Hepatitis

The concept, symptoms and treatment regimen of alcoholic hepatitis

Alcoholic hepatitis is a hepatic pathology, the cause of which is the abuse of hard drinks. This disease is characterized by damage to liver cells caused by prolonged exposure to ethanol. The insidiousness of this pathology consists in its slow development and asymptomatic course in the initial stages. Most often, alcoholics with many years of experience become victims of the disease. They develop a chronic form of alcoholic hepatitis, which subsequently often causes liver cirrhosis.

Regular consumption of alcohol leads to the development of alcoholism. Alcohol contains a large amount of ethanol. Once in the blood, it is carried throughout the body, destroying and poisoning all internal organs. In this case, the liver takes the brunt. One of the most dangerous diseases developing against the background of alcohol abuse is alcoholic hepatitis.

Long-term consumption of alcoholic beverages in large quantities leads to the production of acetaldehyde in the liver, which is the cause of organ damage and the death of its tissues. The development of inflammation is due to intoxication of the body resulting from toxic poisoning. Alcoholic hepatitis may not appear long enough. The period of its development is approximately 6 years after the start of alcohol consumption. Its symptoms may appear at the last stage of the disease, when the patient already has pronounced signs of liver failure. In almost every case, an advanced form of hepatitis passes into cirrhosis.

The cause of alcoholic hepatitis is alcohol-containing drinks. It is worth noting that if you use them within reasonable limits, then toxic poisoning of the liver can be completely avoided. This organ plays the role of a filter in the body, through which all harmful substances are neutralized, including ethanol. Excessive intake leads to an increase in the concentration of acetaldehyde in the liver. As a result, the tissues of the organ are destroyed, and it ceases to cope with its function.

The development of hepatitis leads to the systematic use of alcohol in case of exceeding the daily norm. For women, the permissible dose is 20 g of pure alcohol per day, for men - 40 g. The female body is devoid of enzymes that neutralize the harmful effects of alcohol and its decay products. In the male, they are produced in a sufficiently large amount. It is for this reason that it is much more difficult for a woman to cope with alcohol addiction.

In addition to alcoholics, the risk group includes people who use drugs with a high content of toxic substances, as well as patients with impaired digestive system functions.

There are two main forms of toxic hepatitis:

  1. 1. Persistent.
  2. 2. Progressive.

The first is characterized by a prolonged sluggish course and stabilization of the state. If during the development of the disease stop drinking alcohol, it is quite possible to achieve a complete restoration of the liver.

Progressive hepatitis is characterized by focal organ damage with an increased risk of cirrhosis.

Symptoms of alcoholic hepatitis during the formation have signs characteristic of hepatic pathologies. In patients, the following manifestations are noted:

  • deterioration in general condition,
  • a feeling of heaviness in the right hypochondrium,
  • constant nausea
  • weakness,
  • weight loss,
  • belching with a specific smell,
  • discomfort in the stomach.

The clinical picture of the disease may vary depending on the severity of the disease and its type. If you ignore the above manifestations, then hepatitis will progress and proceed to the next stage. At the same time, the signs of the disease will become more pronounced: the general condition will worsen significantly, the intensity of vomiting will increase, the skin and whites of the eyes will turn yellow, the pains under the rib will intensify, fever will appear, and indigestion may occur.

In this situation, the progressive form of hepatitis will end in the development of acute liver failure, against which a fatal outcome is not ruled out.

Signs of Alcoholic Hepatitis

Long-term alcohol consumption often causes acute hepatitis, characterized by the rapid development of inflammation of the liver and the destruction of its structure.

There are 4 types of acute hepatitis:

  1. 1. Jaundice, for which the yellow color of the skin and mucous membranes, pain in the liver, urge to vomit, diarrhea, sudden weight loss.
  2. 2. Latent, characterized by asymptomatic course. This type of hepatitis can be determined using tests confirming the development of an active inflammatory process.
  3. 3. Cholestatic, manifested by yellowing of the skin, itching, dark color of urine, light feces.
  4. 4. Fulminate - the very last stage of hepatitis in acute form, which often ends with serious complications in the form of liver failure, encephalopathy, hemorrhagic syndrome or coma.

The chronic form of alcoholic hepatitis develops as a result of the systematic use of alcoholic beverages.

Diagnosis of the disease is carried out on the basis of a patient examination and data obtained as a result of laboratory and instrumental studies.

The patient is prescribed blood tests:

  • general, with the help of which the presence of neutrophils and an increase in ESR are determined,
  • biochemical, which allows to determine the level of bilirubin, prothrombin and albumin in the blood and the degree of activity of aminotransferases.

In order to clarify the diagnosis, instrumental research methods are used:

Patient complaints are also taken into account.

Before prescribing treatment, it is important to find out if the patient has an alcohol dependence. The following factors indicate its presence:

  • a person is not able to independently give up alcohol,
  • lives with the awareness of this problem,
  • he has the development of withdrawal symptoms in case of refusal of alcoholic beverages,
  • advanced stage of alcoholism with a number of pronounced symptoms.

The appointment of treatment for alcoholic hepatitis is carried out individually. In this case, an integrated approach is assumed. A complete rejection of alcohol and smoking is required. Conservative treatment of hepatitis includes the following drugs:

  • Phospholipids. Using these drugs, the enzymatic activity of the liver is restored. One of the drugs in this group is Essentiale forte N.
  • Flavonoids. They are prescribed to neutralize toxic substances in the liver and restore cell membranes. Silymarin shows high effectiveness in the treatment of hepatic hepatitis.
  • Hepaprotectors. Medicines of this group reduce the harmful effects of metabolites on hepatocytes, stabilize the membranes of liver cells and stimulate the production of enzymes. These drugs include: Heptral, Ursosan, Rezalyut.
  • Vitamin complexes. They are prescribed in order to increase the functions of the immune system and saturate the body with useful substances.

In order to neutralize ethyl metabolites in the liver, patients undergo additional detoxification with the help of special infusion solutions.

In especially severe cases, with an advanced stage of hepatitis, the patient may undergo surgical treatment. We are talking about transplantation of a donor organ. This operation is quite expensive.

During the treatment of hepatitis, patients are prescribed a special diet, adhering to which it is possible to improve the condition much faster. Diet therapy involves the use of foods high in protein, vitamins and trace elements, including zinc and selenium.

Most patients with alcoholic hepatitis have a decrease in body weight. Therefore, a balanced diet should be aimed at improving liver function, stimulating enzymatic production and increasing immunity.

First of all, it is worth excluding fried foods. The main cooking technology should be cooking. Some products can be baked in the oven or cooked in a water bath. It is advisable to eat minced meat and vegetables.

Allowed and prohibited foods during the diet:

Hepatitis patients are strictly forbidden to cook fatty, fried and spicy dishes, you can not eat chocolate. Alcohol, coffee, cocoa, sodas and grape juice should be excluded from drinks.

To cope with the manifestations of hepatitis at the initial stage, you can use folk remedies. Before using this or that remedy, it is necessary to consult a doctor. In this case, it is recommended to visit an allergist.

