Alcoholic hepatitis is a disease that occurs as a result of exposure to large doses of ethanol on liver cells. It is diagnosed when there is inflammation and degenerative changes in the tissues of the organ. This disease is one of the most common causes lethal outcome. Therefore, it is important to pay attention to its symptoms in time and immediately begin to take remedial measures.
The main cause of this type of hepatitis is the frequent use of alcohol. When it enters the body, only a small part (20%) is neutralized in the digestive tract and excreted by the lungs. The remaining amount of alcohol processes the liver. In this organ, alcohol is converted to acetaldehyde (a toxin) and then to acetic acid.
Note! With the abuse of alcoholic beverages, acetaldehyde accumulates in the liver cells.
This results in the following:
- the formation of fatty acids is disrupted;
- increases the production of tumor necrosis factors (inflammation appears);
- an increase in triglycerides.
The consequence of all these changes is the replacement of healthy cells of the organ with connective tissue: liver fibrosis develops. If treatment is not carried out, cirrhosis develops over time.
The following factors increase the likelihood of alcoholic hepatitis:
Alcoholic hepatitis is conditionally divided into types. Criteria according to which it is classified:
Forms of hepatitis
- Features of manifestation. The disease happens:
- sharp;
- chronic.
- The severity of the pathology. The following degrees are distinguished:
- light;
- average;
- heavy.
- The nature of the changes in the liver. Types of hepatitis:
- persistent;
- progressive.
- Features of manifestation. The disease happens:
It is impossible to determine the form of hepatitis on your own. But if you pay attention to the symptoms of pathology and undergo an examination on time, this will speed up recovery and reduce the likelihood of complications.
Clinical picture
The clinical picture of the disease depends on its form: each of them has its own characteristics of the course and symptoms.
Acute manifestation
Men who have been drinking alcohol for 3-5 years are most likely to develop this form of the disease. But there are also cases when it appears suddenly, after a few days of drinking alcohol. The severity and speed of manifestation of symptoms depends on the variant of the development of the disease (Table 1).
Table 1 - Forms and manifestations of alcoholic hepatitis.
| A form of acute alcoholic hepatitis | Peculiarities | signs |
|---|---|---|
| icteric | most often diagnosed. The clinical manifestation resembles the symptoms of viral hepatitis. | Decreased appetite. |
| Nausea. | ||
| Vomit. | ||
| Weight loss. | ||
| Prostration. | ||
| Elevated temperature. | ||
| Soreness in the area where the liver is located. | ||
| Yellowing of the sclera, skin. | ||
| Eruptions on the hands (rare). | ||
| Diarrhea. | ||
| Cholestatic | It is characterized by a high percentage of deaths among patients | Darkening of the urine. |
| Yellow skin color. | ||
| Chair lighting. | ||
| Itching of the skin. | ||
| Elevated levels of bilirubin in the blood (detected during the examination). | ||
| Fulminant | It has a progressive course. May be fatal within 2-3 weeks of onset of acute symptoms. | Intense pain in the region of the liver and stomach. |
| Fever. | ||
| Sudden weakness. | ||
| Lack of desire to eat. | ||
| Rapid onset of symptoms of jaundice. | ||
| An increase in the volume of the abdomen. | ||
| Hemorrhagic manifestations | ||
| Hepatic encephalopathy. | ||
| Impurities of blood in the urine. | ||
| Latent | Runs almost asymptomatic. | Decreased appetite. |
| Enlarged liver (slightly). | ||
| Intense pain in the right hypochondrium. |
Symptoms of acute alcoholic hepatitis appear after 3-5 weeks. With this pathology (unlike viral liver damage), there is no enlargement of the spleen. There are malfunctions digestive system but they are insignificant.
Signs of a chronic form
It is not easy to suspect chronic alcoholic hepatitis: its clinical manifestation is mild. Its main symptoms:
The active form of chronic alcoholic hepatitis resembles the clinical manifestation of hepatitis B in the acute period of its course. It is possible to distinguish diseases from each other only by examining liver tissues taken during a biopsy.
Persistent and progressive types
The persistent form of the disease is diagnosed when there is little damage to the liver cells. It is characterized by a latent course, when symptoms appear periodically. Therefore, the patient may not even be aware of the presence of hepatitis. Its main features:
This form of alcoholic hepatitis is detected using laboratory diagnostic methods. It is possible to cure her. With the timely detection of pathology and compliance with the recommendations of the doctor, six months after the start of therapy, the state of health improves. But it takes another 5-10 years to deal with the consequences of the disease.
Note! Progressive alcoholic hepatitis leads to cirrhosis of the liver. It occurs if the treatment of the persistent form of the disease was not carried out. Pathology develops in 20% of cases.
It is characterized by small foci of necrotic liver damage. But it is they who often degenerate into cirrhosis.
You can suspect the presence of hepatitis of this type by the following symptoms:
- vomit;
- sparse stool;
- high body temperature;
- pain in the right hypochondrium of high intensity;
- yellow tint of the skin, whites of the eyes;
- lethargy.
The severity of symptoms depends on the severity of the disease. If you do not take any therapeutic measures, a fatal outcome is possible.
Alcoholic hepatitis, like other types of this disease, requires immediate treatment.
Its long course threatens the development of such complications:
Diagnostic methods and treatment tactics
Timely diagnosis of the disease and timely treatment can reduce the likelihood of all these complications. To confirm the presence of alcoholic hepatitis and determine the tactics of treatment, the patient is recommended to undergo a comprehensive examination.
Survey
First, the specialist examines and collects the patient's history, assesses the condition of his liver (by palpation in the right hypochondrium) and skin.
After that, they are assigned:
- Laboratory research. These include:
- general and advanced blood tests;
- lipidogram;
- test for the presence of markers of viral hepatitis and fibrosis;
- Analysis of urine;
- coagulogram;
- coprogram.
- Examination using such instrumental diagnostic methods:
- ultrasound internal organs;
- Magnetic resonance imaging;
- liver biopsy;
- fibroesophagogastroduodenoscopy, to assess the condition of the veins of the esophagus and stomach.
- Laboratory research. These include:
In alcoholic hepatitis, therapy should be comprehensive and include a complete rejection of any form of alcohol, as well as dietary modification and the use of drugs that support liver function. In the complicated course of the disease, surgical intervention is recommended.
Medical therapy
To cure alcoholic hepatitis, hepaprotectors are prescribed. The most commonly used preparations contain:
If necessary, additionally appoint:
- antibiotics (Kanamycin, Norfloxacin);
- glucocorticosteroids (Prednisolone, Metipred);
- means that lower the acidity of the stomach (omeprazole, pantoprazole);
- preparations containing lactulose (Dufalak, Normaze).
Treatment of acute alcoholic hepatitis is carried out in a hospital, under the strict supervision of a doctor. An important component of the complex therapy of the disease is also the refusal to drink alcohol. A psychologist and a narcologist help the patient to cope with the problem.
diet therapy
With alcoholic hepatitis, the body is often depleted due to malnutrition. Following a personalized diet helps to reduce the burden on the liver and speed up the healing process.
It is also necessary to limit the use butter, cottage cheese and sour cream, fatty cheese and sparkling water. The diet must include:
- cereals: buckwheat, rice, oatmeal;
- veal, chicken dishes;
- figs;
- dried fruits;
- lean fish;
- fresh vegetables and fruits;
- green tea;
- skim cheese.
With alcoholic hepatitis, you need to eat in small portions. The frequency of eating is at least 5 times a day. In this case, carbohydrates should not be mixed with proteins. Fruit must be eaten separately.
Surgical intervention
- liver failure;
- damage to the veins of the esophagus (varicose veins);
- accumulation of fluid in the abdominal cavity.
In such cases, resort to clipping, paracentesis or liver transplantation. The latter type of operation requires huge financial outlays. But the main obstacle that both patients and specialists can face is the lack of a suitable donor. They can only become a completely healthy person. It is best that it be a relative of the patient.
Forecasts
Recovery after a liver transplant takes a long time. During the entire period of rehabilitation, the patient must take drugs that prevent organ rejection (immunosuppressants).
Note! The effectiveness of treatment largely depends on whether the doctor's instructions were followed. For patients with mild to moderate severity of alcoholic hepatitis, if they have completely excluded alcohol, the prognosis is good: liver function can be restored.
If the action of the factor provoking the development of hepatitis continues, this leads to the development of cirrhosis. This condition of the liver is irreversible: it is the last stage of alcoholic damage to the organ. The prognosis in this case is unfavorable: there is a high probability of the formation of hepatocellular carcinoma.
The main thing to do to prevent the occurrence of alcoholic hepatitis is to refuse to regularly consume large amounts of ethanol-containing drinks. The optimal daily dose of ethanol for women and men is 20 and 40 g, respectively (1 ml of alcohol contains 0.79 g of alcohol).
Whether the use of alcoholic beverages will lead to the development of hepatitis or not depends on many factors: the dose of alcohol, the frequency of its intake, diet, predisposition and the presence of concomitant diseases.
To reduce the risk of liver pathology, it is recommended to completely abandon bad habits, eat a balanced diet and lead an active lifestyle.
In case of deterioration of health, manifestation of signs of hepatitis, you should immediately consult a doctor.
Version: Directory of Diseases MedElement
Alcoholic hepatitis (K70.1)
Gastroenterology
general information
Short description
alcoholic liver disease is a liver disease caused by long-term use of toxic doses of ethanol. Alcoholic liver disease combines various disorders of the parenchyma structure Parenchyma - a set of basic functioning elements of the internal organ, limited by the connective tissue stroma and capsule.
liver and functional state of hepatocytes hepatocyte - the main cell of the liver: a large cell that performs various metabolic functions, including the synthesis and accumulation of various substances necessary for the body, the neutralization of toxic substances and the formation of bile (Hepatocyte)
caused by the systematic use of alcoholic beverages.
