Alcoholic hepatitis. Toxic hepatitis of the liver: acute, chronic, medicinal, alcoholic

Alcoholic hepatitis is an extensive degenerative-inflammatory changes in the liver tissue that develop due to the toxic effects of alcohol and its decay products. Hepatitis, which has developed on the basis of alcoholism, does not pose a danger to others, it is not contagious.

Is the child often sick?

your child constantly sick?
A week in kindergarten (school), two weeks at home on sick leave?

Many factors are to blame for this. From bad ecology, to weakening of immunity with ANTIVIRAL DRUGS!
Yes, yes, you heard right! By stuffing your child with powerful synthetic drugs, you sometimes do more harm to a small organism.

In order to radically change the situation, it is necessary not to destroy the immune system, but to HELP IT ...

Causes

The toxic effect of alcoholic beverages on the liver is due to the fact that it is in it that 80% of the alcohol consumed is broken down. The resulting acetaldehyde destroys liver cells. Only 20% of ethanol is broken down in the stomach. In women, the enzyme in the stomach for the breakdown of alcohol is produced much less, therefore, the liver tissue is destroyed faster.

With regular alcohol consumption, fatty inclusions are first deposited in the liver cells (hepatocytes), some cells die due to inflammation. Over time, fatty degeneration of the liver leads to the replacement of liver cells with scar (fibrous) tissue, the liver cannot perform its many functions in the body. Toxic alcoholic hepatitis causes cirrhosis of the liver.

For the formation of alcoholic hepatitis, a 5-7-year systematic use of 40-60 ml / day of ethanol (pure alcohol) by men, 30 ml by women and 15-20 ml by adolescents is sufficient. It is known that 10 ml of ethanol is equivalent to 25 ml of vodka, 200 ml of beer or 100 ml of wine. The type of drink is not important. Regularity of use and dose matters. Daily consumption of 0.5 liters of beer after 5 years can lead to cirrhotic changes in the liver.

Factors that increase the risk of developing hepatitis:

large doses of alcohol consumed;
hereditary predisposition to alcoholism;
long-term use
irrational nutrition;
obesity;
infection with hepatotropic viruses (affecting the liver tissue).

Symptoms

The disease develops gradually, imperceptibly for a lover of strong drinks: During this period, it can only be detected during examination. The first symptoms appear 5 years after damage to the liver cells. As liver damage increases, the number of manifestations and their severity increase.

Depending on the intensity of the development of the process, alcoholic hepatitis is distinguished - acute and chronic.

Acute hepatitis is said to be in the case of a progressive process in the liver in people with already existing chronic hepatitis or cirrhosis, but who continue to drink alcohol. At the same time, chronic hepatitis quickly turns into alcoholic cirrhosis, and when acute hepatitis occurs against the background of already existing cirrhosis, it is particularly severe. Acute hepatitis often develops after drinking.

It can proceed in 4 ways:

Latent (hidden): the symptoms of the disease do not appear, it is diagnosed in a blood test that reveals an increased activity of transaminases. The diagnosis can be confirmed with a biopsy.
Icteric, the most common variant. With it, characteristic symptoms appear:

yellowness of the skin, mucous membranes, biological fluids (urine, tears, saliva);
weakness;
lack of appetite;
pain in the hypochondrium on the right;
nausea, possible vomiting;
violation of the stool (diarrhea);
weight loss;
development of bacterial infections with a severe course (pneumonia, urinary tract infections, etc.).

cholestatic variant noted with stagnation of bile. It is manifested by a protracted course with severe jaundice, severe itching, dark urine and discolored feces.
fulminant- the most aggressive and rapidly progressing. Differs in the development of renal and hepatic insufficiency, the occurrence of bleeding. More often ends with the development of hepatic coma and death of the patient.

Why is my child's immune system weakened?

Many people are familiar with these situations:

As soon as the season of colds begins - your child is bound to get sick and then the whole family...
It seems that you are buying expensive drugs, but they only work while you are drinking them, and after a week or two baby gets sick again...
Are you worried that your child's immune system is weak very often disease takes precedence over health ...
Afraid of every sneeze or cough...
It is necessary to strengthen YOUR CHILD'S IMMUNITY!

For the chronic course of alcoholic hepatitis, the following syndromes (a set of signs) are characteristic:

Asthenic: general weakness;

increased fatigue;
poor appetite;
disturbed sleep rhythm (daytime sleepiness);
depressed mood.

dyspeptic:

nausea and vomiting;
liver enlargement;
pain in the hypochondrium on the right;
bloating;
weight loss.

Syndrome of "liver signs":

vascular "asterisks" on the trunk and face;
yellowness of the skin and mucous membranes;
redness of the skin on the palms and soles,
dilation of blood capillaries on the face (telangiectasia).

Syndrome of system signs(due to the influence of alcohol intoxication on other organs and systems):

polyneuropathy is manifested by sensory disorders, limitation of movements;
amyotrophy;
increased heart rate;
dyspnea;
impotence and testicular atrophy;
decreased libido;
tendency to bruising;
gynecomastia (enlarged mammary glands in men);
deformity of the hands due to shortening of the palmar tendons or Dupuytren's contracture;
rise in temperature, etc.

Manifestations of chronic hepatitis are individual, sometimes there are only a few symptoms.

There are 2 forms of chronic hepatitis:

Persistent hepatitis: its symptoms are rather poor, the patient's condition is stable, periodically there is heaviness in the hypochondrium on the right, nausea, a feeling of fullness in the stomach, belching. 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 occurs 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.

Cessation of alcohol consumption and full treatment can lead to stabilization of the process, but at this stage it is no longer possible. With the continuation of the previous lifestyle and without treatment, the disease will lead to the development of hepatic coma and death.

Diagnostics

For diagnosis, the attending physician uses:

a patient survey to clarify complaints, the presence of bad habits, past and concomitant diseases, contact with toxic substances, etc .;
examination allows you to detect "liver signs", determine the size of the spleen and liver, fluid in the abdominal cavity, etc .;
laboratory methods: clinical and biochemical blood tests (determination of the level of bilirubin in the blood, the activity of liver enzymes ALT and AST, protein composition, coagulogram), tumor markers, markers of viral heatitis; marker of liver fibrosis (to exclude cirrhosis), etc.,
instrumental diagnostic methods:

a) Ultrasound - to determine the size and structure of the spleen and liver;

b) EFGDS - endoscopic examination by a doctor of the esophagus, stomach and 12-p. intestines (to detect dilated veins in the esophagus, characteristic of cirrhosis of the liver);

c) spiral CT scan of the spleen and liver;

d) MRI - tomography allows you to evaluate the structure of the spleen and liver using the obtained accurate images of the organs;

e) elastography - a study to detect fibrosis (cirrhosis) of the liver;

f) retrograde cholangiography - X-ray examination to clarify the cause of jaundice in cholestatic hepatitis, to exclude a tumor that obstructs the outflow of bile;

g) ultrasonic dopplerography (UZDDG) allows to detect or exclude increased pressure in the portal vein (portal hypertension), characteristic of liver cirrhosis;

liver biopsy (taking liver tissue with a puncture needle for histological examination).

Treatment

Treatment for all forms of alcoholic hepatitis includes the complete elimination of the use of any alcoholic beverages. Although, according to statistics, only every third patient stops using, another third of patients reduce their use.

If you can’t get rid of addiction on your own, then you need the help of a narcologist, otherwise the treatment of hepatitis will be unsuccessful and the outcome of the process will be cirrhosis and death. An unfavorable outcome may be in these patients even when treatment with antipsychotics prescribed by narcologists is contraindicated due to liver failure.

