Chronic alcoholic hepatitis symptoms. Causes and methods of treatment of alcoholic form of hepatitis. Factors and risk groups
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The term "Alcoholic hepatitis" was included in the International Classification of Diseases in 1995. It is used to characterize inflammatory or degenerative lesions of the liver that are due to alcohol abuse and are capable, in most cases, of turning into cirrhosis of the liver.
Alcoholic hepatitis is the main alcoholic liver disease, which is considered the main cause.
When alcohol is taken in the liver, the substance acetaldehyde is formed, which directly affects the liver cells. Alcohol with metabolites trigger a whole range of chemical reactions that lead to damage to liver cells.
Experts define alcoholic hepatitis as an inflammatory process that is a direct consequence of liver damage by alcohol toxins and its related products. In most cases, this form is chronic and develops 5-7 years after the start of constant alcohol use.
The scale of alcoholic hepatitis is related to the quality of alcohol, the dose and duration of its use.
It is known that the direct path to liver cirrhosis for an adult healthy man is alcohol intake at a dose of 50-80 g per day, for a woman this dose is 30-40 g, and for adolescents even lower: 15-20 g per day(that's 1/2 liter of 5% beer every day!).
Alcoholic hepatitis can manifest itself in two forms:
- progressive form(distinguish mild, moderate and severe) - a small-focal liver lesion, which often results in cirrhosis. The disease accounts for about 15-20% of all cases of alcoholic hepatitis. In case of timely complete cessation of alcohol intake and proper treatment, a certain stabilization of inflammatory processes is achieved, however, residual effects remain;
- persistent form. Pretty stable form of the disease. With it, in the event of stopping alcohol intake, complete reversibility of inflammatory processes can be observed. If the use of alcohol is not stopped, then a transition to the progressive stage of alcoholic hepatitis is possible. In rare cases, alcoholic hepatitis can only be detected through the study of laboratory tests, tk. there are no pronounced specific symptoms: patients systematically feel heaviness in the right hypochondrium, mild nausea, belching, and a feeling of fullness in the stomach.
Persistent hepatitis can be histomorphologically manifested by mild fibrosis, ballooning cells, and Mallory bodies. Given the lack of progress of fibrosis, this picture persists for 5-10 years, even with little alcohol consumption.
The progressive form is usually accompanied by diarrhea and vomiting. In the case of moderate or severe alcoholic hepatitis, the disease begins to manifest itself with fever, jaundice, bleeding, pain in the right hypochondrium, and death is possible from liver failure. There is an increase in the level of bilirubin, immunoglobulin A, gamma-glutamyl transpeptidase, high transaminase activity and a moderately thymol test.
Active chronic hepatitis is characterized by the progress of transition to organ cirrhosis. There are no direct morphological factors of the alcoholic etiology of liver disease, however, there are changes that are extremely characteristic of the effects of ethanol on the organ, in particular, Mallory bodies (alcoholic hyaline), ultrastructural changes in stellate reticuloepitheliocytes and hepatocytes are distinguished. It is these ultrastructural changes in stellate reticuloepitheliocytes and hepatocytes show the level of exposure to ethanol on the human body.
In the chronic form of hepatitis (both alcoholic and any other), ultrasound of the abdominal cavity (spleen, liver and other organs) has a certain diagnostic value, which can reveal structure of the liver, enlargement of the spleen, ascites, determine the diameter of the portal vein and much more.
Ultrasound Doppler ultrasonography may be performed to establish or rule out the presence and extent of portal hypertension (increased pressure in the portal vein system). For diagnostic purposes, hospitals still use radionuclide hepatosplenoscintigraphy. (study with radioactive isotopes).
By development, it is customary to distinguish between chronic and acute alcoholic hepatitis.
OAH (acute alcoholic hepatitis) is a rapidly progressive, inflammatory-destructive lesion of the liver. In the clinical form, OAH is represented by 4 variants of the course: icteric, latent, fulminant, cholestatic.
In the case of prolonged alcohol use, OAG is formed in 60-70% of cases. In 4% of cases, the disease quickly turns into cirrhosis of the liver. The prognosis and course of acute alcoholic hepatitis will depend on the severity of the liver dysfunction. The most severe consequences of acute hepatitis are associated with the development of alcoholic excesses against the background of formed cirrhosis of the liver.
Symptoms and signs of acute alcoholic hepatitis usually begin after prolonged drinking in patients who already have cirrhosis of the liver. In this case, the symptoms are summed up, and the prognosis worsens significantly.
The most common today is the icteric variant of the course. Patients have severe weakness, pain in the hypochondrium, anorexia, vomiting, nausea, diarrhea, jaundice (without skin itching), noticeable weight loss. The liver increases, and significantly, almost always, it is compacted, has a smooth surface (if cirrhosis, then bumpy), painful. The presence of background cirrhosis is evidenced by the detection of severe ascites, splenomegaly, telangiectasias, hand tremors, palmar erythema.
Often, side bacterial infections can also develop: urinary infection, pneumonia, septicemia, sudden bacterial peritonitis, and many others. Note that the last listed infections in combination with hepatorenal syndrome ( connection of the renalinsufficiency) can act as a direct cause of a serious deterioration in the state of health or even death of the patient.
The latent variant of the course, as the name implies, cannot give its own clinical picture, therefore it is diagnosed on the basis of an increase in transaminases in a patient who abuses alcohol. A liver biopsy is performed to confirm the diagnosis.
The cholestatic variant of the course of the disease occurs in 5-13% of cases and is manifested by severe itching, discoloration of feces, jaundice, dark urine, and some other symptoms. If the patient has pain in the hypochondrium and has a fever, then clinically the disease is difficult to distinguish from acute cholangitis (laboratory tests can help). The course of cholestatic OAG is quite severe and protracted.