"Alcoholic Hepatitis"- a term adopted in ICD-10 for acute degenerative and inflammatory liver lesions resulting from alcohol exposure and capable of transforming into cirrhosis of the liver Cirrhosis of the liver is a chronic progressive disease characterized by dystrophy and necrosis of the hepatic parenchyma, accompanied by its nodular regeneration, diffuse proliferation of connective tissue and a deep restructuring of the liver architectonics.
.
Alcoholic hepatitis is one of the main variants of alcoholic liver disease. Just like alcoholic fibrosis, alcoholic hepatitis is considered a precursor or initial and obligatory stage of cirrhosis.
Alcoholic hepatitis can also be associated with fatty liver, alcoholic fibrosis, and cirrhosis.
Note. Acute episodes of toxic necrosis of the liver of alcoholic etiology, along with acute alcoholic hepatitis, are referred to as "alcoholic steatonecrosis", "sclerosing hyaline necrosis of the liver", "toxic hepatitis", "acute liver failure of chronic alcoholics".
Classification
Most clinicians distinguish between acute and chronic alcoholic hepatitis.
General classification of alcoholic hepatitis(Loginova A.S. et al.):
1. Chronic alcoholic hepatitis:
- with moderate activity;
- with pronounced activity;
- in combination with alcoholic hepatitis.
2. Acute alcoholic hepatitis (acute alcoholic liver necrosis):
- in combination with chronic alcoholic hepatopathy;
- developed in an intact liver;
- with intrahepatic cholestasis;
- mild (anicteric) form;
- form of moderate severity;
- severe form.
The severity can also be determined by scales (see section "Prognosis"). According to the score obtained (points), alcoholic hepatitis can be divided into severe and non-severe.
Etiology and pathogenesis
Etiology
Alcohol acts as a direct hepatotoxic agent. Its metabolism involves a number of enzymatic systems that convert ethanol to acetaldehyde, and further, acetaldehyde dehydrogenase Acetaldehyde dehydrogenase is an enzyme found in the human liver and is responsible for the breakdown of acetaldehyde (converts acetaldehyde to acetic acid).
(ALDH) metabolizes to its acetate.
The main factor in the development of alcoholic liver disease is the high content of acetaldehyde in it. This causes most of the toxic effects of ethanol, including through increased lipid peroxidation, the formation of stable complexes with proteins, impaired mitochondrial function, and stimulation of fibrogenesis.
The risk of developing alcoholic liver disease occurs with the use of more than 40-80 g of pure ethanol per day. When using more than 80 g of pure ethanol for 10 years or more, the risk of liver cirrhosis increases. There is no direct correlation between the degree of liver damage and the amount of alcohol taken: according to some reports, less than 50% of people who drink alcohol in dangerous doses have severe forms of liver damage (hepatitis and cirrhosis).
Pathomorphology
1. Acute alcoholic hepatitis. Histological manifestations:
1.1 Mandatory for alcoholic hepatitis structural changes in the liver:
- perivenular lesion of hepatocytes;
- balloon dystrophy and necrosis;
- the presence of Mallory bodies (alcoholic hyaline);
- leukocyte infiltration;
- pericellular fibrosis.
1.2 Symptoms that are optional for the diagnosis of alcoholic hepatitis:
- fatty liver;
- detection of giant mitochondria, acidophilic bodies, oxyphilic hepatocytes;
- fibrosis of the hepatic veins;
- proliferation of bile ducts;
- cholestasis.
Perivenular hepatocyte damage
Acute alcoholic hepatitis is characterized by perivenular damage to hepatocytes or the third zone (microcirculatory periphery) of Rappoport's hepatic acinus. During the metabolism of alcohol, a more noticeable decrease in oxygen tension in the direction from the hepatic artery and portal vein to the hepatic vein is observed compared to the norm. Perivenular hypoxia contributes to the development of hepatocellular necrosis, which is found mainly in the center of the hepatic hexagonal lobules.
Balloon dystrophy and Mallory bodies
With balloon dystrophy of hepatocytes, swelling of individual hepatocytes is observed with an increase in their size, clarification of the cytoplasm and karyopyknosis. Karyopyknosis - the process of wrinkling of the cell nucleus during dystrophic changes in it
.
Mallory's bodies (alcoholic hyaline) are detected centrilobularly using Mallory's tricolor stain; are formed both in the cytoplasm of hepatic cells and extracellularly. Detection of alcoholic hyaline characterizes the severity of liver damage.
Alcoholic hyaline can have a fibrillar, fine and coarse granular structure. Fibrillar alcoholic hyaline is detected in the midst of acute alcoholic hepatitis. Later, when the disease subsides, it transforms into granular material.
Inflammatory infiltration with polynuclear leukocytes with a small admixture of lymphocytes is determined inside the lobule and in the portal tracts. Inside the lobule, leukocytes are detected in the foci of hepatocyte necrosis and around cells that contain alcoholic hyaline, which is associated with the leukotoxic effect of alcoholic hyaline. When the disease subsides, alcoholic hyaline is less common.
Pericellular fibrosis is an important feature of alcoholic hepatitis, and prevalence is the main predictor of the disease. Alcohol and its metabolites (especially acetaldehyde) can have a direct fibrogenic effect. Fibrous tissue is deposited along the sinusoids and around hepatocytes on early stages alcoholic hepatitis. Ito cells, fibroblasts, myofibroblasts, and hepatocytes synthesize various types of collagen and non-collagen proteins.
2. Chronic alcoholic hepatitis:
2.1 Chronic persistent hepatitis: the characteristic manifestations of alcoholic hepatitis are combined with moderate pericellular and subsinusoidal fibrosis in the third zone of the acinar hepatic lobule. In some cases, the portal tracts are dilated and portal fibrosis is observed. This picture can persist for 5-10 years without progressive fibrosis and transition to cirrhosis, even with continued alcohol consumption.
2.2 Chronic active hepatitis: histological picture of alcoholic hepatitis in combination with active fibrogenesis. Along with significant fibrosis, sclerosing hyaline necrosis is noted in the third zone of the lobule. After 3-5 months of abstinence, morphological changes resemble the picture of chronic aggressive non-alcoholic hepatitis.
In chronic alcoholic hepatitis, the progression of the process in some cases is observed even when drinking alcohol is stopped as a result of the addition of an autoimmune destructive reaction.
Epidemiology
Prevalence sign: Common
Age. Acute alcoholic hepatitis often develops at the age of 25-35 years after heavy drinking against the background of 10 or more years of alcohol abuse. The age range for all forms of alcoholic hepatitis can vary from 25 to 70 years. In the United States, the median age of a patient with alcoholic hepatitis is about 50 years old, with the onset of alcohol consumption at age 17.
Prevalence. According to the most minimal estimates, the number of patients in the population of Western countries is about 1-2%. Due to the asymptomatic course of mild forms of alcoholic hepatitis, in the population of patients who moderately consume alcohol and abuse it, the prevalence of the disease (according to biopsy data) is 25-30%.
sex ratio varies in different countries. It is believed that the rate of development of alcoholic hepatitis in women is 1.7 times higher than in men. However, given the predominance of men in the group of drinkers, the value of the sex ratio in the group of patients remains unknown.
Race. The Caucasoid race has a lower rate of development of alcoholic hepatitis than the Negroid and Mongoloid.
Factors and risk groups
Risk factors for the development and progression of the disease:
- taking from 40-80 grams of ethanol per day for 10-12 years;
- genetically determined phenotypes of enzymes that provide a high rate of ethanol metabolism and accumulation of acetaldehyde;
- infection with hepatotropic viruses;
- overweight;
- malnutrition;
- female.
Clinical picture
Clinical Criteria for Diagnosis
Anorexia, nausea, vomiting, weight loss, right upper quadrant pain, fever, jaundice, hepatomegaly, splenomegaly, dyspepsia, weakness, nausea, vomiting
Symptoms, course
Anamnesis
The diagnosis of alcoholic hepatitis is associated with certain difficulties, since it is not always possible to obtain sufficiently complete information about the patient.
Criteria for alcohol addiction(diagnosed on the basis of three of the above signs):
The patient's use of alcoholic beverages in large quantities and the constant desire to use them;
Spending most of the time on acquiring alcohol and drinking it;
Drinking alcohol in life-threatening situations or when it violates the patient's obligations to society;
Alcohol consumption, accompanied by a decrease or cessation of the patient's social and professional activity;
Continued alcohol intake, despite the aggravation of the patient's psychological and physical problems;
Increasing the amount of alcohol consumed to achieve the desired effect;
- the appearance of withdrawal symptoms;
The need for alcohol intake to reduce withdrawal symptoms.
Alcohol abuse(revealed in the presence of one or two signs):
Alcohol use, despite the increased social, psychological and professional problems of the patient;
Reuse of alcohol in life-threatening situations.
In doubtful cases, in the diagnosis of any liver disease or if alcohol abuse is suspected, the use of a special questionnaire is recommended.
Varieties of the clinical course of alcoholic hepatitis:
1. Acute alcoholic hepatitis:
1.1 Asymptomatic or insidious course with a gradual onset (about 50% of patients). The only complaint is often dyspepsia.
1.2 The clinical picture of acute toxic liver necrosis is classically characteristic:
- fever (40%);
- dyspepsia Dyspepsia is a disorder of the digestive process, usually manifested by pain or discomfort in the lower chest or abdomen, which may occur after eating and is sometimes accompanied by nausea or vomiting.
;
- pain in the right hypochondrium (50%);
- diarrhea, nausea, vomiting;
- anorexia;
- weakness;
- weight loss.
