Alcoholic Hepatitis and Cirrhosis
Alcoholic hepatitis – is a dangerous inflammatory disease, which strikes the liver. As a rule, it appears against the background of long-term consumption of alcohol. Probably, many readers want to get know what it means a long-term consumption.
The situation can be illustrated by such example: a human drinks 100 g of absolute alcohol (or more amount of alcoholic drinks on conversion to absolute alcohol) every day during five years. There is 100 % probability that such human will get alcoholic hepatitis, bringing considerable damage to health.
It should be noticed that alcohol influence badly not only on liver. The whole organism sufferers from alcohol, consumed by the patient constantly: brain, cardiovascular system, endocrine functions of the body, excretory system and psyche. Aftermath for liver are ones of the most terrible, because this organ very important for organism. It should be reminded that among vital functions are the next ones:
- liver neutralizes different toxins, toxic substances and allergens, turning them into harmless compounds or removing them from the internal environment;
- removes from the body excess amount(surpluses) of hormones, vitamins and toxic products of metabolism;
- is a storage for one of the most important energetic body’s substratum – glycogen, providing trouble proof work skeletal muscles;
- converts different energetic substrates (turns fats, lactic acids into sugar);
- stores some kinds of vitamins (fat-soluble, water-soluble);
- takes a part in fetus hematopoiesis processes;
- synthesizes cholesterol, phospholipids, bile acid, bilirubin;
- is a reservoir for blood supply, which can be used by body in critical situations;
- synthesizes hormones, which take a part in digestion.
It is difficult to go wrong, calling a liver as an organ, which has a primary importance for organism functioning. A liver plays a role of filter, reservoir for blood and glycogen, produces necessary hormones and converts different substrates into glycol. Naturally, damaged or unhealthy liver will not be able to do its work as effectively as it was defined for her by nature.
Alcoholic hepatitis has also a number of other titles, the most known from which is steatohepatitis or fatty liver. We are talking about that the functioning cells of liver, which were damaged as a result of the constant alcohol consumption, without recovering, die. Organism replaces dead areas of tissue with the fat tissue. Thus, the functioning liver area reduces that also influences negatively on that what workload can be done by this organ. Though the alcoholism consequences for liver are terrible, there are a few of alcoholics who can stop to drink because of the described effect.
Safe alcohol doze, to consumption of which doesn’t bring to regeneration of liver cells, ia about 40 grams per day for men and twenty grams of alcohol for women. Good to know that standard glass of vodka (50g) contains 20 g of alcohol. Thus, having drunk 100 g of vodka, a man is getting tat doze of alcohol, which conditionally can be considered as safely. The danger of vodka and other similar drinks is that the men and women, who decide to daff at bottle with friends, are rarely limited by the prescribed safely doze of alcohol.
Women are more than men falls under influence of alcohol. We are talking about that the woman’s liver easily falls under pestilential influence of alcohol. This is because physiological features of women organism, because of which less of enzymes are produced, which can effectively neutralize consumed alcohol. Even exceeding a little a safely doze, a woman has to fear, because in the long run it can cause an alcoholic hepatitis. Except females the increased risk of this disease is specific for such categories of citizens:
- people, taking medicines, which influence bad on liver;
- people, suffering from some diseases (viral hepatitis);
- patients, having lightweight body;
- patients, the weight of body which exceeds much the rate of growth overall weight indicators.
It often happens that viral hepatitis doesn’t show itself during early stages of disease, signaling about its presence only when a patient already has serious problems with the health.
Symptoms of alcoholic hepatitis
- discomfort, heaviness or pain in the right upper quadrant;
- persistent weakness in the body and fatigue;
- wanton drastic weight loss;
- occurrence of nausea and retching;
- characteristic burping bitterly;
- occurrence of diarrhea after a fatty meal and alcoholic drinks;
- darkening of urine color;
- discoloration of feces;
- yellowness of the skin and mucous membranes;
- appearance of pruritus;
- constant increase of body temperature to 37 degrees.
In such cases, as a rule, biochemical blood tests are made. With positive result – is the analysis on organ biopsy. A sample of liver tissue helps to specify the actual condition of organ and to determine inflammatory foci in liver cells. Herewith the state of the hepatocytes death – liver cells is determined.