In addition to avoiding alcohol intake, treatment includes:

energy diet;
drug therapy;
surgery.

The prescribed diet should eliminate the endogenous depletion of the body, ensure the intake of a sufficient amount of proteins, trace elements, vitamins (especially important from group B and folic acid). The energy value of nutrition should be at least 2000 cal / day, and the amount of protein should be at the rate of 1 g / kg of the patient's weight. In case of anorexia (aversion to food), nutrition is applied through a tube or parenteral (introduction of the necessary solutions into a vein).

Features of diet number 5:

dishes are cooked by boiling, baking or steaming, fried foods are excluded;
the use of spicy, fatty foods, pickles is prohibited. too cold foods and drinks;
eating in fractional portions 5 r. in a day;
rich fish, meat, mushroom broths should be excluded, vegetarian soups are recommended;
carbonated drinks, cocoa, coffee, chocolate, nuts should be excluded.

Medical treatment includes:

detoxification in a severe form of the disease with the help of intravenous infusions of solutions and the use of sorbents (Enterosgel, Polisorb, etc.);
antibacterial drugs (antibiotics Norfloxacin, Ofloxacin, Levofloxacin, etc.) in a short course to prevent bacterial infections;
vitamin therapy;
hepatoprotectors - preparations of selective action on the liver, stimulating the regeneration of liver cells and normalizing liver functions, increasing its resistance to toxic effects.

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.

The surgical treatment is liver transplantation. It is used in rare cases with severe liver failure. The complexity of the method lies in the selection of a donor. A relative can become a donor. They take 60% of the liver from him, and then it regenerates to its original size. After a liver transplant, the recovery period is very important for the liver to take root.

The only way to avoid the development of alcoholic toxic hepatitis and the search for "how to treat?" is the rejection of the abuse of alcoholic beverages, regardless of their type, strength, quality. Only at the initial stage of persistent hepatitis with the cessation of alcohol consumption can one hope for a cure. With continued use, the outcome is one - cirrhosis of the liver.

It might be interesting:

If a child is constantly sick, his immunity DOES NOT WORK!

The human immune system is designed to resist viruses and bacteria. In babies, it is still not fully formed and does not work to its full potential. And then there's the parents "finish off" the immune system with antiviral agents, accustoming him to a relaxed state. The poor ecology and the wide distribution of different strains of the influenza virus make their contribution. It is necessary to temper and pump the immune system and you need to do this IMMEDIATELY!

Acute toxic hepatitis, called "Acute toxic hepatitis", develops as a result of a single, high concentration of poison or a small dose of poison with affinity for liver cells, as a rule, symptoms appear after 2-5 days.

Toxic hepatitis of a chronic course, called "Chronic toxic hepatitis", develops with repeated ingestion of poison, in small doses, which does not have an affinity for liver cells, and can manifest itself after months or years. Manifestations of acute toxic hepatitis, expressed, are severe, the patient must be urgently hospitalized, and if medical care is not provided in time, it can lead to death. Chronic toxic hepatitis develops slowly, the symptoms appear gradually, if the cause is not eliminated, then they are complicated by cirrhosis of the liver and liver failure.

Causes of toxic hepatitis

Ingestion of harmful substances can be accidental, professional (work activity) or intentional (desired). Harmful substances that enter the body and affect the liver are called liver poisons. They enter the body in different ways. Through the digestive tract: mouth → stomach → blood → liver. Through the respiratory system: nose → lungs → blood → liver. Through the skin, poisons can also penetrate into the bloodstream, and then into the liver. Penetrating into the blood, some liver poisons can have a direct effect on the liver cell (hepatotropic poisons), disrupting its function and vital activity. Other types of poisons that disrupt blood circulation in the small vessels that feed the liver, this leads to a lack of oxygen in the cells and their death, followed by a violation of the function of the organ.

Liver poisons have a different origin:

1 . Medications, in doses prescribed by the attending physician, have a therapeutic effect, with a single dose of a large (toxic) dose of one of the drugs of these groups, toxic damage to the liver and the development of acute toxic hepatitis occur.

sulfa drugs: Biseptol, Sulfadimetoksin
antiviral: Interferon, Amantadine;
anti-tuberculosis: Ftivazid, Tubazid; antipyretic: Paracetamol, Aspirin
anticonvulsants: Phenobarbital and others.

2. Industrial poisons enter the body by inhalation or through the skin, when large doses enter the body, acute liver damage develops with the death of its cells and replacement with fat cells, with repeated ingestion of small doses, chronic toxic hepatitis develops.

arsenic- allocated at metallurgical plants;
phosphorus- contained in phosphate fertilizers, used for metal processing
pesticides- used in agriculture, for the destruction of weeds
chlorinated hydrocarbons- components of oil.
aldehydes(for example: acetaldehyde) is used industrially to produce acetic acid
phenols- contained in antiseptics used for disinfection, contained in canned food
insecticides- used in agriculture, to combat harmful insects

3. Alcohol- chronic and excessive alcohol consumption, especially of poor quality, leads to toxic liver damage. 20-40 grams of alcohol per day for men, and up to 20 grams for women, are considered safe doses, at higher doses, it has a toxic effect.
All the alcohol taken from the digestive tract with blood enters the liver. The liver actively processes the incoming alcohol. The main component of the conversion of alcohol in the liver is its interaction with the enzyme alcohol dehydrogenase. As a result of this enzymatic transformation, the breakdown of alcohol leads to the formation of acetaldehyde. Acetaldehyde is a rather toxic substance, under the influence of which, various chemical reactions in the liver are disturbed (in particular, fat metabolism). There is an accumulation of fatty acids and replacement of liver cells with adipose tissue.

4. Vegetable poisons (weed poisons: bitter, ragwort; mushroom poisons: pale grebe), have a hepatotropic effect (they act directly on the liver cell, disrupting its vital activity and replacing it with adipose tissue), resulting in the development of a clinic of acute toxic hepatitis.

Symptoms of toxic hepatitis

Signs of acute toxic hepatitis:

In mild cases, it can proceed almost without symptoms, it is found only during a group examination (for example: the use of poisonous mushrooms).

In more severe cases, it may manifest as the following symptoms:

Pain in the right hypochondrium, occur suddenly, 2-5 days after the penetration of the hepatotropic poison into the body, are the result of stretching of the capsule by the enlarged liver (due to the acute inflammatory process in it);
Signs of intoxication of the body: fever >38 0 C, general weakness, lack of appetite, nausea, vomiting (may be with blood), joint pain;
Bleeding from the nose, gums, small pinpoint hemorrhages on the skin, these manifestations are the result of the destructive action of the toxin on the walls of blood vessels;
Influence on the patient's psyche in the form of agitation or lethargy, disorientation in space, tremor, since poisons have the ability to have a toxic effect on nerve cells;
Progressive jaundice, dark urine, light feces (fatty, shiny) appears simultaneously with signs of intoxication, and is the result of a violation of the outflow of bile through the small intrahepatic bile ducts;
Enlargement of the liver in size, as a result of acute inflammation of the liver cells and their replacement with adipose tissue (fatty liver)

Signs of chronic toxic hepatitis:

Periodic pain in the right hypochondrium, of moderate intensity, worse after eating;
Heaviness in the right hypochondrium, associated with an increase in the liver;
Subfebrile body temperature 37-37.5 0 С;
Nausea, vomiting, loss of appetite, bitterness in the mouth, bloating, diarrhea, these manifestations develop as a result of a violation of the outflow of bile;
Fatigue, decreased performance;
Skin itching, itchy skin due to the accumulation of bile acids;
Enlargement of the liver and spleen.