  1. 1. Lemon juice with soda. This tool quickly repairs damaged liver cells and kills the virus. For cooking, the juice of one lemon is squeezed into a glass container and a teaspoon of baking soda is added. The tool is designed for one time. It should be drunk in the morning an hour before meals. After each use, a four-day break is taken.
  2. 2. Herbal infusion. For cooking, you need to take: 2 tbsp. l birch leaves, 1, 5 tbsp. l St. John's wort herbs, 2 tbsp. l chopped rose hips and 1 tbsp. l celandine, fennel fruits, marigold flowers and corn stigmas. Pour the grass into dry glassware and store in a dark place. Recipe: 2 tbsp. l the collection is poured with boiling water in a volume of 0.5 l, then the broth is infused and filtered. Take 3 times a day half an hour before meals. After a course of treatment, you need to take a month break, then repeat. In total, you must complete 3 courses.
  3. 3. A decoction of corn stigmas. To cook it, a tablespoon of dry corn stigmas must be poured with 250 ml of boiling water and infused for 2 hours. Take 4 times a day for 4 tbsp. l Treatment can be continued until recovery.

Medicinal decoctions for alcoholic hepatitis can only be used as adjunctive therapy.

Alcoholic hepatitis can only be cured at an early stage of development.

Mandatory conditions for this are:

  • refusal to use alcohol and tobacco,
  • dieting.

In this case, minimal medical care and monitoring the patient's condition until recovery is sufficient. Subject to all medical recommendations, the prognosis is favorable.

In all other cases, the patient will need constant maintenance therapy and serious treatment during periods of exacerbation.

The concept of alcoholic hepatitis

This pathology is a complex of degenerative disorders and an extensive inflammatory process, which are provoked by the regular use of ethyl alcohol in large doses. In addition to ethanol, other substances related to surrogate alcohol can also cause this condition.

Before alcoholic hepatitis is diagnosed, the liver undergoes pathological changes in the form of fatty degeneration, then alcoholic steatohepatitis occurs. The next step is cirrhosis.

According to statistics, hepatitis caused by alcohol develops with regular use for 3-5 years, and a chronic form of pathology is acquired after 5-7 years of alcoholism. But there are cases when acute hepatitis appears after 2 weeks of binge, but in the case when a person consumes low-quality alcohol. The toxic substances included in it cause severe intoxication of the whole organism and the liver suffers in the first place.

Experts note that alcoholic hepatitis can develop with daily intake of ethyl alcohol in an amount of 80 g for men, 40 g for women and 20 g for adolescents. The regular use of such doses for 7 years will lead to pathology. And if the amount of daily alcohol consumed is greater, then liver damage will occur much faster.

Healthy and alcohol-affected liver

Contagious or not?

Alcoholic hepatitis is a toxic damage to the liver as a result of drinking alcohol. Therefore, this pathology is not contagious. You can tactilely contact a sick person and use household items together.

You can get infected only if a person is diagnosed with hepatitis A, B, C, since these forms are infectious.

The main cause of hepatitis caused by alcohol is its regular use. But the rate of pathology progression depends on the quantity and frequency of alcohol consumption, the quality of drinks, health status, etc.

Alcohol that enters the body is processed by the stomach (20%) and the liver (80%). In the process of alcohol breakdown, acetaldehyde is formed, which destroys liver cells (hepatocytes) in large quantities.

Factors that can accelerate the development of pathology are:

  • The individual characteristics of the enzymes that metabolize alcohol are due to a genetic disorder.
  • Previously transferred viral hepatitis.
  • Improper nutrition, deficiency of nutrients in the body.
to contents ↑

Types of pathology

There are 2 main types of alcoholic hepatitis:

  • Persistent form.
  • Progressive form.

A persistent type of hepatitis most often occurs without pronounced signs. Most often it is diagnosed with laboratory tests. If these tests are done on time, then this disease can be completely cured. But in the case when the correct therapy is absent, hepatitis develops into a progressive form.

A progressive form of the disease is called a condition that is a harbinger of cirrhosis. At the same time, there are foci of necrosis in the organ. It is complicated by a fatal outcome from liver failure.

There are 3 degrees of disease development:

  1. Easy. At this stage, a doctor can already diagnose liver damage. In this case, the organ is enlarged. Liver tests will also show a malfunction in his work. There are no characteristic symptoms in the mild stage.
  2. Medium. This stage is characterized by a significant increase in the liver, with its palpation there will be severe pain. In the middle stage of alcoholic hepatitis in humans, every hangover is accompanied by delirium tremens.
  3. Heavy. This stage of the disease is already a condition turning into cirrhosis of the liver. An enlarged organ can reach such a size that it reaches the pelvic region. After this, the liver begins to rapidly decrease going under the ribs. This is a sign that an irreversible process is running.

Stages of disease progression

Symptoms of alcoholic hepatitis acute course pronounced, and also it is characterized by rapid development. In this case, icteric signs may prevail.

These include pain in the right hypochondrium, vomiting, diarrhea, jaundice of the skin, tremor of the hands, increased body temperature. In addition, ascites appears as the liver is affected. This condition occurs because the liver does not cope with its functions, the blood begins to stagnate and collect in the abdominal cavity.

One of the manifestations

Cholestatic form the disease is characterized by itching of the skin, colorless feces and dark urine, impaired urination. Alcoholic hepatitis can show complicated symptoms - this is a fulminant form. All of the above symptoms progress, renal failure, encephalopathy, hemorrhage are noted.

Also signs of alcoholic hepatitis are general weakness, weight loss, which sometimes comes to anorexia.

Latent hepatitis It is asymptomatic. This form is characteristic of the chronic course of pathology. In this case, the person will feel pain on the right side, decreased appetite, with palpation, an increase in the liver is diagnosed. In laboratory tests, white blood cells and severe anemia will be elevated.

Chronic hepatitis exhibits such general symptoms:

  • nausea,
  • abdominal discomfort, bloating,
  • pain in the liver,
  • hypogonadism
  • gynecomastia (female breast enlargement) may develop in men,
  • regular increase in body temperature, etc.

Attention! The number of signs shown is an individual factor. Since some people have 2 symptoms, others have it.

Diagnostics

First of all, the doctor examines the patient. He studies the anamnesis, conducts palpation. It is important that the doctor is informed about the alcoholism of the patient, what dose of alcohol he consumes daily. Only with a complete picture can a specialist correctly assess the seriousness of the situation. Sometimes, to establish this fact, it is necessary to attract relatives, since alcoholics often do not perceive their dependence as a disease.

Diagnosis of alcoholic hepatitis is carried out by laboratory and instrumental methods. Laboratory blood tests in this state will show leukocytosis, sometimes leukopenia, anemia, accelerated ESR.

An ultrasound examination of the liver will help to see how enlarged the organ is, the heterogeneous structure of the liver and the evenness of its contours. The most accurate and modern research method is magnetic resonance imaging (MRI). Using this method, the doctor will accurately determine the parameters of the organ and collateral hepatic blood flow.

If alcoholic hepatitis is suspected, a liver biopsy is performed. Such a study will help determine whether there is fibrosis or necrosis in the body, as well as specific signs of an inflammatory nature. Of course, how much these indicators will be expressed in biological material depends on what stage and degree of the disease.

Complications

Alcoholic hepatitis with improper treatment or its complete absence is complicated by various dangerous conditions:

  1. Vascular problems are increased pressure in the portal vein. This occurs due to the spread of fibrous tissue, the blood circulation process slows down significantly and the blood that came through the portal vein comes back.
  2. Ascites is an accumulation of fluid in the abdominal cavity. Such a complication can provoke an infectious lesion.

