamgaa kanipistundi. ayaskanta pratidhvani elastography, ayaskanta pratidhvani imaging yokka oka roopaantaram, fibrosis purogatini nirdhaarinchadaaniki naan-invasive paddhatigaa parisoedhimchabadutumdi. liver biopsy dwara hystological roganirdhaarana anedi 2018 natiki fibrosis mariyu liver kovvu purogatiki atyanta khachitamaina kolata. ultrasound, siti mariyu mri vanti sampradaaya imaging paddhatulu, kovvu kaaleya vyaadhini gurtinchadaaniki taginanta nirdishtamgaa undavu, kaaleya parimaanamlo kaneesam 30 saatam kovvu aakraminchakapothe.
chikitsa.
kelareela teesukovadam kaneesam 30 saatam ledhaa sumaru 750-1,000 kCl/roeju tagginchadam valla hepatic steatosis merugupadutundi. naffled ledhaa naash unnavaariki, aaharam mariyu vyayamam kalayika dwara baruvu taggadam vyaadhini meruguparachadaaniki ledhaa parishkarinchadaaniki choopabadindi. marinta teevramaina sandarbhaallo, insulin nirodhakatanu tagginche mandulu, hyperlipidemia mariyu baruvu taggadaaniki kaaranamayye bariatric shastrachikitsa mariyu vitamin ii vanti mandulu kaaleya paniteerunu meruguparustaayi ledhaa parishkaristaayani choopabadindi.
bariatric shastrachikitsa, 2017loe fld chikitsagaa matrame sifaarsu cheyabadanappatiki, oobakaayam chikitsa kosam eee shastrachikitsa cheyinchukunna 90 saataaniki paiga prajalalo fld, naffled, naash mariyu advanced steatohepatitisnu tirigi istundani choopabadindi.
deerghakaalika mottam-parenteral-poeshakaahaara-prerita kovvu kaaleya vyaadhi vishayamlo, collin lakshanaalanu taggistundani choopabadindi. idhi methionin chakramlo lopam kaaranamgaa kaavacchu.
epidemiology.
naffled paaschaatya deshaalalo 30 saatam mandhi prajalanu mariyu asealo 10 saatam mandini prabhaavitam chestundi.
samyukta rashtraalalo raetlu sumaru 35 saatam undagaa, sumaru 7 saatam mandhi teevramaina roopam naash kaligi unnaaru. naffled anedi united stateslo sumaru 10 saatam mandhi pillalanu prabhaavitam chestundi. iteevala jeevakriya panicheyakapovadam-sambandhita kovvu kaaleya vyaadhi (maffeld) anae padam naffeld sthaanamlo pratipaadinchabadindi. maffeld anedi marinta samagra roganirdhaarana paeru, endukante idhi hystology (biopsy), medical imaging ledhaa blood biomarkerla dwara kovvu kaaleyaanni gurtinchadam meeda aadharapadi untundi, ayithe adhika baruvu/oobakaayam, type 2 diabetes mellitus ledhaa jeevakriya disregulation thoo paatu undaali. kotta nirvachanam ikapai madyam viniyogam ledhaa viral hepatitis vanti itara kaaleya vyaadhula sahajeevanaanni minahaayinchadu. eee marinta samagramaina nirvachananni upayoginchi, prapanchavyaaptamgaa maffled praabalyam aascharyakaramgaa ekkuvagaa undhi. nijaaniki, paatha naffled nirvachananni kooda upayoginchi, eee vyaadhi 80 saatam varaku oobakaayam unnavaarilo, 35 saatam mandhi oobakaayam unnavaarilo mariyu 20 saatam varaku saadhaarana baruvu unnavaarilo, adhika madyapaanam gurinchi etuvanti aadharalu laenappatikee gamaninchabadutundi. united stateslo asaadhaarana kaaleya paniteeru pareekshalaku fld atyanta saadhaarana kaaranam. kovvu kaaleyam tellajati kante hysponic prajalalo ekkuvagaa untundi, nallajati prajalalo athi takkuva praabalyam untundi.
90la adhyayanamlo, 1991 mariyu 1992loe janminchina 2.5 saatam mandhi pillalu 18 samvatsaraala vayassulo ultrasound dwara alcoholic kovvu kaaleya vyaadhini kaligi unnatlu kanugonnaru; aidella taruvaata taatkaalika elastography 20 saataaniki paiga kaaleyampai kovvu niksheepaalu unnatlu kanugondi, idhi alcoholic kovvu kaaleya vyaadhini suuchistumdi; vaarilo sagam mandhi teevramainavigaa vargeekarinchabaddaayi. skaanlu 2.4 saatam mandiki kaaleya fibrosis undani, idhi sirrosisku daariteestundani kooda kanugonnaru.
covid-19 mahammari lockdown taruvaata, liver steatosis unna rogulalo 48 saatam mandhi baruvu perigaarani, 16 saatam mandhi marinta digajaarina steatosis grade kaligi unnaarani oka adhyayanam niroopinchindi. suuchimchina aahaaraaniki takkuva kattubadi undatam, saareeraka shrama sthaayilu taggadam mariyu "pnpla3" rs738409 single nucleotide polymorphism kosam homozygocity yokka praabalyam peragadam vanti vaatitho baruvu peragadam mudipadi undhi. "pnpla3" rs738409 ippatike naffledku telisina pramaada karakam. 
jantuvulalo.
kovvu kaaleya vyaadhi sareesrupaalu (mukhyamgaa taabellu) mariyu pakshulu vanti pempudu jantuvulato paatu pillulu mariyu kukkalu vanti ksheeradaalalo sambhavinchavachhu. athi saadhaarana kaaranam adhika poeshakaahaara lopam. pakshulalo oka pratyaekamaina sanketam oka porapaatu mukkunu kaligi untundi. kovvu kaaleyaalanu phoy graasnu utpatti cheyadaaniki peddabaatulu ledhaa baatulalo gavage dwara prerepinchavacchu. adhika kelareela aaharam dwara gorrelu vanti rommulalo kovvu kaaleyaanni kooda prerepinchavacchu.