These symptoms may subside for a while (remission), and reappear (aggravate).

Complications of toxic hepatitis

In mild cases, toxic hepatitis is completely cured. In other cases, it may be complicated by one of the following diseases:

1. Liver failure, is the result of the death of liver cells, their replacement by fat cells and a violation of its functions, manifested by the following symptoms:

Edema (as a result of a violation of protein metabolism);
Jaundice

Bleeding (decreased production of blood clotting factors);
Weight loss of the body (due to lack of saturation of the body with proteins, fats, carbohydrates, energy produced by the liver);
Hepatic encephalopathy (mental and neuromuscular disorders), develops as a result of a violation of the toxic function of the liver;

2. Hepatic coma, progressive violation of the liver and central nervous system (impaired consciousness, reflexes, convulsions, and others), the result may be death;

3. Cirrhosis of the liver, a chronic disease that results in the death of liver cells and their replacement with connective tissue.

Treatment of toxic hepatitis

Alternative methods of treatment of toxic hepatitis

First of all, it is necessary to prevent contact with the poison. To prevent the poison from entering the bloodstream, and later into the liver, it must be removed from the stomach (in cases where it has entered the digestive tract) by artificially induced vomiting. Take a comfortable position for vomiting (half-sitting position with the head tilted forward), by irritating the root of the tongue, as a result of pressing on it with a finger (but this does not apply in all cases). To weaken the effect of poison on the walls of the stomach, you can drink milk, a decoction of flax seeds. If there is an increase in temperature, cold compresses can be applied to the forehead. While we are doing all this, we urgently call an ambulance, or urgently contact a specialized medical institution (toxicology department).

With the manifestation of signs of acute toxic hepatitis, the patient must be urgently hospitalized, where the following treatment methods will be carried out under the supervision of the attending physician:

Treatment of toxic hepatitis

Bed rest
Gastric lavage, purification of the remaining poison that has entered the stomach. A patient sitting on a chair with his head tilted forward is inserted into the stomach with a special probe, a funnel is attached to the other end of the probe. When pouring water, a funnel (with a capacity of 1 liter) is raised above the level of the mouth, if it is full, it is lowered and water is poured from the stomach into a vessel. And again pour a new portion of water. Water should be at body temperature, for an adult, for gastric lavage, 8-10 liters of water are needed.
Removal of poisons from the body (activated charcoal, droppers with solutions of electrolytes), hemosorption, plasmapheresis (purification of blood from toxic substances). Activated charcoal absorbs on its surface the toxins remaining in the stomach, preventing them from entering the bloodstream.
Vitamin therapy - the use of vitamins B and C.
Hepatoprotectors (Leaf 52, Heptral, Essentiale). These drugs are actively involved in the processes of reproduction of liver cells and their recovery after damage. Lif 52 is prescribed 2 tablets 3 times a day, the duration of administration is individual, depending on the degree of liver damage.
Choleretic drugs (Holosas, Cholenzim). Together with bile, some of the toxic substances are excreted from the liver. Choleretic drugs activate this process.
Antidotes (for mushroom poisoning, Atropine). Chemicals that specifically target toxic agents or cell receptors to prevent toxic damage.

Hepatoprotectors of plant origin for the treatment of toxic hepatitis

Hepatoprotectors- increase the resistance of the liver to harmful effects (drugs, alcohol, plant and chemical poisons). Accelerate the recovery of damaged cells. Strengthen the neutralizing function of the liver.

Preparation Liv.52, description, composition, action

Compound: common chicory, prickly marques, common yarrow, western cassia, terminal arjuna, black nightshade, gallic tamarix.

Mechanism of action and effects of Liv. 52:

- Neutralization of toxic substances
Increases the activity of enzymes (cytochrome P 450, acetaldehyde dehydrogenase, etc.), which are involved in the neutralization of toxic substances. Acetaldehyde dehydrogenase reduces the damaging effect of alcohol and promotes its excretion from the body.
-Combats the harmful effects of free radicals
The components of the drug stimulate the production of substances (tocopherols, glutathione), which reduce the action of free radicals (antioxidant effect). free radicals- these are molecules on the electron shell of which there is an unpaired electron (O , HO , RO , etc.). Such molecules damage healthy cells, accelerate their aging and death.
- Choleretic effect
The drug stimulates the formation of bile by liver cells and promotes its excretion through the bile ducts. Excess fats (cholesterol, B-lipoproteins, triglycerides) and toxic substances (phenols, benzenes, etc.) are excreted from the body with bile.
-Anti-inflammatory effect
The effect is achieved due to the action of the active components of the drug on inflammatory factors (leukotrienes, prostaglandins, cyclins). So an extract from a black nightshade which is a part of Liv. 52 reduces the formation of leukotrienes, substances responsible for the formation of allergic and inflammatory reactions.

How to take Liv. 52?

Essentiale forte preparation: composition, action, how to take.

Essentiale forte. Normalizes the metabolism of lipids, proteins and carbohydrates in the liver, enhances its neutralizing function. Promotes V recovery of the liver after damage, prevents the formation of scar tissue in it. The basis of the drug is special fats (essential phospholipids) obtained from soybeans.

- Strengthens and restores liver cells.
Special fats (essential phospholipids) are incorporated into damaged liver cells, which contributes to the restoration of its integrity and functional ability.

-Reduces blood fat levels
In the blood, the level of cholesterol and other fats (triglycerides, low-density lipoproteins). The effect is achieved by reducing the formation of cholesterol in the liver, reducing its absorption in the intestine and increasing its excretion with bile.

-Reduces the formation of scar tissue in the liver.
The drug stimulates an enzyme (collagenase), which inhibits the formation of the main component of scar tissue (collagen).

Efficacy of Essentiale in the treatment of alcoholic hepatitis.
- The drug stops the progression of the disease in the early stages.
- Slows down the onset of a severe stage (cirrhosis), in which the liver tissue is replaced by cicatricial (fibrous) tissue.
- Improves liver function and in severe stages of the disease.
- The drug is effective in the treatment of toxic liver damage. Especially when poisoning with pesticides, antiepileptic drugs and fungi.

A drug Essentiale available in two versions:

With the addition of vitamins (B1, B2, B6, B12, PP, E) - Essentiale
Without vitamins - Essentiale N

Vitamins in the composition of the drug worsen tolerance and impose a number of restrictions on the use of the drug:

The duration of the use of the essential drug (with vitamins) is reduced, due to the possibility of developing an excess of vitamins in the body.
Patients with hypersensitivity to vitamins should not take this type of drug.
The daily dose of the drug is limited, due to the likelihood of side effects from large doses of vitamins.

Essentiale forte H how to take?

inside	How to use?	Duration of admission
Capsules (300mg)	2 capsules 2-3 times a day with meals	3-6 months
Intravenously(jet) (5 ml ampoules)	10-20 ml (2-4 ampoules) per day. Before administration, it must be diluted with the patient's blood in a ratio of 1:1.	10 days

Heptral tablets instructions, the action of heptral, how to take, dosage

Heptral increases the protective properties of liver cells, promotes their recovery, accelerates the processes of neutralization of toxic substances (alcohol, medicines, etc.). Has an antidepressant effect.

The mechanism of action and effects of the drug:
The main active ingredient of Heptral is ademetionine. Ademetionine is involved in the growth and protection of liver cells, nervous system and cells of other organs. Takes part in the processes of neutralization of toxic substances. Promotes the synthesis of the hormone of happiness (serotonin). In diseases of the liver, brain, its concentration in tissues decreases in parallel with the development of the disease. Heptral compensates for the lack of ademetionine, and also stimulates its formation in the body.

