We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Below we will list the departments and units that form part of Vall d’Hebron Hospital and the main diseases that we treat. We will also make recommendations based on advice backed up by scientific evidence that has been shown to be effective in guaranteeing well-being and quality of life.
Vols saber com serà la teva estada a l’Hospital Universitari Vall d’Hebron? Aquí trobaràs tota la informació.
Steatosis means the accumulation of fat in the cells. In fatty liver disease, this fat accumulation occurs excessively within liver cells, also known as hepatocytes. This can be caused by metabolic factors, dietary habits and lifestyle, excessive alcohol consumption, secondary to certain medications, rare diseases such as Wilson’s disease, or some variants of hepatitis C. Steatotic liver disease due to metabolic causes is called Metabolic Associated Steatotic Liver Disease (MASLD). This diagnosis entails the absence of other alternative causes of steatosis, primarily significant alcohol consumption or hepatic viral infections.
The liver does not contain nerve endings that can send pain signals, making diagnosing it in the early stages of the disease difficult. However, some people may experience nonspecific symptoms such as fatigue or abdominal discomfort. It is important to note that many individuals with liver disease may not have obvious symptoms, making early diagnosis and management crucial.
Its prevalence has increased in recent years. It is estimated that fatty liver disease affects 38% of the global population and between 17% and 46% of European adults. This disease can affect people of all ages, including children.
In the context of this disease, fat accumulation in the liver is caused by a combination of excessive calorie intake and/or a predominantly sedentary lifestyle. Therefore, it is more common, although not always, to find this disease associated with individuals who are overweight/obese. Another population group at risk of suffering from this disease is people with diabetes (more frequently type 2) or prediabetes, with high levels of triglycerides and/or cholesterol or high blood pressure. These conditions above are collectively referred to as metabolic syndrome.
Metabolic syndrome is not a disease but a cluster of conditions that increase the risk of developing cardiovascular diseases and diabetes. There are different definitions of metabolic syndrome; in some, the criteria also vary based on ethnicity (for example, different diagnostic criteria apply in Asian populations compared to individuals of Hispanic ethnicity).
The term hepatitis refers to inflammation of the liver, whatever the cause. When this inflammation is created by excess fat in the hepatocytes, we talk about steatohepatitis or Metabolic Associated Steatohepatitis (MASH). It is considered a further, yet reversible, stage in the evolution of MASLD. When there is sustained liver damage, scar tissue forms, the regression of which is more complex. This scarring is called fibrosis. Steatohepatitis/MASH can more easily progress to liver fibrosis.
Hepatic fibrosis is classified into 5 stages according to the severity of the liver damage visualised through a liver biopsy (from 0 to 4). Terms such as significant fibrosis, referring to stage 2 fibrosis or higher, or advanced fibrosis, referring to stage 3 fibrosis or higher, are frequently used. Stage 4 is also called hepatic cirrhosis.
A cirrhotic liver has a lot of scar tissue, the surface of which has ceased to be smooth and presents a nodular appearance. When the liver can function with this scarring, it is called compensated fibrosis/cirrhosis. Signs of decompensation would include accumulation of intra-abdominal fluid (called ascitic fluid), yellowish discolouration of the skin and mucous membranes (known as jaundice), digestive bleeding due to oesophageal varices, or alterations in behaviour or memory stemming from what is known as hepatic encephalopathy.
Individuals with simple steatotic liver without signs of liver damage or inflammation have a lower risk of developing health issues related to MASLD compared to patients with MASH.
MASH can progress to significant liver problems, such as the accumulation of scar tissue, which can eventually progress to cirrhosis. Cirrhosis can impair liver function (decompensated hepatic cirrhosis and liver failure).
Although liver cancer can appear at any stage of the disease, the risk is higher in advanced stages of fibrosis or cirrhosis. On the other hand, MAFLD also has an impact on other organs beyond the liver and contributes to the development of heart and blood vessel diseases, including stroke (cerebral infarctions), the development of diabetes and kidney diseases, and the onset of other types of cancer, thus affecting the quality of life and well-being of the person suffering from the disease.
There is no universal strategy for screening MASLD. Most screening strategies are based on a combination of the following tests: a blood test score, an abdominal ultrasound, or an assessment of liver stiffness through a test called hepatic elastography or Fibroscan®, or preferably, a combination of these. Other diagnostic tests might include a liver biopsy, a portal pressure gradient, an endoscopic test (gastroscopy) or a computed tomography scan (CT scan).
Today, liver biopsy is considered the gold standard of diagnostic tests. A liver biopsy is an invasive procedure that takes very small liver tissue samples for examination. It allows for the assessment of different areas of the liver and can provide information on the number of liver cells that contain fat droplets (steatosis), the degree of damage and inflammation of the liver cells, and the degree of fibrosis present in the liver.
It is currently impossible to obtain all the information that a liver biopsy provides through a single alternative test. However, work is underway to develop and validate diagnostic methods by combining the previously mentioned tests and developing other non-invasive biomarkers or non-invasive tests (NIT) in MASLD.
Disease management involves lifestyle changes, such as following a healthy diet, regular exercise, losing weight in cases of overweight or obesity, and avoiding alcohol consumption. These modifications can help reduce fat accumulation in the liver, improve insulin sensitivity and reduce the risk of liver complications. Moreover, other hepatic comorbidities such as diabetes, blood lipid disorders like cholesterol and triglycerides, or high blood pressure must be appropriately treated and managed. Alcohol consumption is not recommended in any quantity when a diagnosis of MASLD exists, especially in cases of steatohepatitis or fibrosis, as even though alcohol may not been the original cause, it can significantly worsen the condition.
Unfortunately, there are no pharmacological treatments approved by regulatory agencies. However, some drugs used to treat other conditions have also been tested in patients with MASLD. Currently, dozens of clinical trials evaluate the efficacy and safety of various drugs, either alone or in combination, for treating MASH. The first treatments are expected to be approved in the coming years.
The liver is a large organ in the upper right quadrant of the abdomen. It is mainly covered and protected by the lower part of the ribcage.
It performs a set of extraordinarily complex functions. It receives blood from the digestive system via the portal vein and transports most of the absorbed nutrients, filtering and processing them. It plays a key role in handling sugars, proteins and fats. After ingestion, energy substrates that are not immediately needed as fuel are processed by the liver and stored within the liver or in other parts of the body, such as fatty tissue. Therefore, it plays an important role in regulating blood sugar and lipid levels.
In addition, the liver produces many essential proteins, such as albumin, which acts as a carrier for various molecules that have to be transported in the blood, and proteins necessary for proper blood coagulation. During cellular renewal, many waste products are generated, which are eliminated by the liver and kidneys. The liver also produces bile, a liquid stored in the gallbladder (bile bladder). During a meal, the gallbladder contracts, causing the bile to flow into the digestive system, where bile salts help to break down and absorb food fat molecules.
The liver also takes part in the metabolising of many medicines and other chemical substances. Finally, the liver helps combat infections by filtering harmful organisms as they circulate in the blood, particularly those that enter the body through the digestive system. Therefore, the liver is central to the body’s overall functioning.
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