1.3 Icteric variant - is determined in the presence of jaundice. The most common variant of acute alcoholic hepatitis (35% of cases). Jaundice is usually not accompanied by pruritus, often moderately severe.
1.4 Cholestatic variant (in 5-13% of cases): symptoms of intrahepatic cholestasis Cholestasis is a violation of the progress of bile in the form of stagnation in the bile ducts and (or) ducts.
(skin itch, jaundice, light feces, dark urine, fever).
1.5 Fulminant acute alcoholic hepatitis: may resemble all clinical variants of acute alcoholic hepatitis (except latent), but is characterized by rapid progression with the development of liver and kidney failure and rapid death.
2. Chronic alcoholic hepatitis: manifestations similar to other etiological forms of hepatitis. Dyspeptic disorders are often observed.
Objective examination
Characterized by hepatomegaly Hepatomegaly is a significant enlargement of the liver.
. The liver is enlarged in almost all patients, often compacted, has a smooth surface, painful. The pain is diffuse.
Possible splenomegaly Splenomegaly - persistent enlargement of the spleen
, cutaneous telangiectasias Telangiectasia - local excessive expansion of capillaries and small vessels.
, palmar erythema Erythema - limited hyperemia (increased blood supply) of the skin
.
Alcoholic and hepatic encephalopathy may occur Encephalopathy is the general name for brain diseases characterized by its degenerative changes.
, as well as asterixis Asterixis (symptom of "pop", falling of the hand) - inability to maintain a fixed posture, fluttering tremor - slow and irregular flexion-extension of the limbs
, as an expression of the latter.
Ascites often develops Ascites - accumulation of transudate in the abdominal cavity
, which, with severe fibrosis and obstruction of the central veins, may be resistant to diuretic therapy.
With alcoholic hepatitis, concomitant bacterial infections are often noted: pneumonia, sinusitis, pyelonephritis Pyelonephritis - inflammation predominantly of the interstitial tissue of the kidney and renal pelvis
, active pulmonary tuberculosis, gram-negative septicemia Septicemia is a form of sepsis in which the presence of pathogenic microorganisms in the blood is not accompanied by the formation of metastatic foci of purulent inflammation.
. Possible isolated cases of peritonitis Peritonitis is inflammation of the peritoneum.
and abscess Abscess - a cavity filled with pus and delimited from surrounding tissues and organs by a pyogenic membrane
lungs.
Diagnostics
The criterion for the diagnosis of alcoholic hepatitis is the presence of an alcohol history and specific histological signs (see the section "Etiology and pathogenesis"). Clinical and laboratory parameters play an important role. Imaging of the liver plays a lesser role in diagnosis.
Instrumental Research
1. Ultrasound:
- the liver parenchyma has a diffuse, hyperechoic structure;
- at the stage of cirrhosis - the corresponding sonographic picture.
2.Color duplex sonography Color duplex sonography - a non-invasive and non-radioactive diagnostic method for analyzing arteries and veins (is a combination of Doppler technology with ultrasound imaging)
:
identification of the direction of hepatic blood flow, the degree of development of collateral circulation, the presence of blood clots in the vessels of the liver.
3.FEGDS FEGDS - fibroesophagogastroduodenoscopy (one of the methods for examining the upper digestive tract, which allows you to examine the inner surface of the esophagus, stomach and duodenum)
carried out to identify the presence and degree of varicose veins of the esophagus and stomach, to detect portal gastropathy (erosive-hemorrhagic gastritis) and assess the risk of bleeding.
Rectoscopy is used to identify anorectal varicose veins.
4. Laparoscopy Laparoscopy (peritoneoscopy) is a study of the abdominal organs by examining them with the help of medical endoscopes inserted into the peritoneal cavity through a puncture of the abdominal wall.
with a liver biopsy, they make it possible to describe the surface of the liver, the size of the regeneration nodes and morphologically confirm the diagnosis. These studies are carried out only in the absence of contraindications to them. For example, percutaneous puncture liver biopsy is often not feasible due to contraindications (primarily coagulopathy) and is associated with a large number of diagnostic errors.
5. When puncture liver biopsy with histological examination find:
- hepatocytes in a state of balloon and fatty degeneration;
-
massive lobular infiltration with a predominance of polymorphonuclear leukocytes and areas of focal necrosis;
-
Mallory bodies (sometimes), which, when stained with hematoxylin-eosin, are purple-red cytoplasmic inclusions, consisting of condensed intermediate microfilaments of the cytoskeleton;
To some extent, pronounced fibrosis with a perisinusoidal arrangement of collagen fibers;
- In varying degrees, pronounced intrahepatic cholestasis.
At the advanced stage of acute alcoholic hepatitis, as a rule, there are contraindications to puncture liver biopsy (in these cases, transjugular biopsy may be performed).
6. Magnetic resonance imaging has high rates of sensitivity and specificity in the diagnosis of hepatic steatosis Hepatic steatosis is the most common hepatosis in which fat accumulates in the liver cells.
and cirrhosis, but not hepatitis. There are no criteria for proving the alcoholic nature of the detected changes.
Laboratory diagnostics
The diagnosis of alcoholic hepatitis, like any other form of alcoholic liver disease, is based on evidence of alcohol abuse and evidence of liver disease. None of the changes in the laboratory marker has been definitively associated with alcoholic hepatitis. The etiology of liver disease detected by laboratory testing may be different. In addition, alcohol can be one of a number of factors that cause liver damage. The specific role of alcohol in the development of liver damage can be difficult to assess in a patient with potentially multifactorial liver disease.
Signs of alcohol abuse:
- a sharp increase in the level of gamma-glutamyltransferase in the blood serum and its sharp decrease against the background of withdrawal;
Increasing the concentration of non-carbohydrate transferrin;
- macrocytosis (mean erythrocyte volume> 100 microns 3) associated with high blood alcohol content and toxic effects on the bone marrow; the specificity of this feature is 85-91%, the sensitivity is 27-52%.
Signs of liver damage:
1. An increase in the level of aminotransferases with a predominance of AST by more than 2 times (in 70% of cases). Increasing AST by 2-6 times. AST levels greater than 500 IU/L or ALT greater than 200 IU/L are uncommon and suggest massive necrosis (fulminant form of alcoholic hepatitis), other or combined etiologies of liver damage (eg, viral hepatitis, acetaminophen, etc.).
2. An increase in the level of alkaline phosphatase and hyperbilirubinemia are possible.
In acute alcoholic hepatitis observed:
- neutrophilic leukocytosis up to 15-20 x 10 9 /l, sometimes up to 40x10 9 /l;
- increase in ESR up to 40-50 mm/h;
- hyperbilirubinemia due to direct fraction;
- an increase in the level of aminotransferases (the ratio of AST / ALT - more than 2);
Multiple excess of the level of gamma-glutamyltransferase (in 70% of patients with alcoholic liver disease, GGTP activity is within the normal range);
- with a cholestatic form - an increase in alkaline phosphatase;
Increase in IgA.
Differential Diagnosis
Differential diagnosis of alcoholic hepatitis with the following diseases is carried out:
- non-alcoholic fatty liver disease;
- viral and infectious hepatitis;
- obstruction of the bile ducts;
- neoplastic formations;
- cholecystopancreatitis;
- chronic pancreatitis.
The decisive factor is considered to be a correctly collected alcohol history, negative tests for infectious agents and visualized biliary tract patency. However, in the setting of suspected combined liver disease, it is very difficult to determine the dominant etiological cause. The most reliable diagnostic test in this case is the laboratory determination of CDT (carbohydrate-deficient transferrin).
Complications
Outcomes of alcoholic hepatitis can be:
- fibrosis Fibrosis is the growth of fibrous connective tissue, which occurs, for example, as a result of inflammation.
and sclerosis Sclerosis is a thickening of an organ due to the replacement of its dead functional elements with a connective (usually fibrous) tissue or a homogeneous hyaline-like mass.
liver;
- cirrhosis of the liver;
- hepatic encephalopathy;
- liver cancer.
Infectious complications:
- pneumonia;
- sinusitis Sinusitis - inflammation of the mucous membrane of one or more paranasal sinuses
;
- sepsis;
- liver abscess (rare);
- ICE DIC (disseminated intravascular coagulation, consumption coagulopathy, thrombohemorrhagic syndrome) - impaired blood clotting due to massive release of thromboplastic substances from tissues.
;
- renal failure;
- peritonitis (rare).
Treatment
General provisions
1. The most important principle in the treatment of alcoholic hepatitis is the avoidance of alcohol. The disease can regress quite quickly and completely (compared to hepatitis of other etiologies) with the complete abolition of alcohol intake.
2. There are significant discrepancies in drug therapy between Western and accepted in the CIS recommendations.
3. Many drugs have no (or weak) evidence base and are used either traditionally or based on a small number of studies.
4. Approaches to therapy change over time. The information below reflects the most generally accepted views at the time of writing.
5. Treatment of alcoholic hepatitis depends on many factors:
Form (see section "Classification");
- the severity of the process;
- age of the patient;
- the presence of concomitant diseases and complications.
Diet
It is important to eat a diet that contains sufficient amounts of protein and calories, as people who abuse alcohol often develop a deficiency of proteins, vitamins and trace elements (especially potassium, magnesium and phosphorus).
Deficiencies in folic acid, vitamin B6, vitamin A and thiamine are among the most common.
Trace elements (eg, selenium, zinc, copper, and magnesium) are often altered and, in some cases, are thought to be involved in the pathogenesis of all forms of alcohol disease.