Fulminant OAS is characterized by progressive symptoms: hemorrhagic syndrome, jaundice, renal failure, hepatic encephalopathy. Death, in most cases, leads to hepatorenal syndrome and hepatic coma.
Chronic alcoholic hepatitis
This disease has symptoms may be missing. Characteristically a gradual increase in transaminase activity with the dominance of AST over ALT. Sometimes a moderate increase in the indicators of cholestasis syndrome is possible. There are no signs of portal hypertension. The diagnosis is made morphologically - histological changes are characteristic, which correspond to inflammation, taking into account the absence of signs of the development of cirrhotic transformation.
Diagnosing alcoholic hepatitis is quite difficult, because. It is not always possible to obtain complete information about the patient due to obvious reasons. Therefore, the attending physician takes into account the concepts that are included in the definitions of “alcohol abuse” and “alcohol dependence”.
Criteria for alcohol addiction include:
The use of alcohol by the patient in large quantities and the continuous desire to take it;
Most of the time is spent on the purchase and consumption of alcoholic products;
Use of alcohol in extremely dangerous doses for health and / or situations where this process is contrary to obligations to society;
Continuity of alcohol intake, even taking into account the aggravation of the physical and psychological state of the patient;
Increasing the dose of alcohol consumed in order to achieve the desired effects;
Manifestation of withdrawal symptoms;
The need for alcohol intake to subsequently reduce withdrawal symptoms;
A doctor can diagnose alcohol dependence based on any 3 of the criteria listed above. Alcohol abuse will be identified based on the presence of one or two criteria:
Alcohol use, regardless of the development of psychological, professional and social problems of the patient;
Re-use of alcohol in health-threatening situations.
Treatment of alcoholic hepatitis
The full range of procedures for the treatment of alcoholic hepatitis includes:
high protein energy diet
surgical and medical treatment (including),
elimination of etiological factors.
Treatment of all forms of alcoholic hepatitis, of course, involves a complete rejection of the use of strong drinks. It should be noted that, according to statistics, no more than a third of all patients actually refuse alcohol during treatment. Approximately the same number reduce the amount of the consumed dose on their own, while the rest mindlessly ignore the doctor's instructions. It is in the patients of the latter group that alcohol dependence is observed, therefore they are assigned an appointment with a narcologist and a hepatologist.
In addition, in this group, an unfavorable prognosis can be determined by the patient's strict refusal to stop drinking alcohol in one case, and contraindications to the appointment of antipsychotics recommended by narcologists due to liver failure, in the other.
If the patient refuses alcohol, then jaundice, encephalopathy and ascites often disappear, but if the patient continues to drink alcohol, then hepatitis begins to progress, which sometimes ends in the death of the patient.
The endogenous depletion characteristic of a decrease in glycogen stores can be exacerbated by the exogenous depletion of the patient, who makes up for the energy deficit with non-working alcoholic calories, subject to a direct need for various nutrients, trace elements and vitamins.
A US study found that virtually all patients with alcoholic hepatitis were malnourished, while the level of liver damage was correlated with rates of malnutrition. Let's pay attention to the fact that in the study group the average daily consumption was 228 g (up to 50% of the body's energy accounted for alcohol). In this regard, the main component of treatment was the judicious use of nutrients.
The energy value of the prescribed diet should be at least 2 thousand calories per day, with a combination of 1 g of protein per 1 kg of weight and an acceptable amount of vitamins (folic acid and group B). If anorexia is detected, parenteral or enteral tube feeding is used.
In the above study group of patients with OAH, a correlation was found between the number of calories consumed per day and survival. Patients who took in more than 3,000 calories did not die, but those who consumed less than 1,000 calories had a mortality rate of about 80%. An example of a diet indicated for alcoholic hepatitis is .
The positive clinical effect of parenteral infusion of amino acids is due not only to the normalization of the ratio of amino acids, but also to a decrease in protein breakdown in the muscles and liver, and an improvement in many metabolic processes in the brain. In addition, it should be taken into account that branched chain amino acids represent an important source of protein for patients with hepatic encephalopathy.
In the case of severe alcoholic hepatitis, to reduce endotoxemia and subsequent prevention of bacterial infections, it is customary to prescribe short courses of any antibacterial drugs (preference in this case is given to fluoroquinolones).
The range of drugs that are widely used today in the complex therapy of diseases of the hepatobiliary system is more than 1000 different items. From this rich variety stands out a small group of medicines that have a selective effect on the liver. These drugs are hepatoprotectors. Their impact is aimed at the gradual restoration of homeostasis in the body, increasing the resistance of the liver to pathogenic factors, normalizing activity or stimulating reparative and regenerative liver processes.
Classification of hepatoprotectors
Improve the ability of the liver to process alcohol and its impurities
It is worth considering that if, due to an excess of alcohol and its impurities, bile begins to stagnate in the liver, then all its “useful” properties will begin to harm the liver cells themselves, gradually killing them. Such harm leads to the disease of hepatitis caused by stagnation of bile.
As mentioned earlier, our body is able to convert toxic acids produced in the liver into secondary and tertiary bile acids. It just applies to the tertiary.
The main difference between the tertiary acid UDCA is that it is not toxic, but, nevertheless, it does all the necessary work in digestion: it breaks down fat into small particles and mixes them with liquid (fat emulsification).
Another quality of UDCA is the reduction of cholesterol synthesis and its deposition in the gallbladder.
Unfortunately, human bile contains up to 5%. In the 20th century, it began to be actively extracted from bear bile in order to treat liver diseases. For a long time, people were treated with the help of the contents of bear gall bladders. To date, scientists have managed to synthesize UDCA, which is now possessed.