-Recovery and protection of liver cells
The drug promotes the formation of special fats (phospholipids). Phospholipids form the basis of the cell wall, protect against damage, stimulate the growth and repair of liver cells.

- Choleretic effect
Heptral increases the permeability of the walls of liver cells. This effect increases the formation of bile and improves its excretion into the bile ducts. With bile, toxic substances (drugs, phenols, benzopyrenes, etc.) are excreted from the body.

- Neutralization of toxic substances.
Heptral enhances the neutralizing ability of the liver by stimulating the synthesis of specific amino acids (glutathione, taurine). Glutathione is involved in the processes of neutralization of toxic substances and promotes their excretion. Taurine binds toxic bile acids in the liver, forming harmless bile compounds.

- Antidepressant effect
Heptral promotes the synthesis of mood-enhancing substances (dopamine, norepinephrine), as well as the “hormone of happiness” (serotonin). In addition, heptral enhances the susceptibility of brain structures to these substances, which also improves the antidepressant effect.

Heptral has been clinically proven to be effective and harmless in the treatment of alcoholic and drug-induced liver damage.

How to take heptral?

Mode of application	How to use?	How much to take?
inside Tablets (400mg)	2-4 tablets per day	3-4 weeks
Intravenously Vials (400mg)	400-800mg 1-2 times a day	2-3 weeks
Special instructions: It is better to take the drug in the morning, as it has a tonic effect! It is strictly contraindicated for children under 18 years of age! Use with caution during pregnancy. The exact dose, regimen and duration of treatment is determined by the attending physician!

Diet for toxic hepatitis

Alcohol and smoking are strictly prohibited. The patient should eat, in small portions, and often, thus, the excretion of bile improves. Food should not be fatty, fried, salty, without seasonings, be rich in vitamins and vegetable fiber. Therefore, the main products in the diet should be fresh vegetables and fruits (various salads), legumes (beans, peas). Use only butter and vegetable oils. Eat only easily digestible meat (chicken, rabbit). Completely abandon smoked meats, canned food. Do fasting days, one day out of the week, eat only vegetables or fruits. Persons working in industrial enterprises, with exposure to harmful substances, need daily consumption of dairy products.

The systematic and prolonged use of alcohol leads to the loss of the ability of the liver to neutralize poisons and the occurrence of alcoholic hepatitis. Pathology develops slowly and often goes unnoticed for a long time, and this threatens with serious consequences.

Description of pathology

Alcoholic hepatitis is inflammation of the liver as a result of excess alcohol consumption. Pathology is the most common type of toxic hepatitis.

The likelihood of developing the disease depends on the amount and regularity of drinking alcohol of any strength.

Special liver enzymes break down alcohol, in the process toxic acetaldehyde is formed, which affects liver cells (hepatocytes). Chemical reactions in the liver under the influence of alcohol and acetaldehyde lead to hypoxia, inflammation and necrosis of its cells.

The development of the disease is long, most often the first signs appear after 5-7 years of regular alcohol abuse.

Women are more susceptible to the development of this pathology than men, since their body contains fewer enzymes that neutralize alcohol.

Classification

There are several types of alcoholic hepatitis:

Persistent. This form of the disease is characterized by the absence of clear symptoms. A person may not be aware of the existence of a problem. He is occasionally worried about heaviness in the right hypochondrium, slight nausea and discomfort in the stomach, belching. The disease is discovered by chance during laboratory tests. Timely diagnosis and treatment, adherence to a diet, refusal to drink alcohol help to get rid of the problem. In the absence of therapy, the pathology passes to the next stage.
Progressive. Often precedes cirrhosis of the liver. In this case, the patient's health deteriorates significantly, the cells of the organ are destroyed and die. At this stage, the disease is manifested by vomiting, stool disorders, fever, jaundice, pain in the liver. If left untreated, death from acute liver failure is possible.

Alcoholic inflammation of the liver is acute and chronic. Signs of the acute form of the disease develop suddenly after drinking. The state of health worsens, the patient loses his appetite, nausea and vomiting appear, intense pain in the right hypochondrium, the skin turns yellow, itching occurs. Possible increase in body temperature.

Violation of liver function leads to a change in bilirubin metabolism, as a result of which the urine turns dark and the feces become light. The patient has an enlarged liver and spleen. The acute stage lasts 3-5 weeks, depending on the amount of alcohol consumed.

According to the nature of the course, several forms of acute alcoholic hepatitis are distinguished:

Latent. It is dangerous because it has an asymptomatic course. The problem can only be detected by examination.
Icteric. The most common variety, which is characterized by the acquisition of a yellowish tint by the skin, pain in the liver, loss of appetite, nausea, and vomiting.
Cholestatic. In addition to the specific coloration of the skin, the patient has severe itching, manifestations of intoxication increase, urine darkens, feces becomes light.
Fulminant. A rapidly progressive form of the disease that can be fatal. It is characterized by a sharp deterioration in the condition, fever, yellowing of the skin, complete lack of appetite, weakness, severe pain in the right hypochondrium.

In severe cases, the acute form of the disease can result in the death of the patient.

Chronic alcoholic inflammation of the liver is characterized by a long course and moderate clinical manifestations. The patient may feel a slight malaise, fatigue, loss of appetite, he periodically experiences nausea, vomiting, and abdominal pain. Toxic damage to the nerves leads to polyneuropathy of the lower extremities, the patient's gait is disturbed, there are aching pains in the legs.

The main signs of chronic alcoholic hepatitis are the appearance of spider veins on the skin, sleep disturbances, a purplish hue of the face, and problems in the genital area.

In a chronic course, the pathology often ends in death, since there are no obvious signs of deterioration that could alert the patient.

Reasons for development

The cause of the pathology is the abuse of alcoholic beverages. The rate of its development depends on the quantity, quality of drinks, duration and frequency of use, individual characteristics of the organism.

A safe dose for the male body is 40 g of alcohol per day, for the female - 20 g.

The risk of developing alcoholic hepatitis increases with:

simultaneous use of large doses of alcohol;
daily repeated intake of alcohol;
long-term alcohol abuse;
hereditary predisposition;
irrational and unbalanced nutrition;
infection with hepatotropic viruses.

Symptoms and signs of the disease

Pathology develops over several years. Symptoms of the disease are similar to those of other forms of hepatitis. The earliest symptoms of alcoholic hepatitis are increased weakness, fatigue, loss of appetite, and weight loss. Others join later:

feeling of discomfort, pain in the liver;
belching bitterness;
nausea and vomiting.
stool disorders after taking alcohol or fatty foods;
slight increase in body temperature;
anemia.

With further progression of the disease, the skin and mucous membranes turn yellow, severe itching occurs, the feces become discolored and the urine darkens, the liver increases in volume.

An alarming sign is a significant increase in the abdomen due to excessive accumulation of fluid in the abdominal cavity (ascites). This indicates that the liver does not have time to filter the blood. After the onset of such a symptom, a person can live no more than 3-5 years if he does not refuse to drink alcohol.

Diagnostics

Diagnosis is hampered by the fact that at the initial stage, the pathology does not have any specific manifestations, therefore, its presence can be suspected only after laboratory tests have been carried out.

First of all, the doctor must determine whether a person has alcohol dependence, the main criteria of which include:

the use of large doses of alcoholic beverages. At the same time, a person cannot say with certainty how many days the binge lasted;
psychological dependence on alcohol. The patient constantly thinks about drinking, cannot control the amount of alcohol he drinks, consumes alcohol, despite the awareness of his problem;
withdrawal symptom, which is stopped (eliminated) only by the next intake of alcohol.