Laboratory marker of alcohol consumption not always helps in search of the exact answer for confirmation of the diagnosis. Its significance is raised by combination of several tests, which also are called the profile of alcohol.
The total mass of the liver is formed on 60-80% from hepatocytes. Getting into the body, alcoholic drinks, damage the liver parenchyma, thereby limiting the functions of the body. It influences on liver work and on the whole organism.
Alcohol is considered to be the most dangerous poison for organism. Blood quickly carries it throughout the body, including that its poisons are getting into liver, heart and brain.
All changes in work and structure of liver are logical and pronounced at patients with active expressed alcoholic hepatitis. At such patients mortality is caused predominantly by complications of cirrhosis. That is why diagnostic and terms of disease detection and also the value of its symptoms are very important.
As it has been said above, hepatocytes – are liver cells, which are the basic functional unit of the body. Well known that 60-80% of hepatocytes form the total weight of the liver. Alcohol, getting into the organism, damages the liver’s parenchyma, limiting organ’s functioning. It should be noticed that parenchyma of any organ – is a complex of cells, the union of which provides normal functioning of this or that organ, in a certain system of the organism. Thus, damaged integrity of the functional liver components (its parenchyma) is a reason of interruptions in work not only of the liver but of the whole organism.
Alcohol is one of the most dangerous poisons for a human due to the fact that getting into the blood it begins to spread immediately with its flow throughout the body. It means that almost immediately it reaches liver, heart, brain and other essential for the life support organs. Special enzymes are produced in liver, which begin to split alcohol into substances, which are more harmful for organism than an alcohol. However, this cycle of alcohol splitting in a human body doesn’t end.
Naturally, human body can’t allow the poison substance to walk around circulatory system, which much more harmful than alcohol itself. That is why alcohol splitting in a liver has a place till non-toxic substances begin to form, which may be removed together with urine. As it seen, the main hit on “elaboration” of alcohol, getting into organism, has a liver, which, as a rule, sufferers more than other organs.
It would seem what terrible that the liver successfully splits an alcohol? The fact is that, in alcoholic’s organism this process occurs in some different way. A set of necessary enzymes simply doesn’t have time to be renewed during regular alcohol consumption. It is fraught with so-called deficit of enzymes, and also by the fact that recycled materials don’t leave the ranges of liver. In this manner an alcoholic hepatitis develops at alcoholic, and this hepatitis is usually accompanied with all of the above unpleasant symptoms.
Besides, other gastrointestinal diseases, appearing at alcoholic because of alcohol abuse, also participate in development of hepatitis. We are talking about such diseases:
Some period of time a liver is able to work to the point of exhausting, using internal resources, but soon a cirrhosis begin to develop, and also a condition, which is called hepatic failure.
Development stages of alcoholic hepatitis and its forms
- acute stage of alcoholic hepatitis development;
- the chronic stage of the diseases.
The first form of hepatitis develops fast, roughly and brings much discomfort and powerful negative impact on a body. The second form – is sluggish, but constantly bringing inconveniences and uncomfortable soreness.
An acute form of the disease can may occur if an alcoholic drinks constantly or has during it short commons. Exactly then inflammation of the liver central lobes occurs, which, as a rule, leads to their death (so-called necrosis). The symptoms of acute hepatitis, appearing at alcoholics, are the next ones:
- jaundiced color of all mucosa;
- intense yellow coloring of the skin;
- constant fatigue and nausea;
Besides, during acute alcoholic hepatitis the pain in area of liver surely occurs, which disturb the patient constantly. Sometimes it happens that the flow of bile from the liver is broken, which leads to the fact that the nature of the disease becomes cholecystic. Statistic says that refusing from alcohol consumption, approximately 20% patients can throw off an illness. Continuing to drink, most of alcoholics are getting cirrhosis.
Chronic alcoholic hepatitis can be only a consequence of a disease’s acute form, which develops after another attack of acute hepatitis. A chronic form is characterized by such features:
- permanent weakness;
- pain in the liver, which appears occasionally;
- slight yellowness of a patient’s mucosa and skin.