The systematic and prolonged use of alcohol leads to the loss of the ability of the liver to neutralize poisons and the occurrence of alcoholic hepatitis. Pathology develops slowly and often goes unnoticed for a long time, and this threatens with serious consequences.
Description of pathology
Alcoholic hepatitis is inflammation of the liver as a result of excess alcohol consumption. Pathology is the most common type of toxic hepatitis.
The likelihood of developing the disease depends on the amount and regularity of drinking alcohol of any strength.
Special liver enzymes break down alcohol, in the process toxic acetaldehyde is formed, which affects liver cells (hepatocytes). Chemical reactions in the liver under the influence of alcohol and acetaldehyde lead to hypoxia, inflammation and necrosis of its cells.
The development of the disease is long, most often the first signs appear after 5-7 years of regular alcohol abuse.
Women are more susceptible to the development of this pathology than men, since their body contains fewer enzymes that neutralize alcohol.
Classification
There are several types of alcoholic hepatitis:
- Persistent. This form of the disease is characterized by the absence of clear symptoms. A person may not be aware of the existence of a problem. He is occasionally worried about heaviness in the right hypochondrium, slight nausea and discomfort in the stomach, belching. The disease is discovered by chance during laboratory tests. Timely diagnosis and treatment, adherence to a diet, refusal to drink alcohol help to get rid of the problem. In the absence of therapy, the pathology passes to the next stage.
- Progressive. Often precedes cirrhosis of the liver. In this case, the patient's health deteriorates significantly, the cells of the organ are destroyed and die. At this stage, the disease is manifested by vomiting, stool disorders, fever, jaundice, pain in the liver. If left untreated, death from acute liver failure is possible.
Alcoholic inflammation of the liver is acute and chronic. Signs of the acute form of the disease develop suddenly after drinking. The state of health worsens, the patient loses his appetite, nausea and vomiting appear, intense pain in the right hypochondrium, the skin turns yellow, itching occurs. Possible increase in body temperature.
Violation of liver function leads to a change in bilirubin metabolism, as a result of which the urine turns dark and the feces become light. The patient has an enlarged liver and spleen. The acute stage lasts 3-5 weeks, depending on the amount of alcohol consumed.
According to the nature of the course, several forms of acute alcoholic hepatitis are distinguished:
- Latent. It is dangerous because it has an asymptomatic course. The problem can only be detected by examination.
- Icteric. The most common variety, which is characterized by the acquisition of a yellowish tint by the skin, pain in the liver, loss of appetite, nausea, and vomiting.
- Cholestatic. In addition to the specific coloration of the skin, the patient has severe itching, manifestations of intoxication increase, urine darkens, feces becomes light.
- Fulminant. A rapidly progressive form of the disease that can be fatal. It is characterized by a sharp deterioration in the condition, fever, yellowing of the skin, complete lack of appetite, weakness, severe pain in the right hypochondrium.
In severe cases, the acute form of the disease can result in the death of the patient.
Chronic alcoholic inflammation of the liver is characterized by a long course and moderate clinical manifestations. The patient may feel a slight malaise, fatigue, loss of appetite, he periodically experiences nausea, vomiting, and abdominal pain. Toxic damage to the nerves leads to polyneuropathy of the lower extremities, the patient's gait is disturbed, there are aching pains in the legs.
The main signs of chronic alcoholic hepatitis are the appearance of spider veins on the skin, sleep disturbances, a purplish hue of the face, and problems in the genital area.
In a chronic course, the pathology often ends in death, since there are no obvious signs of deterioration that could alert the patient.
Reasons for development
The cause of the pathology is the abuse of alcoholic beverages. The rate of its development depends on the quantity, quality of drinks, duration and frequency of use, individual characteristics of the organism.
A safe dose for the male body is 40 g of alcohol per day, for the female - 20 g.
The risk of developing alcoholic hepatitis increases with:
- simultaneous use of large doses of alcohol;
- daily repeated intake of alcohol;
- long-term alcohol abuse;
- hereditary predisposition;
- irrational and unbalanced nutrition;
- infection with hepatotropic viruses.
Symptoms and signs of the disease
Pathology develops over several years. Symptoms of the disease are similar to those of other forms of hepatitis. The earliest symptoms of alcoholic hepatitis are increased weakness, fatigue, loss of appetite, and weight loss. Others join later:
- feeling of discomfort, pain in the liver;
- belching bitterness;
- nausea and vomiting.
- stool disorders after taking alcohol or fatty foods;
- slight increase in body temperature;
- anemia.
With further progression of the disease, the skin and mucous membranes turn yellow, severe itching occurs, the feces become discolored and the urine darkens, the liver increases in volume.
An alarming sign is a significant increase in the abdomen due to excessive accumulation of fluid in the abdominal cavity (ascites). This indicates that the liver does not have time to filter the blood. After the onset of such a symptom, a person can live no more than 3-5 years if he does not refuse to drink alcohol.
Diagnostics
Diagnosis is hampered by the fact that at the initial stage, the pathology does not have any specific manifestations, therefore, its presence can be suspected only after laboratory tests have been carried out.
First of all, the doctor must determine whether a person has alcohol dependence, the main criteria of which include:
- the use of large doses of alcoholic beverages. At the same time, a person cannot say with certainty how many days the binge lasted;
- psychological dependence on alcohol. The patient constantly thinks about drinking, cannot control the amount of alcohol he drinks, consumes alcohol, despite the awareness of his problem;
- withdrawal symptom, which is stopped (eliminated) only by the next intake of alcohol.