The specialist also notes the presence of characteristic external signs of alcoholism: puffiness of the face, the presence of spider veins, yellowness of the skin, tremor of the limbs, atrophy of the muscles of the shoulder girdle, palmar fibromatosis.

After questioning and examining the patient, the doctor directs the patient for additional studies:

general blood analysis. With alcoholic hepatitis, the level of hemoglobin will be reduced and the number of leukocytes will be increased;
Analysis of urine. The disease is characterized by an alkaline reaction of urine, traces of protein in it;
coagulogram. Allows you to evaluate blood clotting;
lipidogram. Needed to detect cholesterol levels;
Abdominal ultrasound. The study allows you to determine the size of the liver and its structure, the presence of inflammation, ascites;
blood chemistry. Helps to find out if the liver is doing its job. In the presence of the disease, there is an increase in the level of bilirubin, as well as liver enzymes ALT and AST;
liver biopsy. During the study, a microscopic fragment of liver tissue is removed and examined in order to detect foci of inflammation or necrosis;
An alternative to biopsy is elastography, in which liver tissue is examined using a special apparatus.
spiral computed tomography. Such an examination is necessary to obtain a clear image of the organ under study.

Treatment

Regardless of the form of alcoholic hepatitis, the main principle of treatment is the complete rejection of the use of alcoholic beverages. To achieve the maximum effect, therapy should be comprehensive and include a diet, medications. In the most severe cases, resort to surgical intervention.

Medical therapy

Hepatoprotectors are used to treat alcoholic hepatitis. Such drugs have antioxidant properties, accelerate the process of regeneration of liver cells, restore its functions and provide protection from negative external influences. The course of therapy should last at least a month, in some cases it is recommended to take hepatoprotective medications for two to three months. The patient also needs multivitamin complexes, since as a result of the disease, the absorption function of various useful substances is impaired.

In the acute phase of the disease, detoxification therapy, the introduction of plasma-substituting solutions, and the correction of electrolyte disturbances are prescribed. In severe cases, it may be necessary to use glucocorticosteroids, antibacterial drugs.

Hepatoprotectors for liver restoration - table

Name	Drug properties	Advantages	Flaws
	Complex drug. It has hepatoprotective, anti-inflammatory, antitoxic, choleretic properties.	The composition of the drug contains only herbal ingredients. The drug promotes the regeneration of damaged liver cells, restores liver function, and accelerates the excretion of acetaldehyde. Taking the drug does not affect the concentration of attention and the ability to drive.	When taking the drug, allergic reactions may develop. You can not use the drug for chronic diseases of the digestive tract in the acute stage.
	Hepatoprotective and antidepressant agent. It has detoxifying, neuroprotective, antioxidant, regenerating properties.	It is considered one of the best drugs used in the active restructuring of liver cells, accompanied by other severe pathologies, such as: encephalopathy; depression; osteoarthritis. It is effective in withdrawal symptoms, life-threatening intoxications, cirrhosis and liver fibrosis. Can be used as a prophylactic.	The drug has many side effects: allergic reactions of varying severity; violations of the digestive tract; change in sleep rhythm; dizziness, severe headaches; heart pains.
	Due to the content of essential phospholipids, which are able to integrate into the structure of the liver, its cells are restored, the metabolism of lipids and proteins is normalized, and the processes of replacing hepatocytes with connective tissue are reduced.	The drug contains only natural ingredients. It is effective in pathologies accompanied by massive death of liver cells. Well tolerated, has a minimum of side effects.	The drug is contraindicated in case of individual intolerance. When taken, allergic reactions may develop.
	The active complex nutritional supplement has a detoxifying, anti-inflammatory, regenerating, antispasmodic, choleretic effect.	A natural remedy that has no contraindications (except for individual intolerance to the components).	The drug is not prescribed for progressive liver pathology due to insufficient effectiveness.
	Ursodeoxycholic acid preparation. It has an active choleretic, moderate hepatoprotective effect.	While taking the drug, the concentration of bile acids toxic to liver cells, which are excreted through the intestines, decreases. Against the background of therapy, the level of liver enzymes ASAT, ALT, bilirubin is normalized. The drug helps to activate the patient's immune system, restore damaged liver cells. Can be taken prophylactically when drinking alcoholic beverages.	Possible side effects in the form of: diarrhea; pain in the abdomen; rash. Contraindications to taking the drug are: acute inflammatory diseases of the biliary tract, intestines; gallstones; violations of the pancreas, kidneys. It is necessary to take the drug only under the supervision of the attending physician.
Gepabene	The preparation with milk thistle has a restorative, analgesic, bile-excreting effect.	Plant-based product, well tolerated by the body. It contributes to the normalization of the liver and the restoration of its structure at the cellular level, reduces the intensity of the progression of cirrhosis.	Despite the safety of the drug, there is not enough information about its effectiveness in alcoholic liver damage. The tool can not be used in acute diseases of the biliary tract and liver.

Preparations for the treatment of alcoholic hepatitis - gallery

Liv 52 is a plant-based drug. Helps restore liver cells
Heptral is an effective remedy for withdrawal symptoms of cirrhosis and liver fibrosis
Essentiale forte - contains essential phospholipids that restore the liver, integrating into its structure
Ovesol - an active complex food supplement with anti-inflammatory properties
Ursofalk is a drug of ursodeoxycholic acid. Repairs damaged liver cells

Diet

Prolonged alcohol abuse leads to digestive disorders, the human body does not receive the required amount of vitamins, nutrients and trace elements. A balanced diet is recommended to restore liver function.

The daily calorie content is at least 2000 calories. The patient needs B vitamins, folic acid and protein. Meals should be fractional - up to five times a day.

Doctors advise in case of illness to adhere to diet No. 5, which provides a sparing regimen for the liver.

It is forbidden to use:

fried, spicy food;
marinades;
animal fats;
yeast baking, fresh bread, sweets;
meat, fish, mushroom broths;
coffee, carbonated drinks, alcohol.

Products prohibited in alcoholic hepatitis - gallery

Alcohol Lean meats and fish
Soy Dishes

Surgery

Surgical intervention is necessary for significant damage to the liver, when drug treatment does not work. Such surgeries are rare and very expensive. The difficulty lies not only in the high cost, but also in the problems of selecting a donor, which can only be a person with excellent physical and mental health. Usually part of the organ is transplanted from a relative.

Alcohol must be avoided for six months before surgery.

The recovery period after surgery is long, during this time the patient needs to take immunosuppressants in order for the organ to take root. But sometimes, even under all conditions, the body rejects the transplanted liver.

Consequences and complications

Significantly improves the prognosis for such a disease, the complete rejection of alcohol. But it often happens that those patients who have been diagnosed with a severe form of alcoholic hepatitis continue to drink alcohol, which leads to death in 30% of cases.

And even with a mild course of acute alcoholic hepatitis and timely treatment, as well as a complete rejection of alcohol, there remains a very high risk of further development of cirrhosis.

The most likely complications of alcoholic hepatitis are:

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

Prevention

Prevention of alcoholic hepatitis consists in the refusal of regular consumption of alcoholic beverages. The best solution for a person who cares about his health is the complete exclusion of alcohol, as well as a complete and rational diet.

Alcoholic hepatitis is a fairly serious disease that requires serious medical intervention. Proper and timely treatment increases the chance to restore and maintain health. At the same time, it is important to understand that without a complete rejection of alcohol, a positive result will be very difficult to achieve.

Over time, the abuse of strong drinks will lead to liver problems, among which alcoholic hepatitis is often found.