Combined therapy for alcoholic hepatitis will be effective if a person stops drinking alcohol. Treatment regimen:

  • Detoxification of the body.
  • Drug therapy to restore the functioning of the body. In the severe stage of the development of pathology, regular administration of corticosteroids is required. Surgical treatment is sometimes required in order to remove necrotic lesions.
  • Vitamin Therapy. Vitamin A is administered intramuscularly to patients, and in this case microelements such as potassium, zinc, and nitrogen-containing substances are also needed.
  • If a bacterial infection has joined with alcoholic hepatitis, then antibacterial drugs are necessary.
  • Be sure that the general therapy includes visits to a narcologist and psychologist, since it is also necessary to treat psychological dependence on alcohol.

Preparations of the group of essential phospholipids are always prescribed for alcoholic hepatitis, as they are able to reduce fatty degeneration of the liver and slow down or completely stop fibrosis. Ursodeoxycholic acid preparations have a cytoprotective effect. Silymarin-containing hepatoprotectors are prescribed to block the process of producing acetaldehyde and stop the damage to hepatocyte cell membranes.

Before and after treatment

For each patient, along with refusal from alcohol, it is necessary to adhere to a therapeutic diet.

Forecast and Prevention

In order to prevent alcoholic hepatitis, a person must first give up alcohol. This factor is key in the prevention of this disease.

Medications in combination with alcohol often have a toxic effect, so when taking any medications, you must clearly follow the instructions.

A positive prognosis is possible only when a person completely abandons alcohol. But it also depends on the stage of pathology. According to statistics, mortality is at a fairly high level, since it is characteristic that people with chronic alcoholism are sick. And to give up such a addiction is very difficult for them.

By clicking the "Send" button, you accept the terms of the privacy policy and give your consent to the processing of personal data on the terms and for the purposes specified in it.

Causes of the disease

Hepatitis is a diffuse inflammation of the liver tissue. The alcoholic form of the disease is not contagious (unlike hepatitis C, which is transmitted through blood, saliva, and breast milk). The cause of the pathology is a toxic lesion of hepatocytes with ethyl alcohol and its decay products.

Damage to the liver is caused by products with any degree of strength. A greater impact on the rate of development of hepatitis has the amount of alcohol consumed. On average, pathology occurs after 4–5 years of daily drinking of 70 ml of moonshine, 100 ml of vodka, 600 ml of wine, 1000-1200 ml of beer. If the dose is exceeded, tissue inflammation occurs earlier.

The rate of development of alcoholic hepatitis depends on the genetic content of acetaldehydrogenase and alcohol dehydrogenase - enzymes responsible for the oxidation of ethyl alcohol. In people with a low concentration of AC and AL, alcohol breaks down for a long time and harms the liver harder. At risk are residents of Japan, Vietnam, Korea, West Africa, Siberia, Northern Europe.

The gender of the patient affects the development of the disease: in women, the tendency to chronic liver diseases is higher. Inflammation from alcohol in them develops three times faster than in men, hepatitis is more difficult, worse treatable.

Symptoms and forms

In the first months, hepatitis is asymptomatic, inflammation is detected with instrumental diagnosis of the liver (an ultrasound scan, x-ray revealed an increase in echogenicity, a decrease in the visibility of vascular structures). In a complicated form, signs appear (the same in men and women):

  • Pain in the upper abdomen (under the ribs) on the right side.
  • Asthenovegetative syndrome (weakness, sudden weight loss, lack of appetite).
  • Cholestasia (yellowness of the skin and oral mucosa, discoloration of feces, dark urine).
  • Dyspeptic syndrome (nausea, belching, flatulence, bitterness in the mouth).
  • Fever, often with hepatitis, reaching febrile levels (above 37.5 degrees).

The listed symptoms may not indicate hepatitis, but other liver damage (cirrhosis, cancer). A biopsy and a blood test are done to confirm the diagnosis. Inflammation is confirmed when neutrophilic leukocytosis, ESR of 40–50 mm / h, an increase in the activity of g-glutamyl transpeptidase, and an increased concentration of IgA are detected.

Chronic

The persistent (remission, chronic) form of hepatitis is characterized by the stability of the patient's condition. Symptoms are mild. More often the patient complains of weakness, insomnia, lack of appetite. A moderate increase in cholestasis syndrome is allowed. No acute pain, no vomiting. There are no signs of renal hypertension (increased pressure in the portal vein).

Do not confuse chronic hepatitis with recovery. The absence of exacerbations does not mean that inflammation does not progress. It happens that in an alcoholic the disease goes away without acute phases. Due to easily tolerated symptoms, the person does not start treatment, continues to drink alcohol, as a result, after a year or two, complications such as cirrhosis arise.

Progressive hepatitis is called when the spread of inflammation accelerates, entailing an increase in symptoms. Clinically manifested by a rapid increase in jaundice, fever, confusion, pain in the hypochondrium (changing their character from acute to dull).

Acute hepatitis requires immediate medical attention, not only because of the torment experienced by the patient. During this period, liver failure begins to manifest itself, which often leads to the development of coma and death. A mortal danger is an exacerbation occurring in parallel with alcoholic cirrhosis (massive hepatocyte necrosis, internal bleeding can begin).

Treatment methods

Hepatitis therapy has several goals: inhibiting inflammation and fibrosis of the kidney tissue, relieving symptoms, stimulating liver function, and preventing complications (primarily cirrhosis). At stages 1-2 of the disease, the patient is prescribed a diet, drug treatment (hepatoprotectors, glucocorticoids, vitamins A, B, C, E are taken). With global organ damage (with decompensated function), transplantation is performed.

Important: treating a patient with hepatitis is useless if he does not stop drinking! Alcoholic beverages cause exacerbation, are not compatible with most drugs (reduce their effectiveness or cause adverse reactions). You can count on recovery if you completely stop drinking alcohol.

Folk remedies

Herbal decoctions and tinctures alone will cope with liver hepatitis. They are allowed to be added to medications prescribed by a doctor - together they are more likely to relieve inflammation and improve well-being. Well-known folk remedies:

  • To prevent exacerbation of hepatitis: decoction of St. John's wort, fennel fruits, rose hips. Pour a spoonful of raw materials with a liter of boiling water, hold on the fire for 40 minutes. Take 3 times a day.
  • From severe pain in the liver area: potato poultice. Knead 3 boiled potatoes, wrap in gauze, put under the ribs (keep until cool).
  • For the prevention of cirrhosis: beet juice, radish. Drink on a full stomach of 150 ml.

Calendula is useful for the liver. A tablespoon of dried flowers is poured with 2 cups of boiling water, let it brew for 1 hour. Filtered infusion is recommended to drink 2 times a day in 100 ml.

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. It is useful for the patient to consume such products:

  • Non-acidic varieties of fruits, berries.
  • Low-fat sour cream, kefir, cottage cheese.
  • Potato casserole.
  • Boiled turkey, chicken breast.
  • Oatmeal on the water.
  • Vegetable soups.
  • Boiled fish.

With a sick liver, fried, smoked, pickled dishes, offal, mushrooms, chocolate, coffee, strong tea are prohibited. Patients with hepatitis need to eat warm food - ice cream, ice drink threatens to exacerbate.

