Disease

Alcoholic hepatitis: diagnosis, symptoms, treatment

Pin
+1
Send
Share
Send

Alcoholic hepatitis is a liver disease in which the inflammatory process in the organ occurs as a result of the systematic use of large doses of alcohol. The likelihood of developing the disease is extremely high in people over a long period of time (5 years or more) who consume 100 g of alcohol in terms of 96% alcohol (25 ml of vodka contains 10 g of alcohol). Alcoholic hepatitis usually develops very slowly, and often the disease goes unnoticed for a long time. With the progression of the disease, cirrhosis of the liver and liver failure develop.

It should be noted that for men, the daily safe dose of alcohol in terms of pure alcohol is 40 g, and for women - 20 g.

Due to the anatomical features of the body, women have a higher risk of developing alcoholic hepatitis than men who have more enzymes that neutralize alcohol. In addition, the high-risk group includes people taking drugs that have a toxic effect on the liver, as well as those suffering from viral hepatitis. The presence of concomitant diseases of the digestive system, which often develop as a result of alcoholism (pancreatitis, cholecystitis, gastritis, etc.), is also of certain importance.

A person suffering from alcoholic hepatitis does not pose a danger to others, unlike patients with viral hepatitis, which can be infected by contact with the blood of a sick person.

There are two forms of the disease:

  • The persistent form is considered a relatively stable form of alcoholic hepatitis, in which there is still the possibility of the reverse development of the inflammatory process, but only if alcohol is completely abandoned. With continued abuse of alcohol, this form of the disease can become progressive.
  • The progressive form is characterized by small focal necrotic lesion of the liver, as a result of which cirrhosis most often develops. With timely treatment, it is possible to achieve stabilization of the inflammatory process, but the residual effects will remain for life.

Symptoms of Alcoholic Hepatitis

For a long time, the disease can be asymptomatic, and only then signs appear that allow you to suspect abnormalities in the liver:

  1. Asthenovegetative syndrome is manifested by weakness, increased fatigue, decreased appetite, and decreased body weight.
  2. Pain syndrome is expressed in the appearance of discomfort, a feeling of heaviness and pain in the right hypochondrium.
  3. Dyspeptic syndrome: nausea, vomiting, a bitter aftertaste in the mouth and burping with bitterness, especially after drinking alcohol or fatty fried foods.
  4. Jaundice. Usually, ictericity (icteric shade) of the sclera and mucous membrane of the oral cavity is first noted, with the progression of the disease, yellowness of the skin is observed. Sometimes itchy skin all over the body.
  5. Hepatic enlargement with alcoholic hepatitis is most often minor or moderate.

Treatment of alcoholic hepatitis

First of all, a complete rejection of any alcoholic beverages is necessary. Without fulfilling this condition, all medical measures will be practically ineffective. In many cases, when the disease is caused by alcohol dependence, patients need the help of a psychotherapist and narcologist.

All patients need a diet. For liver diseases, a special therapeutic diet No. 5 is recommended, aimed at maximizing the tenderness of the diseased organ with good nutrition. Fatty, fried, spicy dishes, pickled foods and canned foods, sweets, strong teas and coffee are excluded from the diet. Preference is given to foods rich in protein, fiber, vitamins and minerals.

Drug therapy

Hepatoprotectors - a group of drugs that contribute to the regeneration of damaged liver cells, and also protect it from the negative effects of external factors. Such medicines include Ursosan, Essential N and Essential Fort N, Heptral, Rezalyut Pro and many others. The course of treatment usually lasts at least a month, some patients are shown taking hepatoprotectors for 2-3 months. Despite the fact that drugs of this group are widely available for sale, self-medication is not worth it, the doctor should prescribe treatment.

Vitamin therapy is indicated for all patients with alcoholic hepatitis, since the body with chronic alcohol intoxication is usually depleted. Patients are prescribed multivitamin complexes, intramuscular injections of B vitamins. In addition, natural immunomodulators (echinacea, Chinese magnolia vine, eleutherococcus, etc.) are useful.

Liver transplantation is a treatment method that can be used in severe alcoholic hepatitis, accompanied by progressive liver failure. But if the patient is not cured of alcohol dependence, then treatment will be meaningless.

Which doctor to contact

With alcoholic liver disease, you should be treated by a hepatologist or gastroenterologist. However, without giving up alcohol, the effect of treatment will not be. Therefore, the patient needs the help of a psychiatrist, psychotherapist or narcologist. For the diagnosis of alcoholic hepatitis, ultrasound and EFGDS are used, therefore, doctors of relevant specialties play an important role. Finally, a nutritionist will help you choose the right nutrition for a patient with alcoholic hepatitis.

Shabanova Anna Alexandrovna

  • Therapist
  • Gastroenterologist
  • Specialist in RDT (fasting diet therapy)

The term "Alcoholic Hepatitis" was introduced into the International Classification of Diseases in 1995. It is used to characterize inflammatory or degenerative liver lesions that occur due to alcohol abuse and are capable, in most cases, of cirrhosis.

Alcoholic hepatitis is the main alcoholic liver disease, which is considered the main cause of cirrhosis.