The specialist also notes the presence of characteristic external signs of alcoholism: puffiness of the face, the presence of spider veins, yellowness of the skin, tremor of the limbs, atrophy of the muscles of the shoulder girdle, palmar fibromatosis.
After questioning and examining the patient, the doctor directs the patient for additional studies:
- general blood analysis. With alcoholic hepatitis, the level of hemoglobin will be reduced and the number of leukocytes will be increased;
- Analysis of urine. The disease is characterized by an alkaline reaction of urine, traces of protein in it;
- coagulogram. Allows you to evaluate blood clotting;
- lipidogram. Needed to detect cholesterol levels;
- Abdominal ultrasound. The study allows you to determine the size of the liver and its structure, the presence of inflammation, ascites;
- blood chemistry. Helps to find out if the liver is doing its job. In the presence of the disease, there is an increase in the level of bilirubin, as well as liver enzymes ALT and AST;
- liver biopsy. During the study, a microscopic fragment of liver tissue is removed and examined in order to detect foci of inflammation or necrosis;
An alternative to biopsy is elastography, in which liver tissue is examined using a special apparatus.
- spiral computed tomography. Such an examination is necessary to obtain a clear image of the organ under study.
Treatment
Regardless of the form of alcoholic hepatitis, the main principle of treatment is the complete rejection of the use of alcoholic beverages. To achieve the maximum effect, therapy should be comprehensive and include a diet, medications. In the most severe cases, resort to surgical intervention.
Medical therapy
Hepatoprotectors are used to treat alcoholic hepatitis. Such drugs have antioxidant properties, accelerate the process of regeneration of liver cells, restore its functions and provide protection from negative external influences. The course of therapy should last at least a month, in some cases it is recommended to take hepatoprotective medications for two to three months. The patient also needs multivitamin complexes, since as a result of the disease, the absorption function of various useful substances is impaired.
In the acute phase of the disease, detoxification therapy, the introduction of plasma-substituting solutions, and the correction of electrolyte disturbances are prescribed. In severe cases, it may be necessary to use glucocorticosteroids, antibacterial drugs.
Hepatoprotectors for liver restoration - table
Name | Drug properties | Advantages | Flaws |
Complex drug. It has hepatoprotective, anti-inflammatory, antitoxic, choleretic properties. | The composition of the drug contains only herbal ingredients. The drug promotes the regeneration of damaged liver cells, restores liver function, and accelerates the excretion of acetaldehyde. Taking the drug does not affect the concentration of attention and the ability to drive. | When taking the drug, allergic reactions may develop. You can not use the drug for chronic diseases of the digestive tract in the acute stage. | |
Hepatoprotective and antidepressant agent. It has detoxifying, neuroprotective, antioxidant, regenerating properties. | It is considered one of the best drugs used in the active restructuring of liver cells, accompanied by other severe pathologies, such as:
It is effective in withdrawal symptoms, life-threatening intoxications, cirrhosis and liver fibrosis. Can be used as a prophylactic. | The drug has many side effects:
|
|
Due to the content of essential phospholipids, which are able to integrate into the structure of the liver, its cells are restored, the metabolism of lipids and proteins is normalized, and the processes of replacing hepatocytes with connective tissue are reduced. | The drug contains only natural ingredients. It is effective in pathologies accompanied by massive death of liver cells. Well tolerated, has a minimum of side effects. | The drug is contraindicated in case of individual intolerance. When taken, allergic reactions may develop. | |
The active complex nutritional supplement has a detoxifying, anti-inflammatory, regenerating, antispasmodic, choleretic effect. | A natural remedy that has no contraindications (except for individual intolerance to the components). | The drug is not prescribed for progressive liver pathology due to insufficient effectiveness. | |
Ursodeoxycholic acid preparation. It has an active choleretic, moderate hepatoprotective effect. | While taking the drug, the concentration of bile acids toxic to liver cells, which are excreted through the intestines, decreases. Against the background of therapy, the level of liver enzymes ASAT, ALT, bilirubin is normalized. The drug helps to activate the patient's immune system, restore damaged liver cells. Can be taken prophylactically when drinking alcoholic beverages. | Possible side effects in the form of:
Contraindications to taking the drug are:
It is necessary to take the drug only under the supervision of the attending physician. |
|
Gepabene | The preparation with milk thistle has a restorative, analgesic, bile-excreting effect. | Plant-based product, well tolerated by the body. It contributes to the normalization of the liver and the restoration of its structure at the cellular level, reduces the intensity of the progression of cirrhosis. | Despite the safety of the drug, there is not enough information about its effectiveness in alcoholic liver damage. The tool can not be used in acute diseases of the biliary tract and liver. |
Preparations for the treatment of alcoholic hepatitis - gallery
Liv 52 is a plant-based drug. Helps restore liver cells Heptral is an effective remedy for withdrawal symptoms of cirrhosis and liver fibrosis
Essentiale forte - contains essential phospholipids that restore the liver, integrating into its structure
Ovesol - an active complex food supplement with anti-inflammatory properties
Ursofalk is a drug of ursodeoxycholic acid. Repairs damaged liver cells
Diet
Prolonged alcohol abuse leads to digestive disorders, the human body does not receive the required amount of vitamins, nutrients and trace elements. A balanced diet is recommended to restore liver function.
The daily calorie content is at least 2000 calories. The patient needs B vitamins, folic acid and protein. Meals should be fractional - up to five times a day.
Doctors advise in case of illness to adhere to diet No. 5, which provides a sparing regimen for the liver.
It is forbidden to use:
- fried, spicy food;
- marinades;
- animal fats;
- yeast baking, fresh bread, sweets;
- meat, fish, mushroom broths;
- coffee, carbonated drinks, alcohol.