Difficulties arise in the selection of a diet for concomitant diabetes mellitus or obesity, since the spectrum of malnutrition in these patients varies widely from malnutrition to obesity. The American College of Gastroenterology (ACG) and the American Association for the Study of Liver Diseases (AASLD) recommend an average of 1.2-1.5 g/kg protein and 35-40 kcal/kg body weight per day (at least 2,000 kcal/day for an adult). ).
There is evidence of a beneficial effect (when introduced into the diet) of branched-chain amino acids (BCAA).
Evidence for the effectiveness of introducing polyunsaturated fatty acids into the diet is still questionable.
As an alternative route of administration nutrients(with nausea, vomiting, changes in psychological status), an endoscopically inserted enteral probe with a programmable pump can be used. Parenteral nutrition (partial or supplementary) is extremely rare.
Physical activity not recommended in the acute phase. In the future, it should be aimed at weight loss (if there is concomitant obesity). Individuals with chronic alcoholic hepatitis that occurs without significant symptoms, as a rule, limit physical activity is not required.
Infusion therapy
Applied in inpatient treatment severe forms of acute alcoholic hepatitis (including those with severe cholestasis and, especially, liver failure). Infusion therapy aims at detoxification, correction of acid-base balance, correction of hypoalbuminemia, correction of the coagulation system. Complex saline solutions, albumin, native plasma, or blood clotting factors are commonly used in moderate doses. The introduction of colloids try to avoid.
Medicines
US and UK recommendations
1. Systemic corticosteroids (prednisolone, methylprednisolone) - are prescribed only for severe forms of concomitant liver failure with a course of up to 4 weeks, 40 mg / day. (32 mg / day for metipred), sometimes with a progressive dose reduction by 2 times over the next 2-3 weeks until complete withdrawal. Cause side effects.
2. Pentoxifylline - 400 mg orally 3 times a day, if there are contraindications to systemic corticosteroids.
3. Antioxidant therapy (vitamins C and E and other antioxidants) - does not currently have solid evidence of effectiveness in the treatment of alcoholic hepatitis. Of course, the deficiency of vitamins revealed in the study of blood serum is subject to medical correction, if it is impossible to correct it with a balanced diet.
4. Antibacterial therapy is carried out only with the development of infectious complications.
5. Drugs such as thalidamide, misoprostol, adiponectin and a group of probiotics have shown in preliminary studies good effect but are not yet standard therapy.
1. Systemic corticosteroids (prednisolone) - 40 mg / day, for 4 weeks.
2. Ademetionine (Heptral).
3. Silymarin.
4. Essential phospholipids (in the absence of cholestasis), for example, Essentiale.
5 Ursodeoxycholic acid.
6. Antibacterial therapy for prophylactic purposes, short course (fluoroquinols).
7. Colchicine.
Summary. Generally recognized are measures aimed at giving up alcohol, normalizing nutrition, detoxification corrective infusion therapy, as well as the appointment of systemic corticosteroids (in severe cases). In the absence of a clear evidence base, other medicines should be prescribed by the physician based on the patient's ability and personal experience and judgments.
Surgery. Liver transplant.
Forecast
Non-severe alcoholic hepatitis is a benign disease with negligible short-term mortality. However, when alcoholic hepatitis is severe enough (development of hepatic encephalopathy, jaundice, coagulopathy), mortality can be significant.
The overall 30-day mortality in patients hospitalized with alcoholic hepatitis is about 15%, but in patients with severe forms it approaches or exceeds 50%.
In patients without encephalopathy, jaundice, or coagulopathy Coagulopathy - a violation of the function of the blood coagulation system
The 30-day mortality rate is less than 5%.
In general, one-year mortality after hospitalization for alcoholic hepatitis is about 40%.
Used to predict death Maddrey coefficient(MDF): 4.6 x (difference between prothrombin time in patient and control) + serum bilirubin in mmol/l.
With a coefficient value of more than 32, the probability of death during the current hospitalization exceeds 50%.
According to some studies, MDF may be an inaccurate predictor of mortality in patients with alcoholic hepatitis, especially those receiving glucocorticoids.
Other factors that correlate with poor prognosis include elderly age, impaired renal function, encephalopathy and an increase in the number of leukocytes in the first 2 weeks of hospitalization.
Alternative forecast scales(not widely used):
- The Combined Clinical and Laboratory Index of the University of Toronto;
- Model for end-stage liver disease (MELD);
- Glasgow alcoholic hepatitis score (GAHS);
- Asymmetric dimethylarginine (ADMA).
The last two scales in some studies showed the highest accuracy of the forecast.
Hospitalization
Hospitalization for alcoholic liver disease can be carried out both on an emergency basis and on a planned basis. Patients without signs of a pronounced inflammatory process, liver failure, complications can be treated on an outpatient basis.
Prevention
primary prevention. Refusal to abuse alcohol.
Prevention of complications
Patients recently discharged from the hospital after an acute attack of alcoholic hepatitis should generally be followed up intensively for 2 weeks. Subsequent periodic visits to the doctor are required at intervals of a week to several months.
The goal of patient monitoring is to determine whether there is a response to ongoing therapy (including monitoring of electrolyte levels and liver function tests), as well as to control alcohol withdrawal and encourage sobriety.
It should be borne in mind that a complete abstinence from alcohol is noted in no more than 1/3 of patients, 1/3 of patients significantly reduce alcohol consumption, and the remaining third ignore the doctor's recommendations. The last patients need the joint work of a hepatologist and a narcologist.
In patients with alcoholic hepatitis who have evidence of liver cirrhosis (especially those with concomitant chronic viral hepatitis B or C), periodic monitoring is necessary to screen for hepatocellular carcinoma. The general screening algorithm includes serum alpha-fetoprotein (AFP) every 6 months and ultrasound every 12 months.
Immunization of patients with alcoholic liver disease against common infectious pathogens, including hepatitis A virus, hepatitis B virus, pneumococcus, and influenza A virus, seems to be a very reasonable approach.
Information
Sources and literature
- The Merc manual. Medical guide. Diagnosis and treatment / ed. Beers Mark H./trans. from English. ed. Chuchalina A.G., M.: Literra, 2011
- Damianov I. Secrets of pathology / translation from English. ed. Kogan E. A., M.: 2006
- "Pentoxifylline for alcoholic hepatitis" Kate Whitfield, Andrea Rambaldi, Jørn Wetterslev, Christian Gluud, Cochrane Hepato-Biliary Group, The Cochrane Library, published online: oct, 2009
- "The epidemiology and clinical characteristics of patients with newly alcohol-related liver disease: results from population-based surveillance" Sofair AN, Barry V, Manos MM, Thomas A. etc., "Journal of Clinical Gastroenterology", No. 44(4 ), 2010
- "Treatment of alcoholic liver disease" Thomas H. Frazier, Abigail M. Stocker, Nicole A. Kershner, Luis S. Marsano, "Therapeutic Advances in Gastroenterology", No. 4(1), 2011
- "Use of serum carbohydrate-deficient transferrin values to exclude alcoholic hepatitis from non-alcoholic steatohepatitis: a pilot study" Ohtsuka T., Tsutsumi M., Fukumura A., "Alcoholism: Clinical and Experimental Research", No. 29, 2005
- "Alcoholic liver disease" Bueverov A.O., Maevskaya M.V., Ivashkin V.T.
- http://www.rmj.ru/ - Russian medical journal. Independent publication for practitioners - No. 9, 2002
- "Alcoholic hepatitis: Basic principles of treatment" Adzhigaitkanova S.K.
- http://www.eurolab.ua/encyclopedia/565/46022/
- "General principles of treatment of acute alcoholic hepatitis" Bueverov A.O.
- http://www.rmj.ru/ - Russian medical journal. Independent publication for practicing physicians - №1, 2004
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Alcoholic hepatitis is a collection of degenerative and inflammatory processes that occur in the liver and are due to the regular intake of large doses of ethanol.
The likelihood of developing ALD directly depends on the volume of consumed ethanol-containing drinks and the regularity of this process. At the same time, the type of alcohol is unimportant: beer, vodka, wine - all this creates a good help for the appearance of ABP.
Alcoholic hepatitis does not develop immediately: with regular use of critical doses of ethanol, the patient first develops fatty degeneration of the liver and only then alcoholic steatohepatitis. At the final stage, the disease flows into cirrhosis of the liver.
Reasons for development
The main cause of this type of hepatitis is the frequent use of alcohol. When it enters the body, only a small part (20%) is neutralized in the digestive tract and excreted by the lungs. The remaining amount of alcohol processes the liver. In this organ, alcohol is converted to acetaldehyde (a toxin) and then to acetic acid.
Note! With the abuse of alcoholic beverages, acetaldehyde accumulates in the liver cells.
This results in the following:
- the formation of fatty acids is disrupted;
- increases the production of tumor necrosis factors (inflammation appears);
- an increase in triglycerides.
The consequence of all these changes is the replacement of healthy cells of the organ with connective tissue: liver fibrosis develops. If treatment is not carried out, cirrhosis develops over time.
The following factors increase the likelihood of alcoholic hepatitis:
- taking a large number of ethanol-containing drinks at a time;
- the frequency and duration of alcohol consumption (the disease develops with its daily intake for 5-7 years);
- transferred viral hepatitis;
- genetic predisposition;
- wrong or not good nutrition(leads to a deficiency of nutrients);
- excess weight;
- long-term use of drugs that have a toxic effect on the liver;
- the presence of autoimmune diseases;
- gender of the person who consumes alcohol: women are more likely to develop the disease.
Alcoholic hepatitis is conditionally divided into types. Criteria according to which it is classified:
- Features of manifestation. The disease happens:
- sharp;
- chronic.
- The severity of the pathology. The following degrees are distinguished:
- light;
- average;
- heavy.