When alcohol is taken in the liver, acetaldehyde is formed, which directly affects 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 result 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 drinking.

The extent of alcoholic hepatitis is related to the quality of alcohol, the dose and duration of its use.

It is known that the direct way to liver cirrhosis for an adult healthy man is taking alcohol at a dose of 50-80 g per day, for women this dose is 30-40 g, and for adolescents even lower: 15-20 g per day (this 1/2 liter of 5% beer every day!).

Alcoholic hepatitis can occur in two forms:

  1. Progressive form (secrete mild, moderate and severe) - small focal liver damage, often resulting 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 persist,
  2. Persistent form. A fairly stable form of the disease. With it, in case of cessation of alcohol intake, a 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 by studying laboratory tests, as specific pronounced symptoms are not observed: patients systematically feel heaviness in the right hypochondrium, slight nausea, belching, a feeling of fullness of the stomach.

Persistent hepatitis can histomorphologically manifest as small fibrosis, balloon dystrophy of cells, Mallory bodies. Given the lack of progression 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 as fever, jaundice, bleeding, pain in the right hypochondrium, and fatal outcome is possible from liver failure. There is an increase in the level of bilirubin, immunoglobulin A, gammaglutamyltranspeptidases, high transaminase activity and a moderately thymol sample.

Active chronic hepatitis is characterized by progress in the transition to cirrhosis of the organ. There are no direct morphological factors of the alcoholic etiology of liver disease, but there are changes that are extremely characteristic of the effect of ethanol on the organ, in particular: Mallory bodies (alcoholic hyaline), ultrastructural changes in stellate reticuloepithelial cells and hepatocytes. These ultrastructural changes in stellate reticuloepithelial cells and hepatocytes show the level of exposure of the ethanol to the human body.

In the chronic form of hepatitis (both alcoholic and any other), diagnostic ultrasound of the abdominal cavity (spleen, liver and other organs) has a certain diagnostic value, which can reveal the structure of the liver, enlarged spleen, ascites, determine the diameter of the portal vein and much more .

Ultrasound Doppler ultrasonography can be performed to establish or exclude the presence and degree of development of portal hypertension (increased pressure in the portal vein system). For diagnostic purposes, radionuclide hepatosplenoscintigraphy (a study with radioactive isotopes) is also still used in hospitals.

By development, it is customary to distinguish chronic and acute alcoholic hepatitis.

OAS (acute alcoholic hepatitis) - This is a rapidly progressive, inflammatory and destructive liver damage. In the clinical form, OAS is represented by 4 variants of the course: icteric, latent, fulminant, cholestatic.

In the case of prolonged alcohol consumption, OAS is formed in 60-70% of cases. In 4% of cases, the disease will quickly turn into cirrhosis. The prognosis and course of acute alcoholic hepatitis will depend on the severity of the liver. The most severe consequences of acute hepatitis are associated with the development of alcoholic excesses against the background of the formed cirrhosis of the liver.

Symptoms and signs of acute alcoholic hepatitis, as a rule, begin to appear after prolonged drinking bouts in patients who already have liver cirrhosis. In this case, the symptoms are summed up, and the prognosis is significantly worsened.

The most common today is the icteric version of the course. Patients have severe weakness, pain in the hypochondrium, anorexia, vomiting, nausea, diarrhea, jaundice (without skin itching), marked weight loss. The liver grows, and significantly, almost always, it is compacted, has a smooth surface (if cirrhosis, then tuberous), painful. The presence of background cirrhosis is indicated by the identification of severe ascites, splenomegaly, telangiectasias, hand tremors, and palmar erythema.

Often, side bacterial infections can also develop: urinary infection, pneumonia, septicemia, sudden bacterial peritonitis, and many others. It should be noted that the last listed infections in combination with hepatorenal syndrome (involvement of renal failure) can act as a direct cause of a serious deterioration in the state of health or even the 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 increased transaminases in a patient who is abusing alcohol. A liver biopsy is performed to confirm the diagnosis.

The cholestatic variant of the disease course occurs in 5-13% of cases and is manifested by severe itching, fecal discoloration, 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 may help). The course of cholestatic OAS is quite severe and protracted.

Fulminant OAS is characterized by progressive symptoms: hemorrhagic syndrome, jaundice, renal failure, hepatic encephalopathy. In most cases, hepatorenal syndrome and hepatic coma lead to death.

Chronic alcoholic hepatitis

This disease may not have a symptom. A gradual increase in the activity of transaminases with the dominance of AST over ALT is characteristic. Sometimes a moderate increase in 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 cirrhotic transformation.

It is quite difficult to diagnose alcoholic hepatitis, because Obtaining complete information about the patient is not always possible for obvious reasons. Therefore, the attending physician takes into account the concepts that are included in the definitions of “alcohol abuse” and “alcohol dependence”.