What do doctors advise

In addition to taking medications, diets for patients with alcoholic hepatitis, you must follow the drinking regimen. Drink water should be 100 ml 3 times a day for 40-45 minutes before eating. Mineral calcium chloride waters that improve the function of a damaged liver are beneficial.

Clinical recommendations necessarily relate to physical activity. With exacerbation, bedtime is indicated. In chronic hepatitis, regular walks in the fresh air are needed (at least 20–40 minutes), swimming, yoga, and breathing exercises are useful. Under the ban, running, horse riding, aerobics, weightlifting - loading, shaking provoke exacerbations.

Causes

The reasons for the development of alcoholic hepatitis is the abuse of alcohol for more than 8 - 10 years.

There is a permissible dose of alcohol per day - this is the dose at which alcohol dependence does not develop and liver destruction does not occur. For men, this dose is 40 g of ethanol (pure alcohol) per day, for women - 20 g of ethanol per day. With even a slight excess of the permissible dose, alcoholic hepatitis develops.

Recalculation of the most popular varieties of alcoholic beverages to ethanol in an acceptable dose:

Symptoms of Alcoholic Hepatitis

The disease develops gradually and imperceptibly for the patient.

In mild cases, alcoholic hepatitis is detected only through laboratory tests.

It usually takes about five years from the moment the liver damage occurs until the first symptoms appear. As the liver worsens, the number and severity of symptoms increase.

Acute alcoholic hepatitis usually develops after severe binge in patients with pre-existing cirrhosis of the liver (diffuse (extensive) liver disease, in which the death of its tissue and the formation of nodes from scar tissue that change the structure of the liver).
This leads to the imposition of hepatitis symptoms (inflammation of the liver) on the symptoms of cirrhosis and significantly worsens the prognosis.

All manifestations of alcoholic hepatitis are combined into several syndromes (a stable set of symptoms combined by a single development).

  • Asthenic syndrome:
    • decreased performance
    • fatigue,
    • weakness,
    • drowsiness during the day
    • decreased appetite
    • depressed mood.
  • Dyspeptic manifestations (digestive upset):
    • decreased appetite
    • nausea and vomiting,
    • bloating
    • pain in the umbilical region,
    • rumbling in the stomach.
  • Systemic manifestations of alcohol intoxication (effects of alcohol on various organs):
    • peripheral polyneuropathy (damage to the nerves connecting the organs and limbs of a person to the brain and spinal cord). Manifested by impaired sensitivity and restriction of movement,
    • muscle atrophy (thinning of muscles and a decrease in their volume),
    • tachycardia (heart palpitations) and shortness of breath (rapid breathing) due to damage to the cardiovascular system.
  • Cachexia (exhaustion), weight loss.
  • Low hyper-gamma globulinemia (a moderate increase in gamma globulins (specific proteins of the immune system) in the blood - the norm is 8.0-13.5 grams of gamma globulins in one liter of blood).
  • The De Ritis coefficient is the ratio of aspartate aminotransferase (AsAT, or AST) to alanine aminotransferase (ALAT, or ALT): normally 1. AST and ALT are specific biologically active substances involved in the metabolism and normal liver function. With cirrhosis, the ratio of AST to ALT becomes less than 1.
  • Arterial hypotension - a decrease in systolic (the first figure when measuring) blood pressure below 100 millimeters of mercury.
  • The syndrome of "small" hepatic symptoms (hepatic cell failure syndrome).
    • Teleangiectasias (vascular "stars" on the face and body).
    • Palmar (on the palms) and / or plantar (on the soles of the feet) erythema (redness of the skin).
    • General feminization of appearance - a man acquires a part of the outlines and appearance of a woman:
      • fat deposition on the hips and abdomen,
      • thin limbs
      • scanty hair in the armpit and pubis,
      • gynecomastia (the formation and enlargement of the mammary glands in men),
      • testicular atrophy (decrease in testicular tissue volume, impaired function)
      • impotence (sexual and erectile dysfunction in men, inability to perform normal sexual intercourse).
    • Hypertrophy (enlargement) of the parotid salivary glands (a symptom of a “hamster”).
    • An expanded capillary network on the face (symptom of a dollar bill, red face).
    • The tendency to form “bruises”.
    • Dupuytren's contracture (painless subcutaneous cord - tightening of tissues in the form of a tourniquet) - curvature and shortening of the tendons of the palm, leading to a limitation of palm function and its flexion deformation.
    • Jaundice coloring of the skin, mucous membranes of the oral cavity and sclera (white membranes of the eyeball).
    • Leukonichia (small white stripes on the nails).
    • Symptoms of “drumsticks” (an increase in the size of the fingertips, making their appearance look like drumsticks) and “watch glasses” (an increase in size and a rounded change in the nail plates).

The patient's condition improves significantly after stopping alcohol intake.

Periods of sharp deterioration are associated with continued drinking, leading to the development of episodes of acute alcoholic hepatitis.

Chronic alcoholic hepatitis has less pronounced manifestations than acute, characterized by the above symptoms.

There are 2 forms of alcoholic hepatitis.

  • Persistent form - relatively stable, reversible (treatable) provided that alcohol is stopped (abstinence from alcohol for 3–6 months leads to an improvement in the picture). With continued intake of alcohol can go into a progressive form.
  • Progressive form - increasing deterioration. It occurs in every fifth case of alcoholic hepatitis. It is accompanied by the formation in the liver of small foci of necrosis (cell death), often leads to the development of liver cirrhosis (diffuse (extensive) liver disease, in which normal tissue dies, its gradual replacement by coarse fibrous (scar) tissue (fibrosis process) and the formation of nodes from scar tissue that changes the structure of the liver). With the timely treatment of alcoholism, it is possible to stabilize the state while retaining residual effects (for example, external manifestations of the syndrome of "small" hepatic signs and areas of fibrous (cicatricial) liver changes).
    • Mild activity - increased activity of transaminases (liver enzymes - substances that contribute to certain chemical reactions) no more than 3 times.
    • Medium activity - increased transaminase activity by 3-5 times.
    • Severe activity - increased transaminase activity by more than 5 times.

Downstream distinguish acuteand chronic alcoholic hepatitis.

  • Acute alcoholic hepatitis - acute (lasting less than 6 months) progressive degenerative-inflammatory (occurring with signs of inflammation and cell death) liver damage. In every twentieth patient, it transforms relatively quickly into alcoholic cirrhosis of the liver (diffuse (extensive) liver disease, in which the death of the liver tissue and the formation of nodes from the scar tissue that change the structure of the liver). The most severe course of acute alcoholic hepatitis develops after repeated intake of alcohol against the background of the formed alcoholic cirrhosis of the liver. Clinically acute alcoholic hepatitis can be represented by four course options: latent, icteric, cholestaticand fulminant.
    • Latent option it has no symptoms and is diagnosed with an increase in transaminases in a patient who abuse alcohol. A liver biopsy is required to confirm the diagnosis (taking a piece of an organ to examine).
    • Fincarnation option (most common) - jaundice predominates among the symptoms (staining of the skin, mucous membranes and biological fluids (for example, saliva, tear fluid) in yellow), which is not accompanied by skin itching.
    • Cholestatic option observed in approximately every 10th patient. It is accompanied by symptoms of cholestasis - stagnation of bile (jaundice, severe itching, discoloration of feces, dark urine). It is characterized by a protracted course (can last for years).
    • Fulminant variant characterized by rapid progression of all symptoms. May result in death of the patient.
  • Chronic alcoholic hepatitis - long-term (lasting more than 6 months) degenerative inflammatory disease of the liver caused by alcohol intake and capable of progressing to cirrhosis in a large number of cases.