- The nature of the changes in the liver. Types of hepatitis:
- persistent;
- progressive.
It is impossible to determine the form of hepatitis on your own. But if you pay attention to the symptoms of pathology and undergo an examination on time, this will speed up recovery and reduce the likelihood of complications.
Symptoms of alcoholic hepatitis
Depending on the form of manifestation of the disease, the following symptoms of alcoholic hepatitis are distinguished:
- persistent hepatitis: his symptoms are rather poor, the patient's condition is stable, heaviness in the hypochondrium on the right side, nausea, feeling of fullness in the stomach, belching is periodically noted. The patient may not be aware of the development of his disease. Sometimes it is revealed during the examination.
In case of stopping the use of ethanol-containing drinks, stabilization and reverse development of changes in the liver are possible. With timely detection and implementation of therapeutic measures, observing a healthy lifestyle, hepatitis at this stage can be cured. With continued use of alcohol, the disease will progress. - progressive hepatitis observed in every fifth patient with alcoholic hepatitis. The disease precedes cirrhosis of the liver, the formation of areas of tissue necrosis (complete necrosis), an irreversible process. For progressive hepatitis, the following symptoms are characteristic: jaundice, pain in the hypochondrium, fever, vomiting, diarrhea.
Depending on the development and course of the disease, special signs of hepatitis are distinguished. The disease can be acute (icteric, latent, fulminant and cholestatic) and chronic. If the first symptoms are pronounced, pronounced (the patient may turn yellow, experience pain and deterioration), then the second may be asymptomatic and mild.
Acute alcoholic hepatitis
OAH, or acute alcoholic hepatitis, is considered a rapidly progressive disease that destroys the liver. It appears after prolonged drinking.
There are four forms:
- Icteric - weakness, pain in the hypochondrium, anorexia, vomiting, diarrhea. In men, there is jaundice without skin itching, weight loss, nausea. The liver is enlarged, thickened, smooth, painful. The patient's hands tremble, ascites, erythema, bacterial infections, fever may appear.
- Latent - diagnosed only by a laboratory method, biopsy, latent leakage.
- Cholestatic - rare, symptoms are severe itching, colorless feces, jaundice, dark urine, impaired urination.
- Fulminant - symptoms progress, hemorrhages, jaundice, renal failure and liver encephalopathy are observed. Due to coma and hepatorenal syndrome, death occurs.
Chronic alcoholic hepatitis
At this disease symptoms may be absent. Characterized by a gradual increase in transaminase activity with the dominance of AST over ALT. Sometimes a moderate increase in the indicators of cholestasis syndrome is possible. There are no signs of portal hypertension. The diagnosis is made morphologically - histological changes are characteristic, which correspond to inflammation, taking into account the absence of signs of the development of cirrhotic transformation.
Diagnosing alcoholic hepatitis is quite difficult, because. It is not always possible to obtain complete information about the patient due to obvious reasons. Therefore, the attending physician takes into account the concepts that are included in the definitions of “alcohol abuse” and “alcohol dependence”.
Criteria for alcohol addiction include:
- The use of alcohol by the patient in large quantities and the continuous desire to take it;
- Most of the time is spent on the purchase and consumption of alcoholic products;
- Drinking alcohol in extremely dangerous doses for health and / or situations where this process is contrary to obligations to society;
- Continuity of alcohol intake, even taking into account the aggravation of the physical and psychological state of the patient;
- Increasing the dose of alcohol consumed in order to achieve the desired effects;
- Manifestation of withdrawal symptoms;
- The need for alcohol intake to subsequently reduce withdrawal symptoms;
A doctor can diagnose alcohol dependence based on any 3 of the criteria listed above. Alcohol abuse will be identified based on the presence of one or two criteria:
- Alcohol use, regardless of the development of psychological, professional and social problems of the patient;
- Re-use of alcohol in health-threatening situations.
Complications
Alcoholic hepatitis is dangerous in itself because of the risk of liver damage, but it can also lead to a number of complications:
- cirrhosis of the liver - scarring of tissues, wrinkling of the organ, violation of its functions;
- esophageal varices and bleeding from them is a life-threatening complication. Scar tissue in the liver interferes with normal blood flow, causing the veins in the esophagus to enlarge. If they rupture, 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 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.
Diagnostics
Diagnosis has 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.
Laboratory signs of the acute form are leukocytosis, less often - leukopenia (with the toxic effect of alcohol on the bone marrow), B12-deficiency anemia, accelerated ESR, and an increase in markers of liver damage. 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 enlargement of the liver, an increase in its echogenicity, and a uniform structure. Laboratory parameters changed moderately. A liver biopsy with alcohol damage reveals specific signs of inflammation, fibrosis, and necrosis. The severity of damage depends on the form of the disease and its duration.
How to treat alcoholic hepatitis
Treatment of alcoholic hepatitis in adults consists of the following "three pillars":
- Exclusion of alcohol intake.
- Dieting.
- Medical therapy.
If necessary, treatment is supplemented by surgery (interventions).
Nutrition and diet
Fasting with hepatitis is contraindicated. The energy value of food should be at least 2000 calories per day for men and 1700 for women. Daily protein intake - 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).
For hepatitis, diet No. 5 is prescribed. The patient can and should not eat the following foods:
| Can | It is forbidden |
|
|
The diet is designed in such a way that it provides good nutrition, helps to normalize the process of the gastrointestinal tract and 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.
As a rule, the diet is prescribed not only at the time of treatment of acute forms of alcoholic hepatitis, in the treatment of cholecystitis, cholelithiasis, liver cirrhosis in the absence of liver failure, postoperative periods. The content of the complete diet of proteins, carbohydrates, restriction of fats and acids, essential oils, cholesterol-containing foods, products of fat oxidation during frying leads to great help to the body during the period of illness, remission is very useful.
The basis of nutrition is boiled food, in rare cases stewed. Products should be coarsely chopped, without grinding. Meat, fish in large boiled pieces, one at a time. The process of passerization of vegetables (sauteing) during the preparation of gravy, frying is excluded. Frying is completely excluded. Cold dishes and cold water should not be in the diet due to excessive irritation of the gastrointestinal tract, leading to a slow process of digestion.
Medical treatment
With alcoholic hepatitis, drugs are prescribed:
- suppressing stomach acidity: "Omeprazole", "Rabeprazole", "Pantoprazole";
- sorbents: "Polysorb", "Enterosgel";
- milk thistle and preparations based on it;
- hepatoprotectors: Heptral, Methionine, Glutargin. Essential acids of the "Essentiale" 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: "Normaze", "Dufalak" and others.
It should be noted that it is impossible to allow the development of constipation here: if the stool is delayed, 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:
- Milk thistle preparations (Silimar, Sibektan, Karsil, Gepabene, Legalon) have a pronounced antioxidant (reduce the effect of oxidative processes) and immunostimulating effect.
- Preparations with the active substance ademetionine (Geptral, Ademetionine) neutralize toxins, improve the outflow of bile.
- Ursodeoxycholic acid from bear bile or the synthetic drug Worsan have a choleretic effect and antifibrotic effect.
- Means of animal origin that stimulate regenerative processes in the liver (Sirepar, Hepatosan).
- Products containing essential phospholipids (Essliver Forte, Essentiale Forte N) are one 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
In alcoholic hepatitis, palliative surgery can be performed. They alleviate the patient's condition, but do not eliminate the underlying problem. It:
- paracentesis - with ascites (accumulation of fluid in the abdomen);
- clipping (“stitching” with metal clips) of a bleeding esophageal vein.
These interventions are mainly used already at the stage of cirrhosis.
There is also a radical operation that solves the problem of liver cell death - this is a transplantation of a donor liver (more precisely, a section 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.
Prognosis treatment - how long do people live with alcoholic hepatitis?
Without treatment, the prognosis of alcoholic hepatitis is negative - life expectancy with toxic liver disease, according to pathological anatomy and pathology, depends on individual characteristics body, its endurance and the stage of the disease. With proper treatment, you can stop the problem and continue to lead a normal life, subject to the complete rejection of alcohol.
Unfortunately, patients suffering from the third stage of alcoholism continue to abuse alcohol after successful treatment of the disease and more than 30% of them die prematurely due to relapse and complications. Therefore, an important aspect in the treatment of liver disease is the preliminary treatment of alcohol dependence.
Prevention
Prevention of alcoholic hepatitis is the only way to avoid a long period of treatment and associated difficulties. First of all, it implies the rejection of the regular use of ethanol-containing drinks.
What is the acceptable 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 seek 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 consumed, 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.
Studies have shown that 1 average resident of Germany accounts for about 9.5 liters of alcohol per year, and 10 liters per resident of Russia. The gap is small, but the amount is very dangerous, because with such an active consumption of strong drinks, a person runs the risk of getting cirrhosis of the liver, which is preceded by alcoholic hepatitis. This disease develops from alcohol consumption, leading to inflammatory liver damage that can develop into cirrhosis. It has many forms, is difficult to diagnose, requires long-term treatment and recovery.
About what is alcoholic hepatitis, what are its symptoms and treatment, we will now tell.
Types of alcoholic hepatitis
Alcoholic hepatitis is divided into several types, depending on the symptoms and course of the disease. Consider their signs and features.
Persistent form
With this form of the disease, there are very few symptoms of alcoholic hepatitis, and patients most often complain of such manifestations:
- Nausea and belching.
- Pain on the right (in the region of the liver).
- Heaviness in the stomach.