The criteria for alcohol dependence include:

The use of large amounts of alcohol by patients and the continuous desire for its adoption,

Most of the time is spent on the purchase and consumption of alcoholic beverages,

Alcohol consumption in doses that are extremely dangerous for health and / or situations, when this process contradicts obligations to society,

The 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,

The manifestation of signs of abstinence,

The need for alcohol to further reduce withdrawal symptoms,

The doctor can diagnose alcohol dependence based on any 3 of the above criteria. Alcohol abuse will be identified based on one or two criteria:

Alcohol consumption, regardless of the development of psychological, professional and social problems of the patient,

Repeated use of alcohol in hazardous situations.

Classification of hepatoprotectors

Hepatoprotectors are usually divided into 5 groups:

  1. Preparations containing natural or semi-synthetic thistle flavonoids.
  2. Preparations containing ademetionin.
  3. In rsodeoxycholic acid (bear bile) - Ursosan,
  4. Preparations of animal origin (organ preparations).
  5. Preparations with essential phospholipids.

Hepatoprotectors allow:

Create conditions to repair damaged liver cells

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 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. Ursodeoxycholic acid (UDCA) also refers to tertiary.

The main difference between UDCA tertiary acid 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 a decrease in cholesterol synthesis and its deposition in the gallbladder.

Unfortunately, in human bile UDCA contains up to 5%. In the 20th century, they began to actively extract it from bear bile in order to treat liver diseases. For a long time, people were treated precisely with the contents of bear gall bladders. To date, scientists have managed to synthesize UDCA, which hepatoprotectors like Ursosan now possess.

Liver and alcohol

Excessive consumption of alcoholic beverages on a regular basis leads to poisoning of the human body. Alcohol in a large dosage is poison for humans. In a small amount, ethanol is produced by the body itself, and takes an active part in a number of biological and chemical processes.

Poison is considered the amount of alcohol that exceeds the safe daily dose. So, this is more than 30 ml of alcohol at 40% degrees (vodka, whiskey), from 75 ml of 17% of the drink (fortified wine), from 100 ml of 11-13% alcohol (champagne) and more than 250-330 ml of beer.

Moreover, abuse is even called the situation when a person has no alcoholism, but he uses the above dosages 4-5 times a week.

After the consumption of alcoholic products, the body tries to get rid of toxic substances - the cleavage process begins even in the oral cavity, then ethanol is neutralized by 20% in the stomach. The speed is due to food intake, acidity of the gastric juice. Due to gastric reactions, a component is formed - acetaldehyde, which has a toxic effect.

All the rest is excreted through the lungs, enters the liver. There, ethanol is first transformed into acetaldehyde, and then into acetic acid. The latter does not harm, because after several biochemical reactions it decomposes into components in the form of water and carbon dioxide.

Pathogenesis of the disease

With the constant use of alcohol, the enzyme function of the liver worsens.

This is based on the fact that acetaldehyde damages the liver cells, there is a fat transformation (steatosis).

The process is as follows:

  • Lipid acids are formed in the liver cells. When ethanol gets into them, the process is disrupted.
  • The gland perceives a violation of the natural process as an inflammatory reaction, so a high concentration of TNF is formed in it.
  • When the content of TNF increases, triglycerides accumulate.

Ethanol also leads to cholestatic syndrome. The patient develops fibrosis of the initial stage. It is reversible, but if the action of ethanol is not eliminated, then the disease will soon progress.

Forms and varieties of alcoholic hepatitis

Hepatitis can be divided into two large groups - alcoholic and nonalcoholic (this category includes infectious, viral ailments that can be transmitted from a sick person). Over the course of the classification, there are two forms - acute hepatitis - diagnosed with alcoholism in 70% of the clinical pictures and the ailment of the chronic course.

Acute form and symptoms

Alcoholic hepatitis is a consequence of the negative influence of alcohol; people cannot become infected with this type of disease.

Symptoms of acute alcoholic hepatitis most often occur in men who suffer from alcohol addiction 3-5 years. In very rare cases, the acute course of the disease appears after several days of binge. In this case, severe intoxication, an inflammatory reaction and destructive processes in the liver are detected.

Often, the alcoholic form of hepatitis appears against the background of existing cirrhosis of the liver (alcohol is not always the cause of development). Additional provocative factors include smoking, poor nutrition, and taking medications that adversely affect liver functionality.

For the first time, hepatitis of alcoholic origin manifests itself after consuming a substantial dosage of alcohol.

Symptoms of acute form:

  1. Nausea, vomiting.
  2. Bitterness in the oral cavity.
  3. Loss of appetite.
  4. Body temperature rises to 38 degrees.
  5. Pain in the area of ​​the projection of the liver.
  6. Disruption of the digestive tract.
  7. Increased gas formation.
  8. Weakness.
  9. Mental disorders.

1-3 days after the detection of clinical signs, jaundice is observed - mucous membranes, eye proteins and skin become yellow.

The duration of the acute form varies from 3 to 5 weeks. With a mild form, blood biochemistry is relatively normal, in severe cases, the main indicators of the analysis increase tenfold, there are signs of liver cell failure. To determine the degree of damage, an ultrasound scan is performed.

Forms depending on the course of acute illness

In medical practice, a classification of acute hepatitis of alcoholic origin is distinguished depending on the course.