The cause of alcoholic hepatitis is the use of alcohol, regardless of the type of drink: either the simultaneous use of large doses of alcohol or the long-term (long-term) use of its moderate doses - in terms of ethanol (pure alcohol) is 40-60 grams.

The causes of the damaging effects of alcohol on the liver.

  • The death of hepatocytes (liver cells) under the influence of alcohol occurs faster than their recovery is possible. During this time, instead of hepatocytes, connective (scar) tissue manages to develop.
  • Oxygen starvation of cells, leading to their wrinkling, and then to death.
  • Strengthening the formation of connective tissue.
  • Suppression of protein formation in hepatocytes, which leads to their swelling (increase in their water content) and an increase in the liver.

Risk factors for alcoholic hepatitis.

  • The simultaneous use of large doses of alcohol.
  • Daily repeated use of alcoholic beverages.
  • Long-term use of alcohol (8 years or more).
  • Hereditary predisposition (the disease is transmitted from parents to children).
  • Irrational and unbalanced nutrition (especially protein deficiency in food).
  • Excessive nutrition, including obesity (weight gain due to adipose tissue).
  • Infection with hepatotropic viruses (viruses that can cause inflammation of the liver and death of its cells).

A gastroenterologist will help with the treatment of the disease

Additionally

  • The toxic (damaging) effect does not depend on the type of drinks taken and is determined by the amount of ethanol in them.
  • Alcoholic hepatitis is one of the options for alcoholic liver disease (various violations of the structure and function of the liver, developing as a result of prolonged intake of alcohol).
  • Currently, much attention is paid to the detection of liver fibrosis (the growth of scar tissue in the liver while maintaining its normal structure) and the presence or absence of its progression. The degree of fibrosis is determined by various scales; in Russia, the METAVIR scale is more often used.
    • F0 - no fibrosis.
    • F1 - portal fibrosis (proliferation of scar tissue inside the liver around the branches of the portal vein - a vessel that brings blood to the liver from the abdominal organs) without the formation of septa (connective tissue (based on connective tissue, which plays the supporting and structural function in the body) interlayers).
    • F2 - portal fibrosis with rare septa.
    • F3 - many septa without the formation of cirrhosis (diffuse (extensive) liver disease, in which the death of liver tissue and the formation of nodes from scar tissue that change the structure of the liver).
    • F4 - cirrhosis.

  • Ivashkin V.T., Lapina T.L. (Ed.) Gastroenterology. National leadership. - 2008. M., GEOTAR-Media. 754 p.
  • Sablin O.A., Grinevich V.B., Uspensky Yu.P., Ratnikov V.A. Functional diagnostics in gastroenterology. Teaching aid. - SPb. - 2002. - 88 p.
  • Bayarmaa N., Okhlobystin A.V. The use of digestive enzymes in gastroenterological practice // breast cancer. - 2001. - Volume 9. - No. 13-14. - with. 598-601.
  • Kalinin A.V. Abnormal digestive digestion and its medical correction // Clinical prospects in gastroenterology, hepatology. - 2001. - No. 3. - with. 21–25.
  • Atlas of Clinical Gastroenterology. Forbes A., Misievich J.J., Compton K.K., et al. Translation from English. / Ed. V.A. Isakova. M., GEOTAR-Media, 2010, 382 pp.
  • Internal Medicine by Tinsley R. Harrison. Book 1 Introduction to Clinical Medicine. M., Practice, 2005, 446 pp.
  • Internal Medicine According to Davidson. Gastroenterology. Hepatology. Ed. Ivashkina V.T. M., GEOTAR-Media, 2009, 192 pp.
  • Internal illnesses. Makolkin V.I., Sulimov V.A., Ovcharenko S.I. et al. M., GEOTAR-Media, 2011, 304 pp.
  • Internal diseases: laboratory and instrumental diagnostics. Roitberg G.E., Strutinsky A.V. M., MEDpress-inform, 2013, 800 pp.
  • Internal illnesses. Clinical trials. Volume 1. Fomin VV, Burnevich EZ / Ed. ON. Mukhina. M., Litterra, 2010, 576 pp.
  • Internal diseases in tables and diagrams. Directory. Zborovsky A. B., Zborovsky I. A. M., MIA, 2011 672 pp.
  • Radchenko V.G., Shabrov A.V., Zinovieva V.N. The basics of clinical hepatology. Diseases of the liver and biliary system. St. Petersburg: Dialect, M .: BINOM, 2005.
  • Rusakova O.S., Garmash I.V., Gushchin A.E. et al. Alcoholic cirrhosis of the liver and genetic polymorphism of alcohol dehydrogenase (ADH2) and angiotensinogen (T174M, M235T) // Clinical Pharmacology and Therapy. 2006. No. 5. P. 1–33.
  • Dorland's Medical Dictionary for Health Consumers. 2007
  • Mosby's Medical Dictionary, 8th edition. 2009
  • Saunders Comprehensive Veterinary Dictionary, 3 ed. 2007
  • The American Heritage Dictionary of the English Language, Fourth Edition, Updated in 2009.
  • O’Shea R.S., Dasarathy S., McCullough A.J. Alcoholic liver disease. Hepatology, 2010, 51, 307–328.

Risk factors

Even 10-20 years ago, the main risk group was classified by doctors as men aged 30-45, living in adverse social conditions or in a tense psycho-emotional environment. Nowadays, cases of female alcoholism are increasingly being diagnosed, while alcohol dependence in women is more pronounced and more difficult to treat. Doctors attribute this to emotional lability (frequent mood swings) and low stress resistance, resulting from frequent fluctuations in hormonal levels.

Of particular danger is alcohol for children and adolescents. For the development of acute alcoholic inflammation of the liver tissue, it is enough for them to consume 10-20 ml of ethyl alcohol, which is contained in a can of light beer, a glass of table or fortified wine or a glass of vodka. Taking alcoholic beverages at the age of 12-15 years very quickly leads to liver damage, a nervous system disorder, heart failure and respiratory centers, so parents of children of this age category should be especially careful not to miss the first signs of mild alcohol dependence.

Factors contributing to the development of alcoholic hepatitis can also include:

  • increased consumption of fatty, high-calorie foods, as well as products with the addition of hot spices and marinades (fried meat, sausages, mayonnaise, fatty sauces, canned vegetables with the addition of acetic acid),
  • a history of liver disease (the risk increases several times if a person is sick or has previously had viral hepatitis),
  • overweight and obesity above the second degree,
  • lipid metabolism disordersleading to an increase in blood cholesterol and fatty liver.

Alcoholic cirrhosis of the liver

Important! In medical practice, cases of the birth of children with alcoholic damage to the liver tissue have been recorded. All cases were related to mother consuming alcohol during pregnancy. Women bearing a child should know that even a glass of wine can cause acute intrauterine intoxication of the fetus and its death, therefore, alcohol should be completely abandoned during pregnancy and lactation.

