From the Guidelines
Diffuse hepatic parenchymal disease should be managed by addressing the underlying cause, with a focus on removing the offending agent, managing complications, and preventing further liver damage, as this approach has been shown to improve morbidity, mortality, and quality of life in patients with this condition 1.
Diagnosis and Treatment
Diagnosis of diffuse hepatic parenchymal disease typically requires liver function tests, imaging studies (ultrasound, CT, or MRI), and sometimes liver biopsy. The treatment depends on the underlying cause, but generally, it focuses on removing the offending agent, managing complications, and preventing further liver damage.
- For alcoholic liver disease, complete abstinence from alcohol is essential, as it can help prevent further liver damage and improve liver function 1.
- For non-alcoholic fatty liver disease, weight loss through diet and exercise is recommended, aiming for 7-10% of body weight reduction, as this can help improve insulin sensitivity and reduce liver inflammation 1.
- Viral hepatitis may require antiviral medications such as entecavir or tenofovir for hepatitis B, or direct-acting antivirals for hepatitis C, as these medications can help reduce viral load and prevent liver damage 1.
- Autoimmune hepatitis typically responds to corticosteroids (prednisone 30-60mg daily initially) and azathioprine (50-150mg daily), as these medications can help reduce liver inflammation and prevent further damage 1.
Prevention of Further Liver Damage
Regardless of the cause, patients with diffuse hepatic parenchymal disease should avoid hepatotoxic medications, maintain a healthy diet low in processed foods and saturated fats, and undergo regular monitoring of liver function, as these measures can help prevent further liver damage and improve overall health 1.
Importance of Early Intervention
The liver has remarkable regenerative capacity, and early intervention can prevent progression to irreversible cirrhosis, which would require consideration of liver transplantation, highlighting the importance of prompt diagnosis and treatment of diffuse hepatic parenchymal disease 1.
From the Research
Definition and Prevalence of Diffuse Hepatic Parenchymal Disease
- Diffuse hepatic parenchymal disease refers to a range of conditions that affect the liver, including hepatic steatosis, fibrosis, metabolic diseases, and hepatitis 2.
- Non-alcoholic fatty liver disease (NAFLD) is a major form of chronic liver disease, affecting 25% of people worldwide, and is closely associated with metabolic disorders such as obesity, diabetes, and metabolic syndrome 3, 4, 5.
Diagnosis and Assessment of Diffuse Hepatic Parenchymal Disease
- The gold standard for diagnosis of NAFLD and non-alcoholic steatohepatitis (NASH) is a liver biopsy, which can distinguish simple steatosis from NASH 3, 6, 5.
- Imaging techniques such as ultrasound, computed tomography scan, and magnetic resonance imaging can provide non-invasive options for assessment of liver tissue, but have limitations and disadvantages 2.
- Serum biomarkers and imaging techniques are being developed as non-invasive methods for assessing liver parenchymal tissue 2.
Treatment and Management of Diffuse Hepatic Parenchymal Disease
- Currently, there are no approved FDA treatments for NAFLD, and weight loss and dietary modifications are the only recommendations provided to NAFLD patients 3, 5.
- Pioglitazone and vitamin E are recommended by guidelines in selected patients, and other pharmacological treatments are being studied 6, 5.
- Lifestyle interventions, including weight loss and treatment of underlying metabolic syndrome, remain the mainstays of therapy once the diagnosis is established, but are difficult to maintain 5.