Symptomatic forms:

The formDescription and symptoms
IctericIt occurs most often, accompanied by severe liver damage. The clinic includes jaundice in the absence of itching, a sharp decrease in body weight, chronic fatigue, constant pain in the hypochondrium on the right.
LatentThe form differs in an asymptomatic course. Periodically, the patient complains of pain in the right side, loss of appetite. On palpation, inconsequential hepatomegaly is detected.
CholestaticThe highest mortality rate for cholestatic hepatitis. Symptoms - changes in the color of urine, feces, skin itching, severe yellowing of the skin.
FulminantAlcoholic hepatitis is developing rapidly, progressing rapidly. The patient's body temperature rises significantly, appetite is completely absent, jaundice is manifested almost instantly. Often complications develop in the form of ascites, hepatocellular and renal failure.

Severity classification

Regardless of the type of course of the pathology, the disease is classified into three degrees. They differentiate depending on the concentration of ALT (an enzyme substance, which is determined in the framework of the study “liver tests”).

With a mild degree, ALT increases no more than 3 units, with an average of 3 to 5 U / ml * h, in severe cases, biochemical screening shows a result of more than 5 U / ml * h.

Treatment of alcoholic liver damage

To confirm the diagnosis of “hepatitis of an alcoholic nature”, a comprehensive diagnosis is carried out, including tests that show the functionality of the liver, instrumental methods of investigation - ultrasound, MRI, CT, fibroscan.

Based on the results obtained, a diagnosis is made, a treatment regimen is prescribed.

The standard of treatment is a complete rejection of the use of alcoholic beverages, diet food and the use of medications.

In severe cases, for medical reasons, surgery is performed.

Diet

The patient's diet is compiled in such a way as to provide the body with all those substances that were lost due to alcoholism. Nutrition recommendations - the amount of protein per day is calculated based on body weight, is 1 g per 1 kilogram of patient weight.

You need to eat foods that are rich in folic acid. These are fresh herbs, walnuts and pine nuts, cereals, tuna, salmon. The body needs to “direct” the intake of B vitamins, so the menu includes meat, liver, eggs, grain bread.

The daily calorie intake is not more than 2000 kilocalories. Methods of cooking - cooking, baking on water. The patient should completely abandon fatty foods, spices, spices, fried foods, coffee, carbonated drinks. Fatty broths are not allowed.

Conservative therapy

Treatment of chronic chronic alcoholic hepatitis is carried out at home - on an outpatient basis.

Medicines are prescribed individually.

The goal of therapy is to compensate for the disease, to prevent the development of negative consequences.

Therapeutic strategy and drugs:

  1. Omeprazole - to reduce the acidity of gastric juice.
  2. Polysorb is a sorbent drug.
  3. Heptral is a hepatoprotector for protecting the liver.
  4. Kanamycin is an antibiotic prescribed in a short course.
  5. Normase or other lactulose preparations.

Additionally, you can use folk remedies - decoctions with medicinal herbs that have anti-inflammatory and immunostimulating effects. According to reviews, they help well: yarrow, immortelle and chamomile.

The acute form of alcoholic hepatitis requires hospitalization of the patient, the therapy is carried out in an inpatient setting.

Forecast

The prognosis of any pathology is directly determined by the duration of the disease, the severity, the frequency of exacerbations, the timeliness of the provision of qualified care. No less important is how the patient will live after the diagnosis of alcoholic hepatitis - will he give up alcohol, will he follow the doctor's instructions or will he return to his previous lifestyle.

If, against the background of alcoholic hepatitis, the patient does not give up alcohol, then in 30% of the clinical pictures a lethal outcome is observed. Against the background of the development of cirrhotic processes and hepatitis, complications often develop that end in death.

Development reasons

Regular drinking of alcohol over a long period leads to alcoholic hepatitis. Once in the body, alcohol is broken down by enzymes produced in the stomach and liver, and then the decay products are excreted through the lungs, skin, and urinary system.

The liver has the main burden - it processes more than 80% of the incoming alcohol. At the first stage of alcohol processing, acetaldehyde is formed - a highly toxic substance, which is then broken down into acetic acid, which in turn is converted into water and carbon dioxide. These substances are ultimately excreted from the body.

Alcohol and the liver

With large doses of alcohol, the liver does not have time to process all the toxins and they begin to gradually accumulate in the cells, causing pathological changes. At the first stage, the process of formation of fatty acids is disrupted, fat accumulates in the cells, which leads to alcoholic fatty degeneration of the liver. Then the inflammatory process begins, and healthy cells are gradually replaced by connective tissue - liver fibrosis develops.

The risk of alcoholic hepatitis is significantly increased under the influence of the following factors:

  • a large amount of alcohol drunk at one time,
  • genetic features
  • history of viral hepatitis,
  • nutrient deficiency caused by malnutrition, malnutrition,
  • overweight,
  • autoimmune diseases
  • prolonged use of medications, with side effects in the form of a negative effect on liver function.

Gender is important - in women, the likelihood of developing an ailment is significantly higher.

Types of Alcoholic Hepatitis

There is a conditional division of alcoholic liver hepatitis into species according to several criteria:

  • By features of manifestation:
    • acute,
    • chronic.
  • By severity:
    • light
    • average
    • heavy.
  • By the nature of the changes occurring in the liver:
    • persistent form
    • progressive form.