Causes of Alcoholic Hepatitis

The cause of the disease is prolonged alcohol abuse. In men, liver damage can develop with the use of 50-80 grams of alcohol per day, in women - 30-40 grams, in adolescents - 15-20. The rate of development and progression of the disease is determined by the quantity, frequency of alcoholization, the quality of the drinks consumed, the individual characteristics of the body, and the duration of the abuse.

The likelihood of developing liver damage to the liver is higher in individuals with the genetic characteristics of alcohol metabolizing enzymes, in patients who have undergone viral hepatitis, and also with initial nutritional deficiency.

How is alcoholic hepatitis manifested?

Symptoms of the disease can be very lubricated and require differential diagnosis using hardware, instrumental and laboratory methods. This is most characteristic of chronic alcoholic liver damage. Acute alcoholic hepatitis develops rapidly (no more than six months) and in almost 90% of cases it goes into cirrhosis, a disease characterized by necrosis (necrosis) of certain sections of the liver tissue.

Symptoms of Alcoholic Hepatitis

The clinical manifestations and symptoms of alcoholic hepatitis depend on the form of the disease and the characteristics of its course.

Table. The most characteristic signs of pathology, depending on the classification.

For the diagnosis of alcoholic hepatitis, hardware and instrumental methods are used - for example, liver biopsy, ultrasound diagnostics, MRI (if necessary). A blood test, a coagulogram, a lipidogram are mandatory.

Hand of a healthy person and a patient with alcoholic hepatitis

Important! To obtain an accurate clinical picture of the disease, the patient needs to perform a peripheral blood test for markers of fibrosis (a direct marker of the liver is hyaluronic acid).

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 in 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.

Symptoms of Alcoholic Hepatitis

The severity, pain in the right hypochondrium in a person who is abusing alcohol can testify in favor of the diagnosis 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 eating 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.

Asthenovegetative symptom

  • headache,
  • decreased memory and attention,
  • dizziness,
  • general weakness
  • shortness of breath during physical exertion,
  • a slight increase in body temperature,
  • noise in ears,
  • fatigue,
  • sleep disturbance,
  • depression,
  • irritability,
  • decreased appetite.

Latent option

The latent variant of acute alcoholic hepatitis is asymptomatic. However, many patients have complaints of poor appetite, non-intense pain in the liver, an increase in the liver, a moderate increase in the activity of aminotransferases in the blood serum, and the development of anemia and leukocytosis are possible. For an accurate diagnosis of the latent variant of acute alcoholic hepatitis, a puncture biopsy of the liver and a histological analysis of the biopsy are necessary.

Icteric option

The icteric variant is the most common variant of acute alcoholic hepatitis. It is characterized by the following clinical and laboratory symptoms:

  • patients complain of pronounced general weakness, complete lack of appetite, fairly intense pain in the right hypochondrium of a constant nature, nausea, vomiting, a significant decrease in body weight,
  • severe jaundice appears, not accompanied by skin itching,
  • body temperature rises, fever lasts at least two weeks,
  • in some patients, splenomegaly, palmar erythema are determined, in some cases ascites develops,
  • with severe disease, symptoms of hepatic encephalopathy may occur,
  • laboratory data: leukocytosis with an increase in the number of neutrophilic leukocytes and a stab shift, an increase in ESR, a hyperbilirubinemia with a predominance of the escorted fraction, an increase in the activity of aminotransferases (mainly aspartic) in the blood serum, alkaline phosphatase, γ-glutamyl transpeptidase, an increase in the content of albumin and albumin.

The icteric variant of acute alcoholic hepatitis must be differentiated from acute viral hepatitis.

Cholestatic option

This variant of acute alcoholic hepatitis is characterized by the appearance of clinical and laboratory signs of intrahepatic cholestasis:

  • intense skin itching,
  • jaundice,
  • dark urine
  • light feces (acholia),
  • in the blood, the bilirubin content is significantly increased mainly due to the conjugated fraction, cholesterol, triglycerides, alkaline phosphatase, γ-glutamyl transpeptidase, along with an increase in the activity of aminotransferases is small.

Fulminant variant

The fulminant variant of acute alcoholic hepatitis is characterized by a severe, fast, progressive course. Patients are worried about pronounced general weakness, a complete lack of appetite, intense pain in the liver and epigastrium, high body temperature, jaundice is rapidly growing, ascites, hepatic encephalopathy, renal failure, hemorrhagic phenomena are possible. Laboratory data reflect a pronounced hepatocyte cytolysis syndrome (increased serum activity of aminotransferases, fructose-1-phosphatalvdolase, ornithinecarbomoyl transferase), hepatocellular insufficiency (decreased albumin in the blood, prolonged prothrombin time), inflammation (a significant increase in ESR, leukocyte leukocytosis )

The fulminant variant of acute alcoholic hepatitis can be fatal within 2-3 weeks from the start. Death occurs from hepatic or hepatic-renal failure.

The development of portal hypertension

With the progression of the disease, signs of increased pressure appear in the portal vein - a vessel that carries blood to the liver for cleaning from the organs of the gastrointestinal tract (stomach, duodenum, pancreas, small and large intestine). Of the symptoms of portal hypertension in the early stages of the disease, there are:

  • vomiting with blood
  • ascites (accumulation of free fluid in the abdominal cavity),
  • hemorrhoidal vein bleeding.

The appearance of the patient with alcoholic hepatitis

  • facial redness
  • conjunctivitis (inflammation of the mucous membrane of the eye),
  • pale yellow skin, on which there is a noticeably greater number of telangiectasias (spider veins),
  • Dupuytren's contracture (violation of flexion and extension of the fingers)
  • tremor of the upper and lower extremities,
  • underweight
  • muscle atrophy,
  • redness of the palms
  • hapatomegaly (enlarged liver),
  • splenomegaly (enlarged spleen),
  • swelling of the lower extremities with venous stasis (dilated, full-blooded veins).

Is toxic hepatitis contagious

According to doctors, toxic alcoholic 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.

Three stages of the disease

Three main stages of alcoholic liver damage can be distinguished.

Firstly, fatty hepatosis or fatty degeneration of the organ. This symptom is observed in 90% of people who abuse alcohol for a long time. As a rule, at this stage, people do not consider themselves sick and do not suspect that they are threatened by alcoholic hepatitis. Symptoms, signs of an onset disease are still weak. These include:

  • Decreased appetite.
  • Fatigue and loss of strength.
  • Increase in adipose tissue.
  • The formation of bruises on the skin, even with slight pressure.

At this stage, active fat deposition takes place inside the liver cells, which is why they swell and, as it were, swell.

Secondly, the stage of hepatitis. Pathological changes in the liver are steadily progressing. The fibrosis process starts, in which normal tissue is replaced by connective scars. Symptoms of alcoholic hepatitis begin to manifest actively. On the right side, under the ribs, the patient may experience very painful sensations, the liver is enlarged, which is well felt on palpation. A person begins to lose weight, experiences constant weakness. In the stage of hepatitis, complications such as peritonitis or venous bleeding can be observed.

And the last stage is cirrhosis. Alcoholic hepatitis and cirrhosis, the symptoms of which can be detected in severe cases of the disease, often follow one after another, i.e., hepatitis goes into the stage of cirrhosis. In this case, the following is observed in patients:

  • Severe exhaustion.
  • Ascites (accumulation of fluid in the abdominal cavity, which makes the stomach look unnaturally bloated).
  • On palpation of the liver, a person feels very severe pain.
  • Pronounced jaundice not only of the skin, but also of the sclera of the eyes.
  • Portal hypertension.
  • Bad biochemical blood counts.