For alcoholic hepatitis, the presence of extensive inflammation in the structures of the liver, which arose against the background of toxic effects on the liver with alcohol decay products, is characteristic. Usually, such a pathology develops in a chronic form after 5-6 years of constant alcohol abuse. Such a pathology quite often acts as a precursor of cirrhosis. The probability of transition to cirrhosis is especially high in patients who drink alcohol daily in the amount of 50-60 grams. pure alcohol for men and 20-30 gr. - for women. Provided that 10 gr. alcohol corresponds to 200 ml. beer or 25 ml. vodka.

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The intake of alcohol is accompanied by its further metabolism in the structures of the liver to acetaldehyde, which actively damages the cells of the organ. In the future, acetaldehyde triggers many reactions that cause hypoxia and further death of liver cells. As a result, extensive inflammation develops - alcoholic toxic hepatitis, which experts consider as the initial manifestation of hepatic cirrhosis. With the further development of the pathological process, healthy tissues of the organ are replaced by fibrous ones. As a result, the liver ceases to fully perform its functions.

Forms of alcoholic hepatitis

Hepatitis of alcoholic origin can occur in 2 forms: progressive or persistent.

progressive alcoholic hepatitis is a progressive deterioration in health. This form is diagnosed in 20% of cases of alcoholic inflammation of the liver. It is characterized by the presence of small necrotic foci and a fairly rapid development of cirrhosis;
persistent type of hepatitis is a more stable and curable form, provided that alcohol is avoided. If the patient continues to take alcohol, then the likelihood of degeneration into a progressive form increases significantly.

Also, alcoholic forms of hepatitis are divided into chronic and acute. Acute alcoholic hepatitis lasts less than six months and in 5% of cases is converted into alcoholic cirrhosis. Clinically, this form of acute pathology can occur in the following variants:

Icteric - the most common, characterized by a predominance of an icteric symptom, when the skin, sclera, mucous membranes, tears and even saliva turn yellow.
Latent - when any symptoms are absent, and the pathology is detected only by an increased content of transaminases. To finally confirm the diagnosis, it is necessary to undergo a biopsy with a study of the biomaterial.
Fulminant - for such hepatitis is characterized by rapid progression of clinical manifestations. The real risk of death is literally 2-3 weeks after the onset of the acute period.
The cholestatic variant occurs in 10% of patients with alcoholic liver inflammation. It is characterized by manifestations typical of cholestasis, such as bile stasis, discoloration of feces, pronounced itching, etc. It can develop and proceed for years.

The diagnosis of chronic alcoholic hepatitis is established when degenerative-inflammatory processes in the liver caused by alcohol use last more than six months and in most cases lead to hepatic cirrhosis.

Signs and causes

The main cause of alcoholic liver disease is long-term, moderate drinking or large amounts of alcohol at one time. Under the influence of ethanol, a lot of pathological changes occur in the liver tissues:

Cells are constantly experiencing a lack of oxygen, which leads to their degeneration, and then death;
The cellular structures of the organ die faster than they are restored, which leads to the formation of scar tissue;
Fibrous tissue is strongly formed, which inhibits the functionality of the liver, including and suppresses protein-forming processes in hepatocyte cells. As a result, fluid accumulates in hepatocytes, they swell and the liver enlarges.

There are also characteristic risk factors that can, under certain conditions, contribute to the development of alcohol damage. These include drinking in large doses or daily for many years, heredity and obesity, damage by hepatotropic viruses, or an unbalanced diet.

People suffering from alcoholic inflammation of the liver can be identified by a red face and palms, muscle atrophy, hand tremors and hyperedema of the legs. On their skin, you can see an abundance of spider veins, and in front of their eyes - signs of conjunctivitis. Only a doctor can determine the diagnosis by correctly comparing the symptoms. Although the patient may notice some alarming signs himself. The characteristic symptoms of alcoholic hepatitis depend on the form of the pathology and the variant of its development:

the icteric variant is characterized by weakness, unreasonable weight loss and anorexia, pain in the liver (right hypochondrium), nausea and vomiting, yellowing of the sclera and skin. Hyperthermia is likely, but not required. The liver increases, has a smooth structure, and when probed, it causes pain;
the latent variant usually has no severe symptoms. Patients may be disturbed by mild nausea and slight heaviness in the liver;
the cholestatic variant is accompanied by darkening of urine and discoloration of excrement, jaundice and pruritus;
a sign of the fulminant variant is the rapid progression of hemorrhagic and hepatorenal syndrome, hyperthermia and severe weakness, ascites, liver encephalopathy, and organ failure.
chronic hepatitis occurs with moderate symptoms, so the final confirmation of the pathology is carried out only after a liver biopsy.

In general, the diagnosis of alcoholic hepatitis is reduced to anamnesis, examination and laboratory tests such as blood and urine tests, detection of biochemical markers, lipidograms and coagulograms. Instrumental diagnostics is also carried out, including ultrasound and endoscopy, MRI or cholangiography, CT and biopsy, elastography, etc.

Treatment of alcoholic hepatitis

The basis of the treatment of alcoholic hepatitis is the refusal of alcohol. If this is not done, then further progression of the pathology is inevitable. And if the pathology is mild, then this step is enough to gradually restore the liver. It is also necessary to prescribe a dietary diet and complex drug therapy.

As for diet therapy, it involves increasing the daily calorie intake to at least 2000 kcal, while protein per day should be consumed 1 g per kilogram of weight. With a complication in the form of anorexia, the patient is prescribed parenteral or enteral nutrition through a tube. Amino acid infusions reduce protein catabolism (consumption) and improve brain metabolism.

To cure alcoholic hepatitis, drug therapy with the use of drugs from the group of essential phospholipids is necessary. These include the drugs Ursofalk or Essentiale-Forte, which reduce fatty changes in the liver, slow down fibrotic processes, and have an antioxidant and regenerating effect.

Also prescribed are ursodeoxycholic acid drugs like Ursochol, which have a cytoprotective effect. To block membrane cell damage and the production of acetaldehyde, as well as to obtain an antioxidant effect, hepatoprotectors like Silibor or Gepabene are prescribed.

In the acute course of alcoholic hepatitis, detoxification therapy is mandatory, and severe forms of pathology require the use of glucocorticosteroid drugs. In the chronic form, glycine, interferon and drugs that affect fibrotic processes are additionally prescribed.

In the treatment of liver hepatitis, patients are assigned table number 5. Such a therapeutic diet excludes spicy seasonings and fatty dishes, marinades and canned foods prepared by frying from the menu. The use of any alcohol, tea and coffee is excluded.

Nutrition should be fractional, in small equal portions up to 5 r / d. You should eat foods rich in natural vitamins and minerals, proteins and fiber. They are prepared by boiling or steaming. The body needs a sparing diet, so a raw food diet and similar culinary extremes are not recommended. It is better to stick to a sparing diet, at least partially, and at the end of therapy, for example, give up fried and smoked meats.

Alcoholic hepatitis: life prognosis

If alcoholic inflammation of the liver occurs in a mild or moderate degree, then with the complete rejection of strong drinks, the prognosis is good and the liver is quite capable of recovering.

How long do people live with alcoholic hepatitis? You can't answer this question definitively. If the patient continues to drink, then cirrhosis develops, which is irreversible and acts as the final stage of alcoholic liver damage. Then the forecast is quite the opposite. Such patients are at risk of getting hepatocellular carcinoma, and this is already a malignant process that does not have a positive outcome.

Is alcoholic hepatitis contagious or not?

Unlike viral forms, it is impossible to get infected with alcoholic hepatitis, because the disease develops against the background of many years of drinking alcohol or too much strong alcohol at a time.