It is impossible to determine the stage of development and the form of the disease without a thorough study of symptoms and a medical examination. Liver obesity preceding alcohol hepatitis often often does not appear at all, it can only be determined during an ultrasound scan or liver MRI.

Persistent form

The persistent form of hepatitis proceeds stably and most often is not accompanied by pronounced symptoms. Due to the inflammatory process occurring in the liver, the patient may experience heaviness in the stomach, discomfort in the right hypochondrium, nausea, belching.

With timely treatment and refusal of alcohol, a complete cure is possible. If the patient does not struggle with addiction, then with small doses of alcohol, the clinical picture can persist for 5-8 years, and with a constant increase in the amount of alcohol consumed, the disease becomes a progressive form.

Progressive form

A progressive form is diagnosed in approximately 20% of patients with alcoholic hepatitis. This form is characterized by small focal necrotic lesions of the liver, which often become the precursors of the development of cirrhosis.

Symptoms of mild alcoholic fatty liver hepatosis are vomiting and diarrhea. In moderate to severe cases, the symptoms are supplemented by fever, severe pain in the right side, jaundice, and bleeding. Due to liver failure, a fatal outcome is possible.

With the refusal of alcohol and proper therapy, the patient's condition stabilizes, but it is not possible to achieve a complete cure, the residual effects persist.

Acute

Acute alcoholic hepatitis is characterized by rapid development and a damaging effect on the liver. In the case of chronic alcoholism, the likelihood of developing this form reaches 70%. Most often, symptoms appear after prolonged drinking bouts in patients already suffering from cirrhosis. In this case, the symptoms of both diseases are summarized, and the probability of cure is significantly reduced.

The acute form can be represented by four flow options:

  1. Icteric - the most common form. It is accompanied by severe weakness, nausea, vomiting, weight loss, pain in the right side, diarrhea, jaundice (without skin itching). The size of the liver increases significantly, the organ becomes more dense, painful. If hepatitis develops against cirrhosis, then there is an accumulation of fluid in the abdominal cavity, the appearance of a rash and redness on the skin, and tremor of the hands. In parallel, various bacterial infections can develop.
  2. Latent the form is characterized by an asymptomatic course, it is diagnosed only after laboratory tests (blood test, liver biopsy).
  3. Cholestatic the form is accompanied by darkening of the urine, discoloration of feces, yellowing of the skin, skin itching. Pain on the right and fever are possible. This option is quite difficult and needs long-term treatment.
  4. Fulminant the course is the most dangerous. Symptoms progress quickly, yellowness of the skin instantly appears, the temperature rises, the appetite completely disappears. Renal failure, hemorrhagic syndrome, hepatic encephalopathy develops. If the patient is not provided with medical assistance on time, he may die from a hepatic coma.

Surgical intervention

As a rule, it is recommended to treat alcoholic hepatitis with medications in combination with a diet. But in some cases, the medical history requires surgical intervention. So with ascites, laparocentesis is done to pump out excess fluid. And in case of bleeding, stitching with metal clips is performed.

The most radical treatment option is a liver transplant.A section of a healthy donor liver is transplanted to the patient, which solves the problem of destruction of the liver cells.

Forms of the disease and causes of its development

By the intensity of the course of the disease, one can distinguish its types:

Features of the acute course

This type of disease is observed in patients who suffer from other liver problems (cirrhosis, hepatitis), but regularly drink alcoholic beverages.

Acute alcoholic hepatitis is accompanied by the following symptoms:

  • Very strong weakness.
  • Yellowness
  • 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, the symptoms are weakness, yellowness of the skin, fever, pain.
  • Cholestatic is characterized by the highest mortality. The manifestation of the disease is accompanied by yellowness, itching, colorless feces and dark urine.
  • The fulminant species develops very quickly, and it is difficult to cure it. But if untreated, the patient dies from hepatic-renal failure 14-20 days after the transition of the disease to the acute phase.
  • Latent, characterized by an asymptomatic course and complex diagnosis.

In all of the above cases, a significant increase in the liver is observed, in some patients anorexia is observed.

Chronic form

Classic chronic alcoholic hepatitis develops with regular use of alcohol, but without concomitant liver diseases. It is difficult to identify this form of the disease, a study of the liver and its changes, as well as an increase in the transaminase level, will assist in the diagnosis.

Chronic alcoholic hepatitis is almost asymptomatic, and the patient may complain of the following discomfort:

  • Decreased appetite and nausea.
  • Bad sleep, in men, the mammary glands enlarge.
  • Decreased sexual activity.
  • Pain in the right hypochondrium and enlarged liver.
  • Spider veins, white nails.

The development of this form of the disease leads to frequent alcohol consumption, which is 70 g of pure ethanol for men and 20 g for women.

Who is at risk?

Scientists have proven that most of the alcohol, or rather ethanol, which it contains is broken down by the liver. About 20% of ethanol breaks 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.

There is 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 in 250 ml - 100 g of pure alcohol, and this is already a dangerous dose.