Mass death of the liver cells occurs in the organ, large areas of connective tissue are formed that change the structure of the liver and its functionality. Also, patients have an increase in body temperature and encephalopathy (poisoning of nerve fibers by the breakdown products of the liver structures).

Forms of chronic alcoholic hepatitis

The disease can occur in one of two forms:

  1. Reversible form. In the case of complete abstinence from alcohol and well-chosen treatment, it is possible to restore all liver functions and symptoms of alcoholic hepatitis then completely disappear.
  2. Progressive form. Alas, in this case, the symptoms gradually increase and the patient's condition is steadily worsening. This is due to the fact that liver cells degenerate into connective tissue, that is, in the vital organ dead spots form that do not perform any functions. The liver is greatly increasing in size, thereby trying to compensate for the loss of its functionality.

With a complete rejection of alcohol, persistent treatment and the implementation of all the recommendations of the attending physician, even in the presence of a progressive form of the disease, it is still possible to achieve stabilization. If it is not possible to achieve this, then, unfortunately, alcoholic hepatitis in a progressive form, eventually passes into cirrhosis or even liver cancer.

Acute form of alcoholic hepatitis

The acute form is a degenerative lesion of liver cells, which is inflammatory in nature and is progressive. How many varieties of the disease are there? There are 4 types of acute hepatitis:

  • fulminant
  • icteric,
  • cholestatic
  • latent.

If a patient drinks alcohol for a long time, then in 70% of cases he develops acute alcoholic hepatitis. This disease can quickly go into cirrhosis of the liver cells. The pattern and progression of hepatitis from alcohol depends on the degree of damage to the liver.

Complications of acute hepatitis occur under the influence of the destructive effect of alcohol on the background of degeneration of liver cells.
Symptoms of alcoholic hepatitis appear in patients usually after prolonged binge. Often, cirrhosis of the liver is already observed in this category of patients. In this case, the prognosis of the disease is seriously deteriorating.

An icteric form of acute hepatitis is the most common. It manifests itself with the following symptoms:

  • deterioration of health
  • lethargy,
  • headaches,
  • heaviness in the right hypochondrium,
  • nausea,
  • vomiting
  • yellowing of the skin,
  • strong weight loss.

In this category of patients there is an increase in the liver. The organ has a compacted smooth surface. If the patient has cirrhosis, then the characteristic symptoms are:

Often bacterial infections join the disease:

  • pneumonia,
  • urinary tract infection
  • peritonitis,
  • septicemia.

With serious complications of the disease in combination with severe renal failure, a sharp deterioration in the patient's condition or death of the patient can occur.

The latent nature of the disease does not have a definite clinical picture. Its diagnosis is based on an increase in transaminases in a patient. To make a final diagnosis, a liver biopsy is done.
The cholestatic option is characterized by the presence of itching, dark urine, light feces, yellowing of the skin. The patient has pain in the liver, chills. This form of the disease is protracted and has a severe course.
The fulminant variant has progressive signs of renal failure, jaundice. The patient develops hepatic encephalopathy, a hemorrhagic syndrome. In severe cases, encephalopathy becomes coma. The combination of hepatorenal syndrome and coma can lead to the death of the patient.

Chronic form of alcoholic hepatitis

In the chronic form of the disease, characteristic signs may be absent. The diagnosis is established on the basis of a blood test.

In patients, the activity of transaminases increases, the manifestations of cholestasis increase. There are no signs of portal hypertension. The patient reveals histological disorders corresponding to the inflammatory process, if there are no signs of cirrhosis.
It is difficult to establish a diagnosis of alcoholic hepatitis, because the doctor does not always have information that the patient is abusing alcohol.
Alcoholism is characterized by the following symptoms:

  1. The patient drinks alcohol for a long time and in large quantities.
  2. Craving for alcohol.
  3. Drinking alcohol in doses hazardous to health.
  4. Drinking alcohol even with a deterioration in physical and mental condition.
  5. Withdrawal syndrome.
  6. The need for alcohol to reduce withdrawal symptoms.

The doctor can make a diagnosis of alcoholism in the presence of three of the listed symptoms.
In case of alcohol abuse, the patient takes alcohol, regardless of obligations to society. If the health worsens, the patient still continues to take alcohol.

The difference between alcoholic hepatitis and viral hepatitis

Often, in specialized forums, people ask the question: “What are the symptoms of alcoholic hepatitis C in men and women?” This statement of the question indicates some confusion, since a disease such as hepatitis C, as well as hepatitis A, B, D, E, F, differences from alcoholic (toxic) hepatitis are caused by various viruses that enter the body. Viral liver damage can occur even in young children who have never sniffed alcohol.

Confusion arises from the similarity of most of the initial symptoms of both viral and toxic hepatitis. This is jaundice, pain in the upper quadrant on the right, weakness, fever, digestive upset, etc.

There are situations when a person with hepatitis C also takes alcohol or even falls into a binge. In this case, the course of the disease is aggravated many times, since the protective functions of the liver are weakened by a viral disease and the intake of ethanol practically completes the diseased organ. Such a frivolous attitude to health can lead to rapid death.

When to see a doctor

Alcoholic hepatitis is a serious disease that cannot be treated at home. It develops in 35% of people who regularly drink alcohol. More than a third of them die within 6 months after the onset of symptoms of the disease.

You should immediately consult a doctor if there are any signs of alcoholic hepatitis. When a person no longer has the ability to control the amount of alcohol consumed and needs help in reducing the daily dose, it is recommended that you consult a qualified narcologist.

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.

Therapeutic diet

Clinical nutrition is the most important point in the comprehensive treatment of alcoholic hepatitis. Liver cells are rapidly destroyed under the influence of alcohol and an additional load will slow their recovery, therefore, a special diet (table No. 5 in gastroenterology) will have to be observed not only in remission, but also after the acute symptoms subside to prevent repeated damage to the hepatocytes.

Diet table No. 5 does not provide for serious food restrictions

The basic principles of nutrition for alcoholic hepatitis:

  • the temperature of ready meals should be in the range of 30-35 ° C,
  • during an acute course, thoroughly grind all products to a state of gruel or mashed potatoes,
  • spicy dishes, seasonings, spices, fried foods cannot be eaten,
  • the maximum allowable amount of salt per day is 3 g,
  • food should be frequent (5-6 times a day), and the volume of one serving should not exceed 200 g or 250 ml.

The diet of a person with alcoholic liver damage should consist mainly of stewed and boiled vegetables, cereals, whole grain bread, fish, dairy products. Every day you need to eat meat with a low fat content: veal, beef, turkey, rabbit meat. It is also important to observe a plentiful drinking regime. From drinks, preference should be given to mineral water without gas, herbal tea (linden, chamomile, lemon balm), decoctions of blueberries and rose hips, compotes and berry fruit drinks.

Drug treatment

It is necessary to take a very responsible approach to taking medication for any form of hepatitis. This disease is characterized by acute or chronic intoxication of the body, and an additional load in the form of synthetic substances can only harm, therefore, all drugs, even herbal products, should be taken strictly as directed by the doctor.