If a patient has found these symptoms, then he surely needs to ask the help from specialist, who can diagnose well and to prescribe treatment. Besides, it is important that parallel a patient being treated from alcohol dependence, because therapies, directing to treatment of a liver, don’t have a meaning, if not to resolve this issue, which provokes inflammatory process.
Among the stages of alcoholic hepatitis a contemporary medicine distinguishes:
- slight stage, which is characterized by enlarging the liver (as a rule it is discovered during medical examination;
- middle stage, when an alcoholic begin to fill periodic discomfort and pains in the area of liver and during palpation of the liver painful sensations appear;
- severe stage, when the cirrhosis has almost developed.
Naturally, the earlier a problem is diagnosed, the more a chances to recover completely. If we are talking about severe stage of this disease, then doctors, as a rule, can’t provide almost any guarantees to a patient.
Delirium tremens, ascites and cirrhosis
One of the often observable alcoholic psychoses – is an alcoholic delirium, which is known among the people as delirium tremens. As a rule, its attacks come out during the first 3-6 days after an alcoholic has stopped drinking. It occurs during the second or he third stage of alcoholism, that corresponds to medium-term development of alcoholic hepatitis.
Alcoholic with the middle stage of hepatitis is berated by the external signs:
- pervasive weakness;
- unconcealed yellowness eyes sclera;
- lack of appetite.
Alarming assumptions is confirmed medical examination:
- alcoholic painful bears liver palpation;
- bad biochemistry.
Expected consequences – are disappointing: hepatitis with time turns into cirrhosis. Severity of illness is traditionally compared with malignant tumor. That is why not rare the cases when alcoholics need oncologist’s help.
The second alcoholic’s “companion” is ascites, the predecessor of which is often hepatitis. A characteristic external sign is overly enlarged abdomen. This is because the liquid begins to be accumulated in abdominal.
The kinds of ascites are determined by accumulated liquid.
- Small. Amount of liquid is not more than 3 liters. It can be spotted with the help of ultrasound or laparoscopy.
- Medium. Increased amount of liquid changes the shape of abdomen. On this stage the movements of diaphragm aren’t obstructed yet.
- Big: there are accumulated about two-three dickers of liquid in a stomach. Stomach interferes with movements; the problems with diaphragm’s movement are felt.
Ascites – is a organism alarm, that a liver can’t filter the blood any more, its liquid components are separated and accumulated in an abdomen. This moment can’t be missed: it is stayed for a patient for about five years to sum up life. Pathological disorders in liver work, as a rule, limit the life by this period.
That is why the struggle with alcoholic hepatitis, according to doctors, should be accompanied by compulsory treatment.
There is no alternative.
Treatment methods of hepatitis
Alcoholic hepatitis, as an alcoholic fibrosis, is considered as sad harbinger of an initial stage of cirrhosis. Doctors divide the illness into acute alcoholic hepatitis d chronical, considering them separately.
Chronical hepatitis – is a disease, which isn’t cured at least for a half a year. Any hepatitis can turn into chronical form:
- incurred because of the metabolic disorders.
Autoimmune hepatitis flows with high hypergammaglobulinemic purpura. Wherein, a large concentration of antibodies is gathering in a blood. The reason of this hepatitis development is not discovered yet. In contemporary medical practice one of the strategies for treatment is used:
- monotherapy using prednisolone;
- combination of prednisolone with azathioprine.
Toxic hepatitis can be formed as a result of influence of the several drug groups.
In base of treatment – is a task: to determine and cancel the drugs and preparations, which has caused a chronical illness. In most of cases this way allows to stabilize the process and even to cure a patient.
Alcoholic hepatitis is characterized by chronical defeat of a liver from toxic impact of ethanol on a liver.
Steatohepatitis – is a phenomenon, which is observed in liver tissue, occurs with varying degrees of severity. Changes have irreversible character. If a patient will not stop drinking, hepatitis transforms fast into cirrhosis.
Alcoholic hepatitis flows according to one of forms:
- Persistent form is rather stable. During which there is a chance for positive answer for a question, is it possible to cure a patient and how. That means that there is a chance for inflammatory process reversibility, and wherein an alcoholic should want himself to cure and stop drinking.
- Progressive form means micro focal of liver, which ends often with cirrhosis. It determined that probability of development of cirrhosis is about 15-20%.
Using modern standards of treatment from alcoholism, a doctor can stabilizes inflammatory processes and save residual.
Refusing from alcohol, according to doctors’ recommendations, a patient needs:
- to follow the diet, prescribed by a doctor, including vitamin supplements;
- to take medicines and preparations for maintenance and restoration of the liver.
As practice shows, all alcoholics can be divided into three groups by willpower. The representatives of which react differently on diagnosis, determined by a doctor:
- stop drinking at all and believe, that hepatitis is treatable, seriously think about the question how to treat;
- partially refuse from alcohol, doubting, whether the diseases has being treated;
- ignore recommendations, given by a doctor.
A doctor determines to treat outpatient or in hospital according to severity of disease. Nothing – nor modern treatment, methods will help, if a patient do not refuse from alcohol.
Invalid food during alcoholic hepatitis
As it was said upper, a strict balanced diet is a recipe for success in a struggle with alcoholic hepatitis. An example of the ideal diet for the patient can serve a table #5. It is known, that this diet is prescribed for patients, which have liver diseases, diseases of the biliary tract and GI. The main principles of this diet are:
- it is necessary to exclude yeast bread, limiting by “grey” or “brown”, and also by crackers;
- it is necessary to eat, if it possible, vegetarian soups, excluding meat, fish broths, and also decoctions from poultry;
- it is better to eat meat, fish of low-fat varieties, focusing on boiled and baked dishes from these sorts of protein food;
- a cheese can be ate low-fat and mild;
- it is better to fat-free cottage cheese and dairy;
- as fats you can eat unrefined sunflower or other vegetable oil, and also some butter;
- you can eat not more than one egg yolk per a day;
- cereals are useful, especially if we are talking about oatmeal and buckwheat;
- sauerkraut should be not sour, if you eat it;
- it is better to eat fresh fruits and vegetables every day;
- also fruits and vegetables can be ate baked or boiled or as fruit drinks;
- it is necessary to exclude black coffee and strong black tea;
- cacao is a product, which is better do not include into meal;
- hot and spicy sauces and flavorings are contraindicated during the treatment of alcoholic hepatitis;
- from sweet deserts it is better to eat zephyr, paste, jujube and also different not chocolate candies.
It is necessary to exclude from a diet all food, which have irritant action on a liver: chocolate, coffee, spices, fat and salty. Besides, it is better to bake, boil and steam the food.
Alcoholic cirrhosis of a liver
Liver of every tenth alcoholic suffers from cirrhosis. Alcoholic cirrhosis, as a rule, develops slowly, but forecast is much better than during others diseases. The first man, who has pointed to link of it with alcohol, was M.Baillie at the end of XVIII age. Later a formulation appeared, pointing, that liver alcoholic hepatitis can contribute the development of disease.
Eventually it became apparent early signs, pointing to disease:
- wanton weight loss;
- enlarged abdomen with relatively small body weight;
- bitter taste in a mouth and changes in stool with visible traces of undigested fat;
- puffiness and “necrosis” of skin areas;
- brittle bones, glums bleeding and slow healing of wounds.
The signs of liver alcoholic cirrhosis have different forms. It is not rare when a compensated cirrhosis remains asymptomatic with a minor severity:
- general weakness;
During decompensative period there are new symptoms appear:
- disturbance of consciousness;
- increased bleeding.
At all the patients a hepatomegaly is discovered, and every forth has a splenomegaly. Characteristic liver signs are marked with different frequencies. Among them are gynecomastia, Dupuytren’s contracture, and also so called, alcoholic stigma:
- vasodilatation of the nose and eyes;
- resizing of the parotid glands.
Alcoholics are betrayed by the profusion of spider veins of the top torso skin, reddened palms and abdominal distention. Cirrhosis is accompanied with mental disorder, delirium and sleep disorders.
Specialists make a prognosis based on datum about disease duration and patient’s punctuality in observance of doctor’s instructions. The required condition is full refusing from alcoholic drinks.
If a patient suffers from cirrhosis more than five years, only every second has a chance for recovering. Others leave this life: stiff sentence for the habit.