Doctors also highlight the following reasons that can accelerate the development of the disease:

  1. Long-term use of alcohol (more than 5 years).
  2. Drinking in large quantities.
  3. Genetic predisposition.
  4. Obesity and bad habits.
  5. Overeating, lack of healthy foods high in protein.

Also, the cause of the development of the disease is poor ecology, weakening the immune system, poor-quality food and cheap alcohol made from chemical components. And if the patient drinks strong antibiotics and other medications while continuing to drink alcohol, then he, too, is at risk.

Now consider how to treat the disease and recover from it.

How is the disease diagnosed?

Modern laboratory and hardware methods are used to diagnose the disease. Ways Diagnostics depend on the patient's complaints, clinical presentation and form of the disease. For example, if a person suffers from a latent form of the disease, then a biopsy is required, and a chronic form will reveal an ultrasound of the abdominal organs.

Most often, the following laboratory tests can be prescribed to the patient:

  1. General analysis of blood and urine.
  2. Blood biochemistry and liver test.
  3. An analysis to evaluate blood coagulation 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.

Treatment features

Usually, treatment begins after diagnosis. The main factor in the treatment of alcoholic hepatitis is diet, in these cases a treatment table No. 5 is prescribed, we will talk about it later.

The following medicines are used to treat alcoholic hepatitis:

  1. Detoxification therapy may be prescribed, during which the drugs are administered intravenously. Therapy helps in a short time to cleanse the body, increase its endurance and prepare the patient for drug treatment.
  2. Metabolic and coenzyme therapies aimed at improving metabolism in the cells of the body.
  3. Drugs that help liver cells to remain active, and also contribute to their speedy regeneration.
  4. Drugs that are analogues of hormones of the adrenal cortex. This group of drugs inhibits the production of antibodies and inflammatory processes, prevents tissue scarring.
  5. 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 absorption function of beneficial substances.

The above drugs are prescribed by a doctor, the dosage and duration of admission are calculated individually, depending on the form of the disease, its neglect, diet. Note that it is necessary to abandon the use of ethyl, otherwise the therapy will be ineffective.

Features of 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 to help solve such problems:

  1. Recovery of liver function.
  2. Restoration of the activity of the biliary tract.

The diet menu spares the liver, relieves it from the load and improves the work of medications. Consider the list of prohibited products:

• Very fresh bread and flour products.
• All fatty varieties of fish and meat.
• Strong broths: meat, fish, mushroom, okroshka, cabbage soup.
• Any smoked, spicy and too salty foods.
• Dairy and fermented milk products with high fat content.
• Hard boiled or fried eggs.
• Legumes, spicy and fatty sauces.
• Ice cream, chocolate and sweets, cream products.

The diet is rich in protein foods (cottage cheese, meat, fish), but all dishes should not be greasy, steamed or in foil in the oven.

Calorie intake 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 drink up to 3-4 liters of fluid per day, reducing the amount of salt to 4 g. Thus, the unloading of a vital organ takes place, the body is cleansed, and the duration of the diet can be either 14 or 21 days.

How long does the treatment take?

With timely access 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 an 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 advanced cases, the likelihood of death increases.

How to avoid this disease?

To avoid most liver diseases, it’s enough just not to drink alcohol, exclude fatty foods from your menu, and try to smoke less. But even if you rarely drink alcohol, and the next morning after a feast you feel a pulling pain on the right side under the ribs, then do not postpone going to the doctor, because these may be the manifestations of the first symptoms of alcoholic hepatitis.

General information

Alcoholic hepatitis is a disease that is one of the main manifestations of alcoholic liver disease, which in modern gastroenterology, along with alcoholic fibrosis, refers to precursors or initial manifestations of liver cirrhosis. As a rule, this disease develops after five to seven years of regular use of alcohol. Pathology progresses with continued use of alcoholic beverages.

Diagnostics

Diagnosis of alcoholic hepatitis can be associated with certain difficulties. The mild course of the disease may not be accompanied by any specific symptoms, and it can be suspected only if changes in laboratory parameters are detected.

Acute laboratory signs are leukocytosis, less commonly leukopenia (with toxic effects of alcohol on bone marrow), B12-deficient anemia, accelerated ESR, and an increase in liver damage markers. Ultrasound examination of the liver reveals an increase in its size, heterogeneity of the structure, smooth contours. Magnetic resonance imaging (MRI of the liver) determines collateral hepatic blood flow, concomitant damage to the pancreas.

In the chronic form, an ultrasound examination of the liver reveals a slight or moderate increase in the liver, an increase in its echogenicity, and uniformity of structure. Laboratory indicators are changed moderately. A liver biopsy with alcohol damage can identify specific signs of inflammation, fibrosis, necrosis. The severity of damage depends on the form of the disease and its duration.

The identification of signs of liver damage during the examination should be combined with anamnestic data indicating prolonged use of alcohol, as well as the presence of dependence, abuse. This is difficult because the doctor does not always have complete information about the patient. That is why relatives should be involved to collect a complete medical history, as patients often significantly reduce the amount of alcohol consumed.