Products prohibited in alcoholic hepatitis - gallery
Alcohol Lean meats and fish
Soy Dishes
Surgery
Surgical intervention is necessary for significant damage to the liver, when drug treatment does not work. Such surgeries are rare and very expensive. The difficulty lies not only in the high cost, but also in the problems of selecting a donor, which can only be a person with excellent physical and mental health. Usually part of the organ is transplanted from a relative.
Alcohol must be avoided for six months before surgery.
The recovery period after surgery is long, during this time the patient needs to take immunosuppressants in order for the organ to take root. But sometimes, even under all conditions, the body rejects the transplanted liver.
Consequences and complications
Significantly improves the prognosis for such a disease, the complete rejection of alcohol. But it often happens that those patients who have been diagnosed with a severe form of alcoholic hepatitis continue to drink alcohol, which leads to death in 30% of cases.
And even with a mild course of acute alcoholic hepatitis and timely treatment, as well as a complete rejection of alcohol, there remains a very high risk of further development of cirrhosis.
The most likely complications of alcoholic hepatitis are:
![](https://i2.wp.com/creacon.ru/wp-content/uploads/cirroz-1.jpg)
According to statistics, in women the disease is much more complicated, and severe consequences develop more often than in men.
Prevention
Prevention of alcoholic hepatitis consists in the refusal of regular consumption of alcoholic beverages. The best solution for a person who cares about his health is the complete exclusion of alcohol, as well as a complete and rational diet.
Alcoholic hepatitis is a fairly serious disease that requires serious medical intervention. Proper and timely treatment increases the chance to restore and maintain health. At the same time, it is important to understand that without a complete rejection of alcohol, a positive result will be very difficult to achieve.
Alcoholic hepatitis disease It is characterized by such symptoms of liver damage as: inflammation, fatty degeneration and fibrosis, and the treatment of this disease is aimed specifically at eliminating these pathologies.
All of them are caused by the use of alcohol. Alcohol toxins affect the organ and lead to disease. If, with this diagnosis, a person continues to consume alcoholic beverages, it can go to the next stage - cirrhosis, which can no longer be cured.
Course of the disease " alcoholic hepatitis» can take place in acute or chronic form. Therapy for this form of hepatitis includes: stopping alcohol consumption, eating high-calorie foods, as well as normalizing liver function with medications.
K70.1- code of the disease in ICD-10.
Hepatitis from alcohol
In the international classification of diseases, the diagnosis "alcoholic hepatitis" appeared in 1995. It is from this time that the history of this disease can be documented.
The term "alcoholic hepatitis" was given to a disease that is one of the symptoms of alcoholic liver disease.
Gastroenterology considers alcoholic liver disease and alcoholic fibrosis to be the initial stage of such a serious disease as cirrhosis. How does this happen?
Alcohol, getting into the liver, is metabolized in it to acetaldehyde, which triggers chemical reactions in the body, leading first to hypoxia of liver cells, and then to their death. Due to toxic poisoning in the liver tissues, a diffuse inflammatory process develops. The development of this chronic disease usually occurs after 5-7 years of constant alcohol use.
Etiology of the disease
The main reason for the onset of the disease is the use of alcoholic beverages for a long time. Changes in the liver in a man begin to occur with regular daily alcohol consumption in the amount of 50-80 grams, in women at 30-40 grams per day, and in the liver of a teenager at 15-20 grams.
Depending on the quantity and quality of alcohol consumed, the duration of use, as well as the individual characteristics of the body, this disease progresses at different rates.
The likelihood that a person can develop alcoholic hepatitis increases if the person: is genetically predisposed to the disease, has had viral hepatitis, is not eating well.
Forms of alcoholic hepatitis
This disease can have both chronic development and progressive. chronic course manifests itself in a relatively stable form of the disease. If you stop drinking alcohol with this form of the disease, the liver cells will recover. If a person continues to consume alcohol, then the disease becomes progressive.
Depending on the degree of the process progressive form comes in light, medium and heavy. This form is characterized by the fact that a small-focal necrotic lesion appears in the liver, often turning into cirrhosis. If treatment is started in a timely manner, the development of the disease can be stopped, but residual effects will remain.
During the course of the disease, sharp And chronic form. The acute stage of alcoholic hepatitis is characterized by acute progressive liver damage. Acute hepatitis diagnosed in 70% of people who abuse alcohol. In 4% of these patients, the disease rapidly progresses to cirrhosis of the liver. acute form this disease happens latent, icteric, cholestatic, and fulminant. After a long binge on the background of cirrhosis of the liver, serious forms of the disease often develop.
Symptoms
latent flow alcoholic hepatitis is not characterized by any distinctive symptoms. The person complains of heaviness in the right hypochondrium and slight nausea. The diagnosis is made when an elevated transaminase level is detected in the analyzes, and is confirmed by a biopsy.
icteric course disease is the most common. It is characterized by the following symptoms: anorexia, diarrhea, general weakness, nausea and vomiting, yellowness of the skin and sclera, weight loss. Also, a person may experience an increase in temperature.
During the examination, the doctor notes an increase and tenderness of the liver on palpation. The liver is smooth, while in cirrhosis it is bumpy. The following signs may also indicate background cirrhosis: an enlarged spleen, accumulation of fluid in the abdominal cavity, symmetrical reddening of the palms, and the appearance of spider veins or meshes.
cholestatic variant alcoholic hepatitis is rarely diagnosed, has a long course. It is characterized by symptoms such as: colorless feces and dark urine, jaundice and severe itching of the skin.
