Fatty change, also known as steatosis, is the abnormal accumulation of triglycerides within parenchymal cells. The most common location is the liver, as it is responsible for fat metabolism. Fatty change can be caused by toxins, alcohol abuse, protein malnutrition, diabetes mellitus, obesity, or anoxia. Alcohol abuse and diabetes associated with obesity are the most common causes of fatty liver. In diabetes, insulin resistance results in triglyceride accumulation in liver cells through impaired fatty acid oxidation, increased fatty acid synthesis and uptake, and decreased secretion of VLDL from the liver. Fat-laden liver cells are sensitive to oxidative stress damage from free radicals, which can cause mitochondrial and cell membrane

1. KAINAT JAVED
ROLL NO. 73

2. Fatty Change
 Medical term is Steatosis
 DEFINITION : “Any abnormal accumulation
of triglycerides within parenchymal cells”
 Most common location : Liver ( the reason
being that it is the major organ involved in
the fat metabolism )
 Other Locations : skeletal muscle
kidney
other organs

3. Etiology
 It may be caused by a number of reasons some of
them being :
1- toxins
2- alcohol abuse
3- protein malnutrition
4- diabetes mellitus
5- obesity
6- anoxia
 Among these ALCOHOL ABUSE and DIABETES
associated with obesity are the most common
causes of fatty change in liver.
 Depending upon its etiology , it is divided into
two types : Non alcoholic fatty liver and Alcoholic
fatty liver disease

4. Pathogenesis of fatty liver
disease

5. Pathogenesis of Non Alcoholic
Fatty liver disease in Type 2
Diabetes Mellitus
Insulin resistance that is
observed in Diabetes
mellitus results in
accumulation of
triglycerides in
hepatocytes by 3 different
mechanisms : Impaired
oxidation of fatty acids ,
increased synthesis and
uptake of fatty acids , And
decreased hepatic
secretion of VLDL.

6.  The fat laden hepatocytes are highly sensitive to
lipid peroxidation products generated by oxidative
stress ( that means an imbalance between the
production of free radicals and the ability of the
body to detoxify their harmful effects through
neutralization by antioxidants ). As a result
mitochondrial membrane and plasma membrane
gets damaged by the harmful effects of free
radicals , causing apoptosis .
 Levels of Tissue Necrosis Factor (TNF) ,
Interleukin-6 (IL-6) , and Monocyte
Chemoattractant Protein-1 (MCP-1) increase in
response to oxidative stress and it contributes to
liver damage and inflammation .

7. Gross Morphological Changes
seen in fatty liver
 Hepatic parenchyma
appears a peculiar bright
orange colour and liver
appears pale yellow on its
posterior aspect . Pale
colour is due to presence
of fat vacuoles within
hepatocytes .
 Liver is enlarged
 Rounded inferior margin
 Smooth capsule

8. Steatosis in Non Alcoholic fatty
liver disease as observed under
microscope
 Portal tracts are normal
 Diffuse vacuolation of
hepatocytes
 In majority of liver cells the
Vacuoles are small and
numerous , in other cells
they are larger and in some
a single vacuole replaces
much of cytoplasm.
 No sinusoidal dilatation

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