Alcoholic cirrhosis – process of death of hepatocytes and their replacement with connecting fibrous fabric owing to the long use of alcoholic drinks. It is shown by an adynamy, exhaustion and dispepsichesky symptoms, increase in a liver and yellowness of skin, symptoms of a liver failure, portal hypertensia, toxic encephalopathy. For diagnostics conduct a research of a biochemical profile, ultrasonography, KT, ERHPG. The most reliable methods of diagnostics – a biopsy of a liver or an elastografiya. Treatment is based on full refusal of alcohol and replacement of the lost functions of a liver, at impossibility of restoration transplantation of a part of a liver is made.
Alcoholic cirrhosis – the hardest disease affecting patients with chronic alcoholism, which is characterized by destruction of hepatocytes, often coming to an end with a lethal outcome within several years from emergence of symptoms of a liver failure. Has more adverse current at women as the increased level of estrogen favors to more bystry and heavy injury of a liver. Upon transition of cirrhosis to a terminal stage death comes within half a year at a half of patients. At refusal of binge the state considerably improves, however it is possible to achieve full treatment only by liver transplantation. The depressing statistics demonstrates that from 10 to 50% of patients after liver transplantation resume alcohol intake.
Reasons of alcoholic cirrhosis
The mechanism of development of alcoholic cirrhosis is very difficult. According to researches in the field of gastroenterology, cirrhosis affects only 35% of all patients with alcoholism. It is known that development of heavy fibrosis of a liver requires a combination of several damaging mechanisms. So, risk factors of cirrhosis are genetic predisposition, the long use even of small doses of any alcohol, the use of greasy and spicy food, a lack of protein and vitamins, a female.
As the ethanol getting to an organism is processed in a liver, the free radicals which are formed at the same time most of all influence this body. At the same time there is a damage of membranes of cages and the subsequent their destruction. The structure an endoteliya of vessels is broken, than their spasm with the subsequent hypoxia of hepatic fabric and aggravation of injury of hepatocytes is caused. All these processes stimulate production of fibrous fabric which gradually replaces the died sites. The liver gradually loses the functions, are basic of which belkovoobrazuyushchy, haematogenic, dezintoksikatsionny. These processes are irreversible, lead to an invalidization and a lethal outcome, treatment is possible only at transplantation of body.
Classification of alcoholic cirrhosis
Division of forms of cirrhosis on small nodular, krupnouzlovy and mixed is accepted. Also the disease is divided on severity. The compensated stage usually has no clinical manifestations as the liver is still able to perform the functions, the diagnosis at this stage can be established only by a biopsy.
The subcompensated stage is characterized by emergence of symptoms of a liver failure as clinically, and at researches. At this stage damage of hepatic fabric is still reversible, and at refusal of binge the state can be normalized.
The Dekompensirovanny stage is shown by failure of a liver, the most serious condition with alcoholic defeat of all bodies and systems. At this stage only organ transplantation can help the patient.
Symptoms of alcoholic cirrhosis
The symptomatology of alcoholic cirrhosis depends on a disease stage. Usually at subcompensation stage it is not shown in any way therefore the diagnosis at this stage is made rather seldom. From the moment of the beginning of a fibrozirovaniye of hepatic fabrics before emergence of the first symptoms usually there pass about five years. It is possible to suspect cirrhosis only at increase in a liver.
At subcompensation stage the level of fibrosis becomes critical for preservation of hepatic functions, the first symptomatology begins to appear. The patient notes deterioration in appetite, weight loss, weakness, nausea and dispepsichesky manifestations. The liver increases in sizes.
At a decompensation of process gradual fading of all hepatic functions begins. The sindromokompleks characteristic of cirrhosis develops. The asthenic syndrome is characterized by bystry fatigue, indifference, appetite loss, development of a depression. Gradually the kakheksiya – extreme degree of exhaustion develops. Arterial hypotension with tachycardia is noted. Reddening of a nose, cheeks, feet and palms is characteristic. Parotid glands increase. Men have signs of excess of estrogen: fat is laid in a stomach and hips, legs and hands remain very thin, the breast increases, male gonads atrophy, infertility develops. Skin and mucous turn yellow, on skin bruises are often formed. Fingers take a form of drum sticks, on nails small white strokes appear. Patognomonichno for this pathology development of a contracture of Dyupyuitren – shortening of sinews of muscles-sgibateley of palms with loss of their motive function.
If in time not to begin to treat cirrhosis, loss of functions of a liver leads to the hardest complications and irreversible changes in an organism. There is a varicosity of a gullet and rectum, often there are bleedings from the changed veins leading to considerable deterioration in a state.
There are symptoms of portal hypertensia (increase in pressure in a vorotny vein). In an abdominal cavity the exudate (ascites) is formed. The stomach increases in sizes, on it the venous network in the form of the head of a jellyfish is accurately traced. Further this exudate can inflame (in connection with decrease in immunity), peritonitis develops. Considerably the liver increases.
At late stages hepatic encephalopathy develops – as the liver does not perform function of a detoxication, toxins freely circulate in blood and cause damage of cells of a brain. There are various violations of consciousness, change of the personality. Also injury of a liver can lead to violation of work of lungs, a stomach and intestines, kidneys, to provoke development of pancreatitis. Injury of nerves is shown by a peripheral polyneuropathy. Sometimes owing to tsirrotichesky changes in a liver the malignant new growth – a gepatotsellyulyarny carcinoma is formed.
Diagnosis of alcoholic cirrhosis
The diagnosis after emergence of symptomatology usually does not represent complexity. Blood sampling on clinical and biochemical analyses is carried out. In blood test anemia, reduction of a pool of platelets is noted, can be . In biochemical blood test note increase in levels of gamma globulins, immunoglobulin A, a transferrin. The ratio of nuclear heating plant and ALT is displaced towards nuclear heating plant (normal equals to unit). The PGA index increases (a prothrombin, a gammaglutamiltranspeptidaz, A1) – if it exceeds 9, the risk of cirrhosis is almost equal to 90%. Fibrosis markers are defined (any, not only a liver): laminin, hyaluronic acid, pro-collagen 3 types, collagen 4 types, metalproteinases 4 types, etc.; the koagulogramma worsens. It is necessary to define surely markers of viral hepatitises as tsirrotichesky transformation contributes to their development. In analyses of urine and a calla there are also changes.
Tool techniques of researches are most informative. On ultrasonography of abdominal organs the size and structure of a liver, existence of the centers of fibrosis, a condition of a spleen is estimated. MRT and KT of abdominal organs allow to make aim layer-by-layer pictures, to estimate structure of hepatic fabric, the hepatic courses, surrounding bodies (a pancreas, a spleen) and vessels. EGDS allows to examine walls of a gullet and a stomach regarding varikozno expanded veins. ERHPG gives the chance to estimate a condition of the hepatic courses, existence them and narrowings.
The most informative are the elastografiya and a puncture of a liver. Elastografiya – an ultrasonic method of a research which allows to estimate amount of connecting fabric in body and on the basis of it to define severity of fibrosis. More invasive technique is the chreskozhny biopsy of a liver with the subsequent research of a bioptat.
For exact assessment of degree of expressiveness and weight of cirrhosis the scale of Chayld-Pyyu is used. In it levels of a prothrombin, bilirubin