For fulminant flow The disease is characterized by the intensive development of hemorrhagic and hepatorenal syndromes, as well as a pronounced change in laboratory markers. A lethal outcome is possible against the background of hepatic coma and hepatorenal syndrome.
For chronic stage The disease is characterized by moderate severity of both clinical symptoms and laboratory markers. Diagnosis is made by biopsy and is based on distinguishing features that, in the absence of cirrhosis, indicate an inflammatory process.
Diagnosing this disease is quite difficult. With a mild course of alcoholic hepatitis, no distinguishing signs may be observed. Only changes in the clinical parameters of a person's blood test can help to detect it.
indicators acute stage diseases in the blood test serves an increase (or rarely a decrease) in the number of leukocytes, accelerated ESR, marker increase liver damage, and anemia caused by a lack of vitamin B12.
A decrease in the number of leukocytes occurs under the action of alcohol toxins on the bone marrow. During an ultrasound examination of the liver, it is found that it is enlarged, has a heterogeneous structure and even contours. MRI examination of organs reveals damage to the pancreas such as collateral hepatic blood flow.
An ultrasound examination of the liver in the chronic stage shows that it is slightly or moderately enlarged, has a homogeneous structure and increased echogenicity. A blood test shows little change. Fibrosis, necrosis, and inflammation of the liver with alcohol damage can be detected by biopsy. The manifestation of these lesions depends on the duration of the disease, as well as on its form.
If the doctor during the examination revealed symptoms of liver damage, he should ask the patient about his addiction to alcohol. The patient himself does not always give complete information about himself. In addition, a person who abuses alcohol very often misjudges the amount of alcohol consumed. In such cases, the doctor should interview not only the patient himself, but also his relatives and only then give recommendations.
Prevention and prognosis
How long can a person diagnosed with alcoholic hepatitis live? If the patient is diagnosed with a mild or moderate severity of the disease, and he is ready to completely stop consuming alcohol, then the prognosis is favorable. In this case, the liver, with appropriate treatment, can fully recover.
Content
When the shape and volume of the patient's liver changes on the background of alcoholism, alcoholic hepatitis is diagnosed. This is a degenerative disease with a risk of developing cirrhosis. It requires surgical treatment of the disease, the rejection of alcoholic beverages and the transition to a healthy lifestyle. Learn how to recognize hepatitis at home, what symptoms it is characterized by.
What is alcoholic hepatitis
In 1995, the term "alcohol hepatitis" was coined, which indicates a characteristic of liver damage due to ethanol consumption. This disease is inflammatory, causes cirrhosis. Alcohol toxins enter the liver, where acetaldehydes are formed, which damage cells. The disease becomes chronic after six years with the constant use of ethanol. Hepatitis C and alcohol are not directly related, but the development of toxic disease contributes to the daily intake of 50-80 g of alcohol for men, 30-40 g for women and 15-20 g for adolescents.
Alcoholic hepatitis - symptoms
Depending on the form of manifestation of the disease, the following symptoms of alcoholic hepatitis are distinguished:
- Persistent form - proceeds hidden, the patient is unaware of the disease. Signs of it can serve as heaviness in the right side under the ribs, nausea, belching, pain in the stomach. The type is detected with the help of laboratory tests, it is treated by giving up alcohol and following a diet.
- Progressive form - it is formed in the absence of treatment of persistent hepatitis, is considered a harbinger of cirrhosis. The patient's condition worsens, foci of necrosis are observed in the liver (the cells die completely). Signs are: vomiting, diarrhea, fever, jaundice, pain in the right side. Without treatment, the disease threatens death from liver failure.
Signs of alcoholic hepatitis
Depending on the development and course of the disease, special signs of hepatitis are distinguished. The disease can be acute (icteric, latent, fulminant and cholestatic) and chronic. If the first symptoms are pronounced, pronounced (the patient may turn yellow, experience pain and deterioration), then the second may be asymptomatic and mild.
Acute alcoholic hepatitis
OAH, or acute alcoholic hepatitis, is considered a rapidly progressive disease that destroys the liver. It appears after prolonged drinking. There are four forms:
- Icteric - weakness, pain in the hypochondrium, anorexia, vomiting, diarrhea. In men, there is jaundice without skin itching, weight loss, nausea. The liver is enlarged, thickened, smooth, painful. The patient's hands tremble, ascites, erythema, bacterial infections, fever may appear.
- Latent - diagnosed only by a laboratory method, biopsy, latent leakage.
- Cholestatic - rare, symptoms are severe itching, colorless feces, jaundice, dark urine, impaired urination.
- Fulminant - symptoms progress, hemorrhages, jaundice, renal failure and liver encephalopathy are observed. Due to coma and hepatorenal syndrome, death occurs.
Chronic alcoholic hepatitis
The absence of obvious symptoms is characterized by chronic alcoholic hepatitis. It is detected only by laboratory tests - transaminase activity, cholestasis syndrome are checked. The indirect development of the disease is indicated by the criteria for alcohol dependence:
- drinking large amounts of alcohol, desire to drink;
- withdrawal symptoms;
- increase in alcohol dosage.
How to recognize hepatitis at home
To correctly recognize hepatitis at home, you need to pay attention to the patient. If he has at least one sign of an acute course of the disease, the intervention of a doctor is necessary. When observing indirect signs of involvement in alcoholism, you should also contact specialists to examine the liver and identify abnormalities in its function.
If the disease is not treated in time, complications are possible, up to the death of the patient against the background of liver necrosis:
- high blood pressure;
- intoxication of the body;
- hypertension, varicose veins;
- jaundice, cirrhosis.
Is toxic hepatitis contagious?