The characteristic external signs of alcoholic illness (alcoholism) are also revealed: puffiness of the face, tremor of the hands, tongue, eyelids, atrophy of the muscles of the shoulder girdle, Dupuytren's contracture (fibrous change in the palmar tendons, leading to their shortening and flexion of the hand), damage to the peripheral nervous system, and others target organs (kidneys, heart, pancreas, central nervous system).

Complications

Alcoholic hepatitis is dangerous in itself because of the risk of liver damage, but it can lead to a number of complications:

  • cirrhosis of the liver - scarring of tissues, wrinkling of the organ, violation of its functions,
  • esophageal varicose veins and bleeding from them are a life-threatening complication. Scar tissue in the liver interferes with normal blood flow, which causes an increase in veins in the esophagus. If they burst, the consequence may be death due to hemorrhage,
  • encephalopathy due to the inability of the liver to process and remove toxins. This can lead to changes in the mental state (confusion, overexcitation) and coma,
  • ascites (abdominal dropsy) leading to compression and disruption of the internal organs. Up to 50% of patients die within two years.

Nutrition and Diet

Fasting for hepatitis is contraindicated. The energy value of food should be at least 2000 calories per day for men and 1700 for women. Daily intake of protein - at least 1 g per 1 kg of body weight, carbohydrate - more than 400 g, fat - less than 80 g. Products must necessarily contain many vitamins (especially group B, folic acid, a deficiency of which is always observed in alcoholics).

With hepatitis, diet No. 5 is prescribed. The patient can and should not consume the following products:

CanIt is impossible
  • Rye bread (yesterday’s pastry),
  • Unfinished dough products (filling - boiled meat, fish, apples, cottage cheese),
  • Pasta milk soup
  • Soups on vegetable broths (cereals, cabbage soup, beetroot soup, fruit),
  • Low-fat fish species (fillet, baked, boiled, dumplings, meatballs),
  • Poultry meat (fat-free, skinless, boiled poultry, beef, rabbit meat, turkey eaten chopped or whole piece),
  • Dairy sausages, children's sausage,
  • Pilaf with a high content of carrots and boiled meat,
  • Stuffed cabbage,
  • Dairy products (yogurt, kefir, low-fat yogurt, cottage cheese, low-fat, not sharp cheese),
  • Vegetable oil,
  • Butter (in small doses),
  • Cereals (oatmeal, buckwheat),
  • Dried fruits,
  • Krupeniki,
  • Protein omelet without yolk
  • One yolk per day
  • Boiled, stewed or raw vegetables (green peas, broccoli, boiled onions, carrots, beetroot),
  • Salads from boiled zucchini (squash caviar),
  • Seafood (boiled),
  • Fruits and berries (not sour, in the form of compotes, jelly, mousse, jelly),
  • Vegetable juices
  • Green tea,
  • Rosehip broth,
  • Coffee with cream, milk,
  • In moderate doses, spices, parsley, dill, sour cream sauce are allowed.
  • Butter dough (products),
  • Fresh bread
  • Puff pastry,
  • Fried pies
  • Soup (mushroom, fish broth, sorrel soup, okroshka),
  • Fish (canned, fatty, smoked, salted),
  • Meat (smoked meat, brains, kidneys, liver, fatty pork with veins, lamb, poultry skin, goose, duck, fatty and smoked sausages),
  • Fat sour cream, fermented baked milk, cream, feta cheese, fat home-made cottage cheese,
  • Fat lamb, lamb, chicken and mutton fat,
  • Legumes
  • Fried eggs,
  • Radish, spinach, sorrel, garlic, green onions,
  • Pickled vegetables,
  • Salted and pickled mushrooms,
  • Chocolate, pastries, pastries with cream,
  • Horseradish, mustard, hot pepper,
  • Strong coffee, strong tea,
  • The complete exclusion of alcoholic beverages of any kind.

The diet is designed in such a way that provides good nutrition, helps to normalize the process of the gastrointestinal tract, liver. Compliance with the diet guarantees the accumulation of glycogen in the liver, which leads to the normalization of fat and cholesterol metabolism. Bile secretion is well stimulated, and all activity of the gastrointestinal tract is normalized.

The basis of nutrition is boiled food, in rare cases, stew. Products should be coarsely chopped, without chopping. Meat, fish in large boiled pieces, one at a time. The process of passerization of vegetables (passivation) in the preparation of gravy, frying is excluded. The grill is completely eliminated. Cold dishes and cold water should not be in the diet due to excessive irritation of the gastrointestinal tract, leading to a slowed down process of digestion of food.

Drug treatment

With alcoholic hepatitis, drugs are prescribed:

  • suppressing acidity of the stomach: Omeprazole, Rabeprazole, Pantoprazole,
  • sorbents: Polysorb, Enterosgel,
  • milk thistle and preparations based on it,
  • hepatoprotectors: Heptral, Methionine, Glutargin. Essential acids of the "Essential" type - after the appointment of a hepatologist, gastroenterologist or therapist specializing in liver diseases,
  • a short course - antibiotics such as Norfloxacin or Kanamycin,
  • lactic acid bacteria
  • lactulose preparations: "Normase", "Dufalac" and others.