The presence of liver disease is detected by laboratory tests, after which the attending physician prescribes a diet and strongly advises to give up alcoholic beverages. After six months, there is an improvement in the patient's condition, but the unpleasant consequences of this liver disease accompany a person for 5-10 years. If time does not begin to treat alcoholic hepatitis at this stage, then it flows into the next form - progressive.
progressive form of the disease
This form is observed in 20% of patients who suffer from alcoholic hepatitis, and it is a harbinger of imminent cirrhosis. Symptoms of alcoholic hepatitis in a progressive form are pronounced:
- Jaundice and fever.
- Vomiting and diarrhea.
- Severe pain in the right hypochondrium.
Non-specific symptoms may also appear, corresponding to the stage of the disease (mild, moderate, severe). If this form of liver disease is left untreated, then the patient will die, the cause of which is acute liver failure.
Forms of the disease and the causes of its development
According to the intensity of the course of the disease, the following types can be distinguished:
- Spicy
- Chronic.
Features of the course of the acute form
This type of disease is seen in patients who suffer from other liver problems (cirrhosis, hepatitis) but regularly consume alcoholic beverages.
Acute alcoholic hepatitis is accompanied by the following symptoms:
- A very strong weakness.
- Jaundice.
- Pain in the hypochondrium.
- Nausea and vomiting.
- Weight loss and stool changes.
Acute alcoholic hepatitis can also occur in several forms:
- The icteric appearance is most common, 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 jaundice, itching, colorless feces and dark urine.
- The fulminant appearance develops very quickly and is difficult to cure. But in the absence of treatment, the patient dies 14-20 days after the transition of the disease to the acute phase from hepatic-renal failure.
- Latent, characterized by an asymptomatic course and difficult diagnosis.
In all of the above cases, there is a significant increase in the liver, some patients have anorexia.
Chronic form
Classical chronic alcoholic hepatitis develops with regular alcohol consumption, but without concomitant liver disease. It is difficult to identify this form of the disease; an examination of the liver and its changes, as well as an increase in the level of transaminase, will help in making a diagnosis.
Chronic alcoholic hepatitis is almost asymptomatic, and the patient may complain of the following discomfort:
- Decreased appetite and nausea.
- bad dream, increase in men mammary glands.
- Decreased sexual activity.
- Pain in right hypochondrium and liver enlargement.
- Vascular stars, white nails.
The development of this form of the disease leads to the frequent use of alcohol, which is 70 g of pure ethanol for men, 20 g for women.
Who is at risk?
Scientists have proven that most of the alcohol, or rather the ethanol that it contains, is broken down by the liver. About 20% of ethanol is broken down in the stomach, turning into acetaldehyde. This substance destroys cells and leads to pathological changes internal organs. Note that alcohol is doubly dangerous for women, because the ability of a woman's stomach to break down ethyl is two times lower than that of a man.
A high probability of getting hepatitis in people who have been drinking 100 g or more of pure alcohol daily for several years. 50 ml of vodka contains 20 g of alcohol, it turns out that 250 ml contains 100 g of pure alcohol, and this is already a dangerous dose.
Doctors also identify the following reasons that can accelerate the development of the disease:
- Long-term alcohol use (more than 5 years).
- Drinking alcohol in large quantities.
- genetic predisposition.
- Obesity and bad habits.
- Overeating, lack of healthy foods high in protein.
Also, the cause of the development of the disease is poor ecology, which weakens the immune system, poor-quality food and cheap alcohol made from chemical components. And if the patient drinks strong antibiotics and other medicines, while continuing to drink alcohol, then he also falls into the risk group.
Now consider how to treat the disease and recover from it.
How is the disease diagnosed?
To diagnose the disease, modern laboratory and hardware techniques are used. Ways 
diagnostics depend on the patient's complaints, the clinical picture and the form of the disease. For example, if a person suffers from a latent form of the disease, then a biopsy is required, and an ultrasound of the abdominal organs will reveal the chronic form.
Most often, the following laboratory tests can be prescribed to the patient:
- General analysis of blood and urine.
- Biochemistry of blood and liver sample.
- Analysis to assess blood clotting and cholesterol.
Depending on the nature of the course of the disease, ultrasound, MRI or CT may be prescribed, but these methods are ineffective. Best Option diagnosis is a biopsy.
Features of treatment
Treatment usually begins after diagnosis. The main factor in the treatment of alcoholic hepatitis is diet, in these cases, treatment table No. 5 is prescribed, we will talk about it later.
For the treatment of alcoholic hepatitis, the following medicines are used:
- Detoxification therapy may be prescribed, during which drugs are administered intravenously. The therapy helps in a short time to cleanse the body, increase its endurance and prepare the patient for drug treatment.
- Metabolic and coenzyme therapies aimed at improving the metabolism in the cells of the body.
- Drugs that help liver cells to remain active, and also contribute to their speedy regeneration.
- Drugs that are analogues of the hormones of the adrenal cortex. This group of drugs suppresses the production of antibodies and inflammatory processes, prevents tissue scarring.
- Naturally, for the treatment of any alcoholic hepatitis, the patient is prescribed a course of vitamins, including vitamins A, B, C, E and others. The disease is accompanied by a deterioration in the function of absorption of nutrients.
The above drugs are prescribed by a doctor, the dosage and duration of administration are calculated individually, depending on the form of the disease, its neglect, and diet. Note that it is necessary to abandon the use of ethyl, otherwise the therapy will be ineffective.
Features of the treatment table No. 5
A set of diets for various diseases was developed by the Soviet nutritionist Pevzner, and although they are actively criticized today, their use gives good results in treatment. different types alcoholic hepatitis. In particular, with this disease, treatment table No. 5 is used, which helps to solve such problems:
- Restoration of liver function.
- Restoration of the activity of the biliary tract.
The diet menu spares the liver, relieves the load from it and improves the work of medicines. Consider the list of prohibited foods:
Very fresh bread and flour products.
All fatty fish and meats.
Strong broths: meat fish, mushroom, okroshka, cabbage soup.
Any smoked, spicy and overly salty foods.
Dairy and sour-milk products with high fat content.
Eggs, hard boiled or fried.
Legumes, spicy and fatty sauces.
Ice cream, chocolate and sweets, products with cream.
The diet is rich in protein foods (cottage cheese, meat, fish), but all dishes should be non-fat, steamed or in foil in the oven.
The calorie content of the diet is about 3000 kcal, the daily amount of protein is 90 g, carbohydrates 400 g, and fats 80 g, but 30% of them should be vegetable. The patient must consume up to 3-4 liters of fluid per day, reducing the amount of salt to 4 g. Thus, the vital organ is unloaded, the body is cleansed, and the duration of the diet can be either 14 or 21 days.
How long does the treatment take?
With a timely visit to the hospital and the early abandonment of a bad habit, a favorable prognosis can be made. The liver is able to recover, so the treatment of alcoholic hepatitis in the initial stages gives good results, and the patient can forget about the unpleasant disease for a long time.
But remember that with a successful cure, you must avoid drinking alcohol, otherwise you can again be under a dropper. And in especially neglected cases, the likelihood of death increases.
How to avoid this disease?
To avoid most liver diseases, it is enough just not to drink alcoholic beverages, exclude fatty foods from your menu, and try to smoke less. But even if you rarely drink alcohol, and the next morning after the feast you feel a pulling pain on the right side under the ribs, then do not delay going to the doctor, because these may be manifestations of the first symptoms of alcoholic hepatitis.
Alcoholic hepatitis is an inflammatory process. It occurs against the background of a large consumption of alcoholic beverages. As a result of this, the body is affected by toxins. The chronic form of the disease occurs 5-7 years after the onset of the inflammatory process. The scale can be serious, it all depends on the quality of alcohol consumed and its quantity.
ICD-10 code
For convenience, a special international classification diseases. Thanks to it, you can understand the diagnosis made anywhere in the world. Simply put, this encoding is used everywhere. Hepatitis is one of the diseases of the digestive system.
K00-K93 Diseases of the digestive system. . K00-K14 Diseases of the oral cavity, salivary glands and jaws. K20-K31 Diseases of the esophagus, stomach and duodenum. K35-K38 Diseases of the appendix [vermiform appendix]. K40-K46 Hernias. K50-K52 Noninfectious enteritis and colitis.
K55-K63 Other bowel diseases. K65-K67 Diseases of the peritoneum
K80-K87 Diseases of the gallbladder, biliary tract and pancreas. K90-K93 Other diseases of the digestive system
K70-K77 Diseases of the liver.
- K70 Alcoholic liver disease (alcoholic liver disease, liver cirrhosis).
- K70.0 Alcoholic fatty degeneration of the liver.
- K70.1 Alcoholic hepatitis.
- K70.2 Alcoholic fibrosis and sclerosis of the liver.
- K70.3 Alcoholic cirrhosis of the liver.
- K70.4 Alcoholic liver failure (Liver failure).
- K70.9 Alcoholic liver disease, unspecified
- K71 Toxic damage to the liver.
- K72 Liver failure, not elsewhere classified. (Liver failure).
- K73 Chronic hepatitis, not elsewhere classified. (Chronic hepatitis).
- K74 Fibrosis and cirrhosis of the liver (cirrhosis of the liver).
- K75 Other inflammatory diseases of the liver.
- K76 Other diseases of the liver.
- K77 Liver disorders in diseases classified elsewhere
ICD-10 code
K70.1 Alcoholic hepatitis
Causes of chronic alcoholic hepatitis
The name speaks for itself. The main cause of liver problems is heavy alcohol consumption. The systematic intake of alcoholic beverages in an increased amount will sooner or later affect the condition of the liver. Alcohol contributes to the disruption of the oxidative processes of cellular structures. It has a toxic effect and disables the body. Eventually, cirrhosis of the liver may develop, requiring a liver transplant.