According to doctors, alcoholic toxic hepatitis is considered a non-contagious disease, because it occurs as a result of poisoning the body with a chemical. It develops against the background of long-term use of alcoholic beverages in large quantities, affects only the patient's body. For treatment, it is important to eliminate the destructive factor and increase the functionality of the organs.
How to treat alcoholic hepatitis
To carry out effective treatment of alcoholic hepatitis of the liver, you must definitely stop drinking alcohol and consult a doctor. He will prescribe complex therapy, including:
- detoxification - droppers, intravenous or oral cleansing drugs;
- visiting a psychologist, narcologist to eliminate a bad habit;
- energy diet, it is recommended to consume more proteins;
- surgical or drug treatment - you can remove foci of necrosis, take methionine and choline to replenish the lipid function of the organ;
- intramuscular injection of vitamins, potassium, zinc, nitrogen-containing substances;
- the use of corticosteroids in severe disease;
- taking hepatoprotectors (Essentiale, Ursosan, Heptral);
- elimination of etiology factors;
- taking antibiotics with the development of bacterial, viral infections or the development of a severe form of the disease.
Doctors forbid self-treatment, since liver damage can be serious and lead to uncontrolled consequences. If the case is very severe and neglected, it may require liver transplantation, the survival prognosis is average. As a strengthening treatment after elimination of symptoms and an acute course, traditional medicine based on corn stigmas, milk thistle can be used.
These rules are used to prevent the occurrence of a recurrence of the disease:
- reduction of doses of alcohol or complete rejection of it;
- compliance with medication, refusal of alcohol during treatment;
- proper nutrition, complete in calories and BJU.
Diet for alcoholic hepatitis of the liver
In the majority of patients with alcoholic hepatitis in the clinical history, there was an exhaustion of the body due to the lack of good nutrition. To improve health and reduce the severity of the liver, a special diet is needed. The diet for alcoholic hepatitis includes the following recommendations:
- rejection of fatty meat, lard, fish, eggs, canned and smoked foods;
- a ban on mushrooms, seasonings and sauce, pastries, white bread, strong tea, coffee;
- you can not eat nuts, onions, garlic, sorrel, radish, confectionery, ice cream;
- do not abuse the intake of carbonated water, fatty cheeses, cottage cheese, sour cream, butter;
- a categorical ban on alcohol, nicotine;
- products can be steamed, baked, boiled;
- inclusion in the diet of cereals, dried toast, bran, dairy products, veal, lean fish, fat-free cottage cheese, chicken;
- it is useful to eat vegetables, fruits, green tea, dried fruits, green vegetables, figs;
- meals 5-6 times a day, separate - do not mix proteins with carbohydrates in one meal, eat fruits separately.
Video: how toxic hepatitis manifests itself
Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.
Did you find an error in the text? Select it, press Ctrl + Enter and we'll fix it!Studies have shown that 1 average resident of Germany accounts for about 9.5 liters of alcohol per year, and 10 liters per resident of Russia. The gap is small, but the amount is very dangerous, because with such an active consumption of strong drinks, a person runs the risk of getting cirrhosis of the liver, which is preceded by alcoholic hepatitis. This disease develops from alcohol consumption, leading to inflammatory liver damage that can develop into cirrhosis. It has many forms, is difficult to diagnose, requires long-term treatment and recovery.
About what is alcoholic hepatitis, what are its symptoms and treatment, we will now tell.
Types of alcoholic hepatitis
Alcoholic hepatitis is divided into several types, depending on the symptoms and course of the disease. Consider their signs and features.
Persistent form
With this form of the disease, there are very few symptoms of alcoholic hepatitis, and patients most often complain of such manifestations:
- Nausea and belching.
- Pain on the right (in the region of the liver).
- Heaviness in the stomach.
The presence of liver disease is detected by laboratory tests, after which the attending physician prescribes a diet and strongly advises to give up alcoholic beverages. After six months, there is an improvement in the patient's condition, but the unpleasant consequences of this liver disease accompany a person for 5-10 years. If time does not begin to treat alcoholic hepatitis at this stage, then it flows into the next form - progressive.
progressive form of the disease
This form is observed in 20% of patients who suffer from alcoholic hepatitis, and it is a harbinger of imminent cirrhosis. Symptoms of alcoholic hepatitis in a progressive form are pronounced:
- Jaundice and fever.
- Vomiting and diarrhea.
- Severe pain in the right hypochondrium.
Non-specific symptoms may also appear, corresponding to the stage of the disease (mild, moderate, severe). If this form of liver disease is left untreated, then the patient will die, the cause of which is acute liver failure.
Forms of the disease and the causes of its development
According to the intensity of the course of the disease, the following types can be distinguished:
- Spicy
- Chronic.
Features of the course of the acute form
This type of disease is seen in patients who suffer from other liver problems (cirrhosis, hepatitis) but regularly consume alcoholic beverages.
Acute alcoholic hepatitis is accompanied by the following symptoms:
- A very strong weakness.
- Jaundice.
- Pain in the hypochondrium.
- Nausea and vomiting.
- Weight loss and stool changes.
Acute alcoholic hepatitis can also occur in several forms:
- The icteric appearance is most common, symptoms are weakness, yellowness of the skin, fever, pain.
- Cholestatic is characterized by the highest mortality. The manifestation of the disease is accompanied by jaundice, itching, colorless feces and dark urine.
- The fulminant appearance develops very quickly and is difficult to cure. But in the absence of treatment, the patient dies 14-20 days after the transition of the disease to the acute phase from hepatic-renal failure.
- Latent, characterized by an asymptomatic course and difficult diagnosis.
In all of the above cases, there is a significant increase in the liver, some patients have anorexia.