You need to pay attention that it is impossible to prevent constipation here: with a delay in stool, you need to make an enema and increase the dosage of lactulose preparations.

Acute alcoholic hepatitis is treated only in a hospital.

Hepatoprotectors

There are 5 groups of hepatoprotectors:

  1. Milk thistle preparations (Silimar, Sibektan, Karsil, Gepabene, Legalon) have a pronounced antioxidant (reduce the effect of oxidative processes) and immunostimulating effect.
  2. Preparations with the active substance ademethionine (Geprtral, Ademethionine) neutralize toxins, improve the outflow of bile.
  3. Ursodeoxycholic acid from bear bile or the synthetic drug Uorsan have a choleretic effect and antifibrotic effect.
  4. Means of animal origin that stimulate regenerative processes in the liver (Sirepar, Hepatosan).
  5. Products containing essential phospholipids (Essliver Forte, Essential Forte N) are some of the best medicines. They have an antioxidant effect, anti-inflammatory, increase the detoxification function of liver cells, stimulate the development of new cells.

Operation

With alcoholic hepatitis, palliative surgery can be performed. They alleviate the condition of the patient, but do not eliminate the underlying problem. It:

  • paracentesis - with ascites (accumulation of fluid in the abdomen),
  • clipping (“stitching” with metal clips) of the bleeding dilated vein of the esophagus.

These interventions are mainly used already at the stage of cirrhosis.

There is also a radical operation that solves the problem of the death of liver cells - this is a transplant of a donor liver (more precisely, a portion of the liver). Such an intervention can be performed in foreign clinics - for 150-200 thousand euros. It can be performed cheaper in domestic hospitals, but in this case, a long wait for such an operation is possible.

Prevention

Prevention of alcoholic hepatitis is the only way to avoid a long period of treatment and the associated difficulties. First of all, it implies the rejection of the regular use of ethanol-containing drinks.

What is the allowable daily dose of pure ethanol? For women, this figure is 20 g, for men, the threshold is slightly higher - 40 g. Calculations must be made based on the fact that 1 ml of alcohol contains about 0.79 g of ethanol.

The best solution for people who want to maintain their health is to stop drinking alcohol altogether.

Whether or not alcoholic hepatitis will develop in a person who periodically consumes alcohol depends on many factors: the amount of drinks drunk, lifestyle, heredity, diet, etc. In any case, it’s not worth the risk: if you don’t have enough strength to defeat alcohol addiction, you need to contact specialists and start complex treatment in a timely manner.

What is alcoholic hepatitis

In 1995, the term “alcohol hepatitis” appeared, which indicates the characterization of liver damage due to the use of ethanol. This disease is inflammatory, causes cirrhosis. Alcohol toxins enter the liver, where acetaldehydes are formed that infect 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 a 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 the disease, the following symptoms of alcoholic hepatitis are distinguished:

  1. 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 using laboratory tests, is treated when you refuse alcohol and follow a diet.
  2. A progressive form - it is formed in the absence of treatment for persistent hepatitis, is considered a harbinger of cirrhosis. The patient's condition worsens, foci of necrosis are observed in the liver (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 worsening), then the second course may be asymptomatic and mild.

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, a doctor's intervention is necessary. When observing indirect signs of involvement in alcoholism, you should also contact specialists to examine the liver and identify deviations in its function.

If the disease does not begin to be treated on time, complications are possible, up to the death of the patient on the background of liver necrosis:

  • high blood pressure,
  • body intoxication
  • hypertension, varicose veins,
  • jaundice, cirrhosis.

Is toxic hepatitis contagious

According to doctors, alcoholic toxic hepatitis is not considered a contagious disease, because it occurs due to poisoning of the body with a chemical substance. It develops against the background of prolonged intake of alcoholic beverages in large quantities, affects only the patient's body. For treatment, it is important to eliminate the damaging factor and increase the functionality of organs.

How to treat alcoholic hepatitis

In order to conduct effective treatment of alcoholic liver hepatitis, you must definitely refuse to take alcohol and consult a doctor. He will prescribe complex therapy, including:

  • detoxification - droppers, intravenous or oral administration of cleansing drugs,
  • a visit to a psychologist, narcologist to eliminate a bad habit,
  • an energy diet, it is recommended to consume more proteins,
  • surgical or drug treatment - you can remove the 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 cases of the disease,
  • taking hepatoprotectors (Essentiale, Ursosan, Heptral),
  • elimination of etiological factors,
  • taking antibiotics for the development of bacterial, viral infections or the development of a severe form of the disease.

Doctors prohibit treatment on their own, since liver damage can be serious and lead to uncontrolled consequences. If the case is very severe and neglected, liver transplantation may be required, the survival prognosis is average. After the elimination of symptoms and acute course, traditional medicine based on corn stigmas and milk thistle can be used as a strengthening treatment.

As a prevention of a relapse of the disease, these rules are used:

  • reduction of doses of alcohol or complete abandonment of it,
  • compliance with medication, refusal of alcohol during treatment,
  • proper nutrition, high-calorie and BZHU.

Pin
+1
Send
Share
Send

Watch the video: What is Alcoholic Hepatitis? Liver Inflammation (March 2020).