The minimum amount of alcohol that can lead to inflammation is 20-30 grams regularly. This figure refers to the female population. For a man, it is slightly higher and amounts to 60-70 grams per day. As can be seen from these statistics, a very small amount of alcohol is enough to get serious problems. There are simply no other reasons contributing to the development of inflammation. It's all about alcohol. Therefore, its consumption should be kept to a minimum.
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Pathogenesis
The toxic effects of ethanol lead to dependence. Ethanol has a particular effect on the concentration of acetaldehyde and acetate in the blood. The oxidative process increases NAD*H / NAD+ levels. It is these indicators that play an important role in the formation of fatty degeneration of the liver. As soon as the concentration of the first indicator increases, there is an increase in the synthesis of glycero-3-phosphate. As a result, fatty acids begin to actively accumulate in the liver.
Acetaldehyde has a hepatotoxic effect. It manifests itself mainly due to the intensification of lipid peroxidation processes. Ultimately, the functions of cell membranes are disrupted. In the complex of acetaldehyde with proteins, it leads to a change in the structure of hepatocyte microtubules. As a result, the formation of alcoholic hyalgin occurs. Intracellular transport is disturbed, hepatocyte dystrophy occurs.
Increased formation of acetaldehyde leads to a decrease in the activity of mitochondrial enzymes. As a consequence of this, the synthesis of cytokines is significantly enhanced. Cellular immunity is significantly impaired. Ultimately, the liver is exposed to a strong negative effect. The inflammatory process begins, the functionality is undermined. As a result, alcoholic hepatitis develops, flowing into a chronic form.
There are different points of view regarding the terminology of this type of alcoholic liver injury. L. G. Vinogradova (1990) gives the following definition: “chronic alcoholic hepatitis” is a term that refers to relapses of acute alcoholic hepatitis that occur against the background of an incomplete previous attack of acute alcoholic hepatitis and lead to a kind of liver damage with features of chronic hepatitis.
Histological examination reveals two forms of chronic alcoholic hepatitis: chronic persistent and chronic active. Morphologically chronic persistentalcoholic hepatitis combines the characteristic features of alcoholic hepatitis with moderate pericellular and subsinusoidal fibrosis in the third zone of the acinar hepatic lobule, expansion of the portal ducts, portal fibrosis, and slight portal infiltration. In the clinical picture, there is a decrease in appetite, mild pain in the liver, belching, general weakness, a slight enlargement of the liver, a mild increase in the activity of γ-glutamyl transpeptidase in the blood serum.
Chronic alcoholic active hepatitis histologically combines signs of alcoholic hepatitis with active fibrosis and hyaline necrosis in the hepatic lobules, bridging and multilobular necrosis is possible with a high activity of the pathological process. Clinical manifestations are characterized by severe weakness, lack of appetite, pain in the liver, jaundice, enlarged, dense and painful liver, significant changes in liver function tests, in particular, high activity of γ-glutamyl transpeptidase, aminotransferases in the blood serum, an increase in the blood level of immunoglobulin A.
Chronic alcoholic hepatitis can progress to cirrhosis of the liver even in conditions of abstinence from alcohol due to the addition of autoimmune mechanisms - sensitization of T-lymphocytes to alcoholic hyaline.
Chronic alcoholic hepatitis is a liver disease. Naturally, caused by a large consumption of alcoholic beverages. This disease must be eliminated, because, in most cases, it flows into cirrhosis of the liver. During the intake of alcoholic beverages, acidaldehyde is formed in the liver. It is he who strongly affects the liver cells. It is able to start a number of chemical reactions in the body and thereby lead to damage to the organ.
Symptoms of chronic alcoholic hepatitis
The clinical manifestation of this disease is limited to meager symptoms. So, the organ may slightly increase in size, while pain appears. Severe pain, lack of appetite is not ruled out. Over time, the symptoms are supplemented by nausea and vomiting. There are no physical data.
Often there is a violation of the rhythm of sleep and wakefulness. A person has a decrease in libido, an increase in body temperature is noted. A number of other signs can be identified. So, the nails become white, spider veins appear, palmar erythema and ascites often develop. These changes are characteristic directly for the chronic form of the course of the disease. The symptoms described in the first paragraph appear at the initial stage.
The chronic course is characterized by the severity of symptoms, as well as their diversity. They may well appear at the same time. If treatment is not started on time, a fatal outcome is not ruled out. This happens due to the rapid development of cirrhosis of the liver. Severe liver damage requires liver transplantation. The risk factor is present in people with low weight, jaundice and increased liver density. Alcoholic hepatitis together with these factors is fraught with aggravating consequences.
First signs
The whole danger lies in the fact that for a long time the disease can be asymptomatic. Symptoms appear in severe stages. You can suspect something is wrong by violations of the liver. A person begins to feel weak, he has increased fatigue, appetite worsens, body weight decreases sharply. These are the first signs to look out for. As a rule, the pain syndrome does not particularly manifest itself at this stage. Therefore, a person most often thinks that his condition is associated with a decrease in immunity and other diseases. He is in no hurry to visit the doctor.
Over time, the pain syndrome begins to manifest itself. To a greater extent, it is similar to discomfort and a feeling of heaviness in the right hypochondrium. Again, this situation does not really bother a person. After all, you can easily think that low-quality products were used. Alcoholics, as a rule, do not understand that all troubles arise against the background of uncontrolled drinking. Gradually, nausea, vomiting and a bitter taste in the mouth are added to all the symptoms. There may be an eructation with bitterness. This sign is associated with the use of alcohol and fatty foods.
Jaundice may also appear. An icteric shade of the sclera and membranes of the oral cavity appears. As the disease progresses, yellowness of the skin occurs. Sometimes itching is added to this, as well as an increase in the liver.
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Effects
If the treatment was started on time, then there can be no consequences. In most cases, everything ends successfully. Subject to all recommendations and the exclusion of alcoholic beverages, there can be no consequences. Otherwise, the development of cirrhosis and fibrosis of the liver is possible.
Fibrosis is a reversible stage of the process. It can be eliminated with the right treatment. Cirrhosis cannot be cured this case perhaps get rid of the problem by organ transplantation.
If the treatment is started on time, and the transplant gave a positive result, then the prognosis will be favorable. But, in no case should you drink alcoholic beverages. Otherwise, there is a risk of re-inflammation. Therefore, you should always follow all the recommendations given and not deviate from them. Otherwise, death is not ruled out. Whether there are consequences or not, in most cases depends directly on the patient.
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Complications
It must be understood that this inflammatory process has disappointing complications. The fact is that in most cases hepatitis turns into cirrhosis of the liver. It is impossible to cope with the problem at the medical level. All that is needed here is a transplant. By its severity, cirrhosis is equated to a malignant tumor.
Ascites can be another complication. It is also caused by hepatitis. The main sign of a problem is a strong protrusion of the abdomen. This is due to the fact that in the human abdominal cavity there is a large number of free liquid. The type of ascites is completely determined by the amount of that same fluid. With a small form, it can be 3 liters, medium - more than 3 liters. With a high form, the amount of liquid varies up to 20-30 liters. A person is not able to move normally, there are some difficulties.
It should be understood that ascites is an alarm signal. It indicates that the organ is not able to filter the blood. You can't miss this moment. After all, otherwise the patient will live no more than 5 years.
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Diagnosis of chronic alcoholic hepatitis
The first step is to collect an anamnesis of the disease and complaints. It is important to identify how long the symptoms began. Important information is the amount of alcohol consumed and its frequency. It is important to collect an anamnesis of life. Does the patient have any chronic processes in the body, are there any hereditary diseases. The presence of bad habits, tumors and contact with toxic substances are also taken into account.
Then a physical examination is performed. On examination, the shade of the skin, the size of the abdomen, and the presence of spider veins on the body are taken into account. On palpation, a person feels pain in the abdomen. Thus, you can also feel the enlarged organ. It is important to assess the mental state of the patient.
If necessary, an ultrasound is performed. The complete picture consists of laboratory studies, instrumental and differential diagnostics. Detailed information will be provided below.
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Analyzes
An important role is played by laboratory research. They include a complete blood count. Thanks to it, you can determine the level of red blood cells, as well as hemoglobin. It is easy, it turns out, to detect leukocytosis.
In addition to the general analysis, a biochemical blood test is given. It allows you to evaluate the functionality of the liver, pancreas. biochemical markers. According to them, blood coagulability indicators, the work of gamma-glutamyl transpeptidase are checked. Aliproprotein A1 is monitored. It can be used to determine the condition of the liver. If proline and hydroxyproline are significantly elevated in the blood, then, most likely, liver fibrosis occurs. This condition is characterized by the growth of scar tissue.
The coagulogram is also widely used. It is an analysis of the coagulability of blood systems. Lipidogram is a study of fat-like substances in the blood. It is possible to determine the long-term use of alcohol by laboratory signs. In humans, the activity of gamma-glutamyl transpeptidase, immunoglobulins, aspartate aminotransferase is significantly increased.
To get a complete picture, markers are defined. These are specific indicators that allow you to determine the presence of inflammatory processes in the liver that were caused by specific viruses. They also give a general urine test. It allows you to determine the general condition of the kidneys and urinary system. A coprogram is also carried out, in other words, an analysis of feces for the presence of undigested fragments of food and fat in it.
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Instrumental diagnostics
This research methodology is diverse. So, most often resort to the help of ultrasound. This will allow you to assess the condition of the abdominal organs and notice any changes in them.
Esophagogastroduodenoscopy is widely used. It is a diagnostic procedure during which the specialist manages to assess the condition of the esophagus as a whole. This allows you to identify pathologies. Inspection lends itself to the stomach and duodenum. The study is carried out using a special tool - an endoscope.
In addition, a needle biopsy is performed. For this, a damaged piece of the liver is taken and carefully examined. This allows you to assess the structure of the organ and make the correct diagnosis.