Chronic form
Classical chronic alcoholic hepatitis develops with regular alcohol consumption, but without concomitant liver disease. It is difficult to identify this form of the disease; an examination of the liver and its changes, as well as an increase in the level of transaminase, will help in making a diagnosis.
Chronic alcoholic hepatitis is almost asymptomatic, and the patient may complain of the following discomfort:
- Decreased appetite and nausea.
- Poor sleep, in men, the mammary glands increase.
- Decreased sexual activity.
- Pain in right hypochondrium and liver enlargement.
- Vascular stars, white nails.
The development of this form of the disease leads to the frequent use of alcohol, which is 70 g of pure ethanol for men, 20 g for women.
Who is at risk?
Scientists have proven that most of the alcohol, or rather the ethanol that it contains, is broken down by the liver. About 20% of ethanol is broken down in the stomach, turning into acetaldehyde. This substance destroys cells and leads to pathological changes in internal organs. Note that alcohol is doubly dangerous for women, because the ability of a woman's stomach to break down ethyl is two times lower than that of a man.
A high probability of getting hepatitis in people who have been drinking 100 g or more of pure alcohol daily for several years. 50 ml of vodka contains 20 g of alcohol, it turns out that 250 ml contains 100 g of pure alcohol, and this is already a dangerous dose.
Doctors also identify the following reasons that can accelerate the development of the disease:
- Long-term alcohol use (more than 5 years).
- Drinking alcohol in large quantities.
- genetic predisposition.
- Obesity and bad habits.
- Overeating, lack of healthy foods high in protein.
Also, the cause of the development of the disease is poor ecology, which weakens the immune system, poor-quality food and cheap alcohol made from chemical components. And if the patient drinks strong antibiotics and other medicines, while continuing to drink alcohol, then he also falls into the risk group.
Now consider how to treat the disease and recover from it.
How is the disease diagnosed?
To diagnose the disease, modern laboratory and hardware techniques are used. Ways diagnostics depend on the patient's complaints, the clinical picture and the form of the disease. For example, if a person suffers from a latent form of the disease, then a biopsy is required, and an ultrasound of the abdominal organs will reveal the chronic form.
Most often, the following laboratory tests can be prescribed to the patient:
- General analysis of blood and urine.
- Biochemistry of blood and liver sample.
- Analysis to assess blood clotting and cholesterol.
Depending on the nature of the course of the disease, ultrasound, MRI or CT may be prescribed, but these methods are ineffective. The best diagnostic option is a biopsy.
Features of treatment
Treatment usually begins after diagnosis. The main factor in the treatment of alcoholic hepatitis is diet, in these cases, treatment table No. 5 is prescribed, we will talk about it later.
For the treatment of alcoholic hepatitis, the following medicines are used:
- Detoxification therapy may be prescribed, during which drugs are administered intravenously. The therapy helps in a short time to cleanse the body, increase its endurance and prepare the patient for drug treatment.
- Metabolic and coenzyme therapies aimed at improving the metabolism in the cells of the body.
- Drugs that help liver cells to remain active, and also contribute to their speedy regeneration.
- Drugs that are analogues of the hormones of the adrenal cortex. This group of drugs suppresses the production of antibodies and inflammatory processes, prevents tissue scarring.
- Naturally, for the treatment of any alcoholic hepatitis, the patient is prescribed a course of vitamins, including vitamins A, B, C, E and others. The disease is accompanied by a deterioration in the function of absorption of nutrients.
The above drugs are prescribed by a doctor, the dosage and duration of administration are calculated individually, depending on the form of the disease, its neglect, and diet. Note that it is necessary to abandon the use of ethyl, otherwise the therapy will be ineffective.
Features of the treatment table No. 5
A set of diets for various diseases was developed by the Soviet nutritionist Pevzner, and although they are actively criticized today, their use gives good results in the treatment of various types of alcoholic hepatitis. In particular, with this disease, treatment table No. 5 is used, which helps to solve such problems:
- Restoration of liver function.
- Restoration of the activity of the biliary tract.
The diet menu spares the liver, relieves the load from it and improves the work of medicines. Consider the list of prohibited foods:
Very fresh bread and flour products.
All fatty fish and meats.
Strong broths: meat fish, mushroom, okroshka, cabbage soup.
Any smoked, spicy and overly salty foods.
Dairy and sour-milk products with high fat content.
Eggs, hard boiled or fried.
Legumes, spicy and fatty sauces.
Ice cream, chocolate and sweets, products with cream.
The diet is rich in protein foods (cottage cheese, meat, fish), but all dishes should be non-fat, steamed or in foil in the oven.
The calorie content of the diet is about 3000 kcal, the daily amount of protein is 90 g, carbohydrates 400 g, and fats 80 g, but 30% of them should be vegetable. The patient must consume up to 3-4 liters of fluid per day, reducing the amount of salt to 4 g. Thus, the vital organ is unloaded, the body is cleansed, and the duration of the diet can be either 14 or 21 days.
How long does the treatment take?
With a timely visit to the hospital and the early abandonment of a bad habit, a favorable prognosis can be made. The liver is able to recover, so the treatment of alcoholic hepatitis in the initial stages gives good results, and the patient can forget about the unpleasant disease for a long time.
But remember that with a successful cure, you must avoid drinking alcohol, otherwise you can again be under a dropper. And in especially neglected cases, the likelihood of death increases.
How to avoid this disease?
To avoid most liver diseases, it is enough just not to drink alcoholic beverages, exclude fatty foods from your menu, and try to smoke less. But even if you rarely drink alcohol, and the next morning after the feast you feel a pulling pain on the right side under the ribs, then do not delay going to the doctor, because these may be manifestations of the first symptoms of alcoholic hepatitis.