Typically, a treatment regimen includes the following groups of drugs:

    hepatoprotectors - drugs that restore the damaged structure of hepatocytes (Essential Forte-N, Karsil, Karsil Forte),

Important! Any drugs, as well as the method and duration of use, the dosage regimen should be prescribed by the attending physician.

Folk recipes

Recipes of alternative medicine are inferior in effectiveness to medical treatment, but can help reduce the negative effects of alcohol on the liver and improve the functioning of the liver system. It is impossible to use these methods as the main therapy - only as an addition to the traditional treatment.

Decoction of currant leaves

Currant leaves not only contain many vitamins and mineral salts, but also perfectly purify the blood of toxic substances. A decoction of them is prepared according to the following recipe:

  • Rinse a handful of leaves with cold water and put in a pan,
  • add 500 ml of boiling water,
  • simmer for 12 minutes,
  • cool and add 50 ml of freshly squeezed currant juice.

You need to take such a decoction 2 times a day. The first time - before breakfast, on an empty stomach (200 ml). In the evening, you need to drink the drug after dinner (100 ml). The duration of therapy is three months. Ready broth can be stored in the refrigerator for 48 hours.

Infusion of galangal root

Pour a small amount of dried root (about half a teaspoon) with a glass of boiling water and leave for 20 minutes. Take a glass 3 times a day between meals for 1 month.

Alcoholic hepatitis is a serious pathology, the treatment of which requires strict adherence to all doctor's prescriptions, correction of lifestyle and eating behavior. If the patient does not follow the recommendations of a specialist, the disease can go into a necrotic form - cirrhosis of the liver. Even an organ transplant operation does not guarantee complete recovery and maintaining the quality of life, therefore it is better to abandon alcohol altogether or use it in a strictly dosed volume no more than 1-2 times a month.

Varieties of hepatoprotectors

Hepatoprotectors are divided into 5 types:

  1. Substances that contain components of milk thistle.
  2. Medications that contain ademetionin.
  3. Ursosan containing bear bile and ursodeoxycholic acid.
  4. Organic matter of animal origin.
  5. Medicines containing essential phospholipids.

Hepatoprotectors restore damaged liver cells, improve liver function, its ability to process various toxins.

With alcoholic hepatitis, when bile stagnates in the body due to an excess of alcoholic toxins, it harms the liver itself, while destroying it. Such a devastating effect leads to hepatitis, which is caused by stagnation of bile.

In the body of a healthy person, the processes of transformation in the liver of toxic acids into secondary and tertiary bile acids constantly occur. Tertiary acids include ursodeoxycholic acid. It is not toxic and performs all the necessary functions in the digestion, breaks down fat, mixes it with liquid.
This acid reduces cholesterol synthesis and its deposition in the gallbladder. How many percent of this substance is contained in the gallbladder? Human bile contains only 5% of this acid.

In medicine, it began to be extracted from bear bile for the treatment of liver diseases. Currently, doctors have synthesized ursodeoxycholic acid, which hepatoprotectors possess.

In the treatment of alcoholic hepatitis, essential phospholipids are actively used.
These drugs significantly accelerate the recovery of the liver from exposure to alcohol toxins, reduce the destruction of liver tissue.
Phospholipids are compatible with other drugs and nutrients.

Now, for the treatment of alcoholic hepatitis in medicine, a wide group of modern highly effective drugs are used that can cure the disease or stabilize the condition of the liver and the patient’s body as a whole for a long time.

Consequences and Complications

Significantly improves the prognosis for such a disease, a complete rejection of alcohol. But very often it 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:

  • portal hypertension. It develops as a result of impaired blood flow and increased pressure in the portal vein (a large vein that carries blood from the intestines to the liver),
  • varicose veins. If circulation through the portal vein is disturbed, blood can flow back into the vessels of the stomach and esophagus, and this can lead to rupture and bleeding. This condition is life-threatening, so medical care should be provided as soon as possible,
  • ascites. The complication arises as a result of excessive accumulation of fluid in the abdominal cavity,
  • bleeding disorder. Due to the disease, the production of proteins that contribute to blood coagulation is disrupted
  • jaundice. It develops when the liver cannot remove bilirubin from the body. When it accumulates in the skin and on the mucous membranes, characteristic yellowness occurs,
  • hepatic encephalopathy. The liver cells affected by alcohol cannot cope with the elimination of toxins from the body. As a result of general intoxication, the brain is damaged, the patient's mental state changes. A person becomes forgetful, aggressive, memory gaps occur, intelligence decreases,
  • cirrhosis. A long-existing inflammatory process leads to the fact that liver cells die and are replaced by fibrous tissue. This condition is irreversible, the result of it is liver failure.

Cirrhosis is a formidable complication of alcoholic hepatitis, in which liver cells die and are replaced by fibrous tissue.

According to statistics, in women the disease is much more complicated, and serious consequences develop more often than in men.

Forms of Alcoholic Hepatitis

There are 2 forms of alcoholic hepatitis with the corresponding symptoms:

  1. The persistent form externally gives almost no symptoms, so the patient may not be aware of liver damage, while ethanol continues to exert its toxic effect. The signs of this form are nonspecific - a person feels periodic nausea, discomfort in the stomach and heaviness in the right hypochondrium. This type of hepatitis is usually discovered by chance, according to the results of the analyzes, since most patients are reluctant to tell the doctor about alcohol abuse. This form of hepatitis can be cured if you give up alcohol completely. The liver regenerates quite well, and after 6 months visible improvements are noted. This form can last for many years, until the liver reserves are depleted.
  2. The transition to a progressive form occurs when the patient worsens. This form accounts for approximately 20% of all cases of alcoholic hepatitis and precedes cirrhosis. In the tissues of the organ, foci of cell death are formed, which significantly disrupts the liver, so the corresponding signs appear: jaundice, fever, vomiting and diarrhea. The severity is determined by the activity of liver enzymes in a biochemical analysis, the so-called tranaminases:
    • Easy - increase in enzymes less than 3 times,
    • Medium - increase in enzymes by 3 - 5 times,
    • Severe - increase in enzymes by more than 5 times.

Acute alcoholic hepatitis

Acute alcoholic hepatitis (OAS) develops in patients who already have chronic liver damage (cirrhosis, hepatitis of another etiology), but despite this they continue to drink alcohol.

Signs of acute inflammation appear after prolonged binge, when there is already alcoholic cirrhosis of the liver, which leads to a sharp deterioration in the condition.

There are several variants of the course, the symptoms and treatment of which will differ:

  1. Jaundice is the most common, the main manifestation, as the name implies, is jaundice. Other symptoms are also observed:
    • fast fatiguability,
    • nausea and vomiting,
    • stool disorders
    • significant weight loss.
  2. The cholestatic variant is characterized by stagnation of bile. Due to an increase in the concentration of fatty acids and bilirubin in the blood, the external manifestations are as follows:
    • itchy skin
    • dark urine
    • discolored stool
    • jaundice.
  3. Latent (hidden) option - does not manifest itself with any symptoms and can be detected only by biochemical analysis of blood (increase in liver enzymes). The patient can live for many years and not know about his illness.
  4. The fulminant variant is characterized by a malignant and progressive course. Hemorrhagic syndrome, liver failure, and brain damage in the form of encephalopathy, which often goes into a coma and ends with the death of the patient, are rapidly developing.

Watch the video: Advanced Liver Disease Case Discussions (February 2020).