Helical computed tomography is widely used. This method consists in obtaining X-ray images at different depths. The study allows you to get an accurate image of the affected area. Magnetic resonance imaging has a similar effect. This technique is built on the chain of interaction human body with liquid. It allows you to get a clear image of the organ under study.
Elastography. This technique allows you to examine the liver tissue. Everything is carried out using a special apparatus that allows you to determine the presence of liver fibrosis. During the procedure, a special compression of the tissue under study is carried out. As a result, you can see the changes. Most often, the procedure is used as an alternative to a biopsy.
Retrograde cholangiography. This technique is based on contrast management. It is usually introduced into Vater's nipple. The procedure allows you to determine the deterioration of the outflow of bile. Cholangiography is performed for people with severe cholestasis syndrome.
Differential Diagnosis
This type of diagnosis includes laboratory tests. Initially, a person needs to pass a general blood test, as well as a biochemical blood test. By the level of leukocytes, hemoglobin and erythrocytes, it is possible to determine the presence of abnormalities and the inflammatory process. Particular attention is paid to blood clotting.
In addition to this procedure, a biopsy is performed. It allows you to make a sample of the affected tissue and examine it. This technique is the most reliable, but only works in conjunction with blood tests.
To determine the state of the urinary system, a urine test is taken. It is important to determine the presence of markers. In addition, the stool is examined for the presence of coarse dietary fiber or undigested food fragments. It is impossible to get a complete picture by instrumental or diagnostic methods alone. All studies must be carried out collectively.
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Treatment of chronic alcoholic hepatitis
First of all, a person must refuse to take any alcoholic beverages. Naturally, for an alcoholic this is an unbearable burden. Therefore, it will have to be controlled. Because sooner or later all this will flow into cirrhosis of the liver. This is a very severe lesion, which most often ends in death.
It is worth visiting a psychologist and a narcologist. This will allow you to get rid of addiction and understand the severity of the whole process. Indeed, in most cases, a person is not able to cope with the problem on his own. All patients must strictly follow the diet number 5. Its purpose is to reduce the load on the diseased organ. That is why fatty, fried and spicy foods are among the forbidden foods. It is worth giving up salt, canned food, sweets and strong teas. Preference is given to food, which contains a lot of fiber, vitamins and minerals.
Naturally, it is impossible to do without medicines. True, in this case it is necessary to show special care. Because drugs should have a positive effect on the body and not injure it. Most often, hepatoprotectors are prescribed. This is a group of drugs that are able to regenerate liver cells and protect it from negative effects. It is mainly recommended to use Ursosan, Essentiale N, Heptral and Rezalyut Pro. The course of treatment does not exceed one month. Detailed information about medications will be presented below.
It is important to fill the human diet with vitamins and minerals. Herbal teas, including those based on echinacea and mint, will be useful. If a person is pestered by an overexcited and stressful state, it is worth drinking a sedative. Valerian can act as it, but only in tablets! Tincture should not be used in any case! Enough 2 tablets 3 times a day. With severe liver damage, when cirrhosis is observed, it is worth resorting to organ transplantation. Otherwise, the person will not survive.
Medications
Ursosan. The dosage of the drug is prescribed by the attending physician. In especially severe cases, 14 mg per kilogram of body weight is used. The duration of therapy can be from one month to six months. In some cases, even 2 years. Contraindications: hypersensitivity, pregnancy, impaired liver and kidney function. Side effects: pain in the liver, nausea, vomiting, allergic reactions.
Essentiale N. The dosage is 2 capsules 3 times a day. The duration of therapy depends on the condition of the person. Contraindications: hypersensitivity. Side effects: extremely rarely, intestinal upset may occur.
Heptral. The drug can be used both in the form of tablets and injections. With prolonged therapy, the daily dose should not exceed 4 tablets. If the agent is administered, then 400-800 mg is sufficient. The duration of treatment is determined by the doctor. Contraindications: hypersensitivity. Side effects: heartburn, nausea, sleep disturbance, allergic reactions.
Resolution Pro. The drug is used 2 capsules, 3 times a day before meals. The duration of treatment depends entirely on the course of the disease. Contraindications: hypersensitivity, antiphospholipid syndrome. Side effects: diarrhea, allergic reactions.
Alternative treatment
Traditional medicine has a lot of useful recipes. Many herbs, fruits, plants and roots can be used for treatment. True, some of them can be toxic. Therefore, independent use can lead to a lot of unpleasant consequences. Before starting treatment, you should consult with a specialist.
Recipe 1. Blueberries. The beneficial properties of this berry have long been known. Its leaves contain special enzymes that help fight hepatitis. Many healers recommend using blueberry decoctions. You can use fruit drinks, juices and just eat the berry. Even jam will have a positive effect. The leaves themselves have special power. They are able to block viruses and protect the body.
Recipe 2. Pumpkin. It is useful with minerals and vitamins. Its pulp can be used both for treatment and just nutrition. It should be noted that it is not recommended to use it for more than 3 months. Traditional healers recommend using it fresh for about half a kilogram per day. You can cook porridge, stew it, and also eat it in the form of candied fruits. Of particular benefit is raw pumpkin along with sour cream. You can use pumpkin juice. Pumpkin treatment is useful in cirrhosis of the liver.]
Herbal treatment
Medicinal herbs have a positive effect on many organs and systems. But, it is important to understand which of them can be used, and which ones should be avoided.
Recipe 1. Dandelion herb. With its help, many diseases can be eliminated. Especially those associated with liver failure. In the treatment of hepatitis, dandelion grass should be consumed fresh. Salads are fine. You can use jam from them. Dandelion has a choleretic effect. A decoction of it should be consumed before each meal, half a glass. It is prepared simply, dandelion leaves are taken and poured with boiling water. Then the tool must be allowed to brew and cool. The root of the plant is used to fight hepatitis. It should be crushed and evaporated for an hour. Then apply a tablespoon before meals.
Recipe 2. You need to take St. John's wort, calendula flowers, and chicory. Mix all this and take only 2 tablespoons of the collection. Then pour them with two glasses of cold water. Everything is infused all night, boiled for 5 minutes in the morning and filtered. You can drink the remedy regardless of the meal. The course of treatment is 2 months.
Recipe 3. Take the herb horsetail, yarrow and rose hips. It is important that everything is in equal proportions. After that, everything is mixed and only one tablespoon is taken. The collection is poured with a glass of boiling water and infused for 2-3 hours. You can use the resulting remedy 3 times a day 30 minutes before meals. The duration of treatment is 2 weeks. If necessary, the course is repeated after a month.
Homeopathy
Homeopathic remedies have always been in demand. True, they are not suitable for everyone. So, there are both positive and negative opinions about them. Among homeopathic remedies, only a few are able to help. So, the funds deserved special popularity: Hepel and Galstena. They have a positive effect, but only if applied under the supervision of an experienced homeopath. The main action of the funds is aimed at regenerating liver cells and creating a protective barrier around it. Drug therapy is long-term. It should be noted that monopreparations have always been distinguished by a special affinity for liver cells. Among them, it is worth noting May celandine and milk thistle. These two drugs are able to eliminate most of the symptoms that occur with liver damage. In addition, they support her.
The negative opinion is that not all people resort to the help of homeopathy. It's not like she can help everyone. The fact is that homeopathic remedies do not undergo any clinical trials, so it is difficult to say whether a positive effect will be observed.
Surgical treatment
Surgery refers to liver transplantation. This operation not only difficult, but also expensive. Such an intervention is appropriate only if a person has cirrhosis of the liver or the last degree of liver failure.
High-quality transplantation can be carried out exclusively in German clinics. As mentioned above, the procedure is really expensive. The complexity of this operation lies not only in the price, but also in the search for a donor, because finding a person with good physical and mental characteristics is not always so easy. Some people stand in the "queue" for a new organ for years and do not always wait for it.
The operation itself is difficult. The recovery period is very long. It is necessary to monitor the condition of a person and an organ. After all, he takes root long time and it's not always possible. Naturally, it is best not to resort to such an operation. Nobody gives 100% positive result. To avoid such a need, you should simply exclude alcohol consumption and treat pathological and inflammatory processes in the body in time.
Prevention
Prevention of alcoholic hepatitis is the only way to avoid this problem. After all, the treatment is not only long, but also difficult. Moreover, during the recovery period, many difficulties can arise. First of all, the consumption of ethanol-containing drinks should be excluded. In this case, we mean alcoholic beverages, of any percentage significance. The daily intake for a woman should not exceed 20 grams, and for a man 40 grams. If these figures are significantly higher, the likelihood of developing alcoholic hepatitis also increases.
The only way to avoid this problem is to avoid alcohol completely. If a person consumes it periodically, it is difficult to draw conclusions regarding his health. The development of alcoholic hepatitis depends entirely on the amount of alcohol consumed, the person's lifestyle and the nature of his diet. Naturally, a special place is given to the condition of the liver. It may not initially be at its best and alcohol will only make matters worse.
Forecast
The prognosis depends entirely on the condition of the liver and the stage of development of the disease. The best prognosis is observed in the presence of alcoholic fatty degeneration. This condition is characterized by the presence of fatty droplets inside the liver cells. It happens under the influence of alcohol. Eliminate this problem not so difficult. Therefore, the prognosis is usually favorable.
A negative course is observed in cirrhosis of the liver. In this case, the problem can be eliminated only by means of transplantation. Medicines are unlikely to required action. With cirrhosis, the prognosis is poor.
A positive course is possible only if a person completely refuses to take alcohol and begins timely treatment of inflammatory processes in the body. Young age and normal body weight also affect the favorable prognosis. Finally, the disease proceeds much more favorably in men than in women.