Alcoholic Hepatitis and Hepatitis C: What's the Difference?

All hepatitis is united by one thing - inflammatory liver damage. The difference between hepatitis C and the alcoholic form of pathology is directly the etiology of these diseases.

Viral hepatitis is caused by infection of the body with a viral agent, which is usually spread through contact with the patient's blood. The alcoholic form of hepatitis occurs for a completely different reason - due to the use of alcohol and has nothing to do with viruses.

The liver with moderate lesions will be able to recover on its own, but it needs help, be sure to give up any booze and other unhealthy habits.

Alcoholic hepatitis - is included in the group of liver lesions not associated with infection. This type of inflammation, unlike viral hepatitis, is not transmitted from a patient to a healthy one, but is associated exclusively with prolonged alcohol consumption and the formation of alcohol dependence in a person. The disease is considered the main etiological cause of liver cirrhosis.

The prevalence of alcoholic hepatitis is, according to statistical studies, in different countries from 7 to 10 per 100 thousand population. An assessment of the health status of people who abuse alcohol allows us to conclude that 25–40% will develop inflammation of the liver within a few years, turning into the stage of cell destruction and complete failure of this important organ.

In the International Statistical Classification (ICD-10), a group of diseases is distinguished under the general term "alcoholic liver disease". Among them, hepatitis is encoded by K70.1. The disease is most common among the male population aged 30 to 55 years.

The effect of alcohol on the liver

The breakdown of alcohol begins already when it enters the human stomach. The juice constantly contains the enzyme alcohol dehydrogenase, which oxidizes up to 25% of the accepted ethanol and turns it into acetaldehyde. Thus, ¼ part is absorbed into the blood bypassing the liver. The presence of food (especially fatty food) delays absorption but does not detoxify toxic foods.

The opposite effect is possible against the background of the patient taking drugs from the group of H2-histamine receptor blockers. They reduce the concentration of alcohol dehydrogenase in the stomach and dramatically increase the volume of ethanol entering the bloodstream.

Alcohol is carried by the bloodstream to all organs, enters any liquids and tissues, causing significant damage to cell function.

The enzymatic system of the liver enters the struggle for neutralization due to its specific active proteins. The transformation reaction begins with the action of alcohol dehydrogenases and the transformation of ethanol into acetaldehyde (aka acetaldehyde, ethanal, methylformaldehyde).

The substance has several tens of times greater danger in terms of its toxic properties than alcohol itself. It is classified as a carcinogen of the first order in terms of its ability to destroy the DNA of genes and cause cancerous degeneration. Therefore, the negative consequences of the action, in addition to alcoholic hepatitis, include the development of a malignant tumor of the stomach, esophagus and liver. Further transformation occurs under the influence of acetaldehyde dehydrogenase. It converts methylformaldehyde to acetic acid and non-toxic substances that are excreted in the urine.

It is important that with the constant use of alcoholic beverages, the synthesis of the necessary enzymes lags behind the need. This leads to increased exposure to the liver of unsplit acetaldehyde. Liver cells (hepatocytes) respond with an inflammatory response.

In the pathogenesis of alcoholic hepatitis, a significant role is played by the defeat of other organs of the digestive system:

pancreas (pancreatitis);
stomach (gastritis);
gallbladder (cholecystitis).

Features of the defeat of women

More severe and faster liver damage in women is explained by:

The physiological feature of the composition of gastric juice in the female body is that in women there is a significantly lower production and content of the enzyme alcohol dehydrogenase than in men, therefore, ethanol is not broken down in the stomach, enters the liver in a massive amount and is a significant burden.
A greater mass in the body of adipose tissue and less - water, which leads to the absence of dilution of ethanol, increases its toxicity. Fats in the hepatic parenchyma enhance oxidative reactions, promote rapid inflammation and fibrosis.
An imbalance of estrogens during menopausal restructuring, which negatively affects alcohol intoxication.

All factors point to a significant reduction in alcohol abuse time for women compared to men for the same liver injury.

Treatment of alcoholic hepatitis requires taking into account gender characteristics and their correction.

Is there a racial predisposition?

In people of the Mongoloid race, the indigenous people of North America, genetic features of the transformation of alcohol were revealed. They consist in a sharp weakening of the synthesis of alcohol dehydrogenase and acetaldehyde dehydrogenase. The intake of alcohol-containing products causes a rapid overdose and alcoholic toxic hepatitis with characteristic symptoms.

How important is the dose of alcohol?

The development of alcoholic hepatitis is due to:

dose of contained ethanol;
the quality of the alcoholic beverage;
duration of use.

The daily amount of alcohol for the development of hepatitis and cirrhosis of the liver is:

for an adult male 50–80 g;
women - 30-40;
teenager - 15-20.

Men drink 3–5 liters at a time, which is equivalent to 120–200 g of ethanol and is 3–4 times higher than the allowable norm.

For a teenager, the danger is 0.5 liters of "non-alcoholic" beer. According to the preparation technology, it must contain up to 5% ethanol. In addition, the load on the liver increases with beer due to the carbohydrates contained, which are processed into fats and remain in the parenchymal cells.

A special role in the development of an acute form of alcoholic hepatitis is given to poisoning by surrogates of alcohol-containing household liquids. Toxic substances in these cases are, in addition to alcohol:

isopropyl alcohol;
diethyl phthalate;
methyl alcohol;
polyhexamethylene guanidine hydrochloride (component of disinfectants);
acetaldehyde.

Most of the attending physicians (gastroenterologists, hepatologists) consider it important in making a diagnosis not to specify the dose of the drink consumed by the patient, but the regularity of the intake of alcohol into the body.

Risk factors

For the occurrence of hepatitis in the liver against the background of alcohol abuse, the following are important:

malnutrition (lack of fruits and vegetables, meat products);
treatment with hepatotoxic drugs and herbs (for example, St. John's wort should be taken according to the name);
infection with viruses with a predominant effect on liver cells;
lack of immunity;
genetic predisposition in the form of inhibition of the synthesis of the necessary set of enzymes.

The clinical course of alcoholic hepatitis is associated with a combination of all these factors. Depending on the duration and symptomatic complex of the lesion, it is customary to distinguish between an acute form and a chronic one.

acute form

The acute form of alcoholic hepatitis is caused by rapidly progressive inflammatory and destructive processes in the liver cells, more often after prolonged drinking against the background of liver cirrhosis that has already begun. In the case of a severe course, the outcome is liver failure and death from coma. The duration of the course ranges from 3 to 5 weeks.

The acute form of hepatitis is caused by a single "hit" of alcohol on the liver.

There are 4 clinical variants that differ in symptoms and prognosis.

Icteric hepatitis is most common among people suffering from alcoholism. Symptoms of alcoholic hepatitis in this type are:

in jaundice of the skin and mucous membranes;
paroxysmal nausea;
weaknesses;
loss of appetite;
diarrhea, followed by constipation;
weight loss;
dull pains in the right hypochondrium.

Patients are prone to joining a bacterial infection with fever, inflammatory diseases of the urinary system. Itching of the skin is not typical. set during examination.

Latent (hidden) - there are practically no symptoms, it is detected by transaminase tests.

Cholestatic - found in 13% of patients, the signs of impaired bile secretion are concentrated:

significant yellowness of the skin and mucous membranes;
dark urine;
intense itching and scratching on the skin;
discoloration of feces.

Differential diagnosis is always carried out with obstructive jaundice, formed against the background of cholelithiasis, tumors of the liver and pancreas, inflammation of the bile ducts.

Fulminant - the most severe fulminant form, because it quickly leads to:

to brain damage (encephalopathy) with cell edema;
accompanied by hemorrhagic syndrome with hemorrhages;
simultaneous damage to the kidneys with a block of filtration function to the degree of renal failure;
a state of hypoglycemia;
accession of infection.

It differs from others by rapid necrosis of hepatocytes. Patients rapidly develop confusion to a coma, severe jaundice.

Encephalopathy is characterized by swelling of the brain tissue.

A liver smell appears from the mouth, a high temperature is constantly kept. Unlike viral hepatitis, acute forms are not accompanied by an enlarged spleen. The lack of timely treatment of alcoholic hepatitis in this case quickly leads to irreversible changes and death of the patient.

The most severe course is observed in patients with acute hepatitis against the background of existing cirrhosis of the liver.

Toxic hepatitis proceeds with a pronounced stoppage of the movement of bile in the ducts (cholestasis). With this pathology, the destruction of hepatocytes is less pronounced. In severe forms, it leads to acute liver failure.

Features of the chronic type

Chronic alcoholic hepatitis occurs with prolonged constant use of alcohol, detection shows its presence in 1/3 of patients with alcoholism. Symptoms are mild, may be completely absent. The diagnosis is made when violations are detected by the laboratory method, compared with the patient's alcohol history.

With a detailed survey, it is possible to identify some signs of pathology:

loss of appetite;
tendency to constant bloating;
rare bouts of nausea;
insomnia;
decreased libido (sexual desire) due to impaired synthesis of sex hormones.

Palpation reveals a dense, painful edge of the liver, protruding from under the right hypochondrium, signs of organ enlargement. This form of liver damage is also called alcoholic steatohepatitis, since fatty degeneration occurs in hepatocytes.

According to the clinical course, the degrees are distinguished:

mild - the patient does not complain, but on examination an enlarged liver is detected;
medium - in addition to an enlarged organ, the patient has obvious soreness in the right hypochondrium, icterus of the sclera and skin, weight loss, loss of appetite;
severe - characterized by a significant increase in the liver and spleen, the onset of cirrhosis.

Diagnostics

In the process of diagnosis, it is difficult to determine the fact of alcohol abuse. Significantly different behavior of patients at work and at home. Often patients hide their weakness, do not understand the meaning. Establishing the etiology of liver damage helps to establish:

addiction to drinking;
development of abstinence;
prolonged use of alcohol;
hangover;
inability to refuse alcohol-containing liquids.

To decide how best to treat the patient, it is necessary to exclude toxic hepatitis. The examination includes laboratory tests:

on hepatic transaminases (aspartic and alanine), in hepatitis, aspartic is several times higher than alanine;
moderately altered thymol test;
the growth of bilirubin in the blood and urine indicates a difficult outflow of bile;
gamma-glutamyl transpeptidase increased activity;
growth of immunoglobulin A.

Ultrasound and dopplerography of the abdominal cavity reveals a disturbed structure of the liver, an increase in the size of the organ, an expansion of the diameter of the portal vein, as a sign of portal hypertension.

The method of radionuclide hepatosplenoscintigraphy consists in the use of specific isotopes deposited in the hepatic parenchyma. According to the picture of the absorbed substance, one can judge the degree of damage to the organ.

Computed tomography - clarifies the presence of changes in the structure of the liver

It is important that it is possible to confirm the alcoholic etiology of hepatitis only by characteristic features on a biopsy. They are to discover:

alcoholic hyaline (Mallory bodies);
changes in hepatocytes and stellate reticuloepithelial cells.

Differential diagnosis of the chronic form

Diagnosis needs to identify differences with non-alcoholic steatohepatitis in metabolic disorders, drug-induced hepatitis. Metabolic steatohepatitis is more common in women aged 40 to 60 who suffer from:

obese,
diabetes mellitus.

At the same time, triglycerides accumulate in the liver, which can damage cell membranes and stimulate the development of fibrous tissue (the path to cirrhosis).

In the blood test, a violation of the composition of fatty components, a sharp increase in triglycerides, and hyperglycemia are detected. There is no jaundice in the symptoms. Drug-induced steatohepatitis occurs as a result of side effects of medications with prolonged use:

drugs of the estrogen group;
amiodarone;
high doses of acetylsalicylic acid;
Sulfamethoxazole;
calcium antagonists;
anti-inflammatory drugs of the aminoquinolone series (Delagil, Plaquenil).

In the pathogenesis of this type of hepatitis, it is important to inhibit the process of fatty acid oxidation at the level of hepatocyte mitochondria, and activate the peroxide type of lipid oxidation. The doctor can find out what drugs the patient was taking, their dangerous dosage and duration of treatment. The outcome of non-alcoholic steatohepatitis is also cirrhosis of the liver. Rarely, fatty degeneration is of a drip nature and causes a fulminant form of acute hepatitis.

It is possible to be definitively convinced of a non-alcoholic lesion only by the results of a liver biopsy. Statistics show the presence of steatohepatitis in 7-9% of all studies. Some experts consider it necessary to consider the disease as a separate nosology.

Treatment of alcoholic hepatitis

It is possible to cure alcoholic hepatitis only if you completely stop drinking alcohol. There should be no substitutions for less concentrated drinks. The patient is offered a strict diet that provides the necessary calories, but excludes any toxic effects on the liver.

A typical table No. 5 is assigned:

the calorie content of the diet should be at least 2000 kcal per day;
protein products are prescribed at the rate of 1 g per kilogram of the patient's weight;
a mandatory component are B vitamins and folic acid.

In a hospital, in the absence of appetite and refusal to eat, food is organized through a tube or intravenous administration of amino acids, nutritional mixtures.

Often patients suffer from alcohol withdrawal and need parallel treatment from a narcologist.

The specialist tries to explain whether it is possible to drink beer, cognac, thereby destroying the stereotypical behavior of an alcoholic.

In severe forms of alcoholic hepatitis, courses of antibiotics are used to prevent bacterial infections. The drugs of the fluoroquinolone group work better.

Hepatoprotectors have a selective effect on liver cells. It is believed that they restore oxidative processes in hepatocytes, promote the regeneration of the parenchyma. Treat alcoholic hepatitis help protectors based on:

milk thistle flavonoids;
bear bile (Ursosan);
Admetionina;
essential phospholipids.

Ursodeoxycholic acid, contained in Ursosan, reduces the synthesis of cholesterol, helps to compensate for the lack of bile during digestion. The transformation of the inflammatory process into fibrosis and the formation of cirrhosis has only one option for help - liver transplantation. Operations are still rare, associated with the search for a donor and high cost.

Forecast

Alcoholic hepatitis occurs in two forms:

Progressive - accounts for about 20% of cases, characterized by small-focal lesions of the liver parenchyma with an outcome in cirrhosis. Accompanied by the clinic described above. Allows you to achieve stabilization of metabolic indicators, stop inflammation, if treatment is started on time and is not accompanied by repeated binges.
Persistent - the form is characterized by a stable course, reversibility of processes in the liver. The asymptomatic picture lasts up to 10 years. There is no deterioration even with occasional alcohol consumption.

In the absence of refusal from alcohol, mortality in the acute phase of hepatitis against the background of another binge is up to 60%. The prognosis for an increase in life expectancy increases significantly for patients who were able to stop the addiction.

However, even with good results of therapy, one should be aware of the high risk of malignant neoplasms and monitor nutrition.

The problem of treatment of alcoholic hepatitis is solved by different specialists. It is important that in the presence of liver damage, narcologists and psychiatrists cannot prescribe potent drugs. The choice of therapy is limited as the destructive processes in the liver tissue. Therefore, experts advise alcohol addicts to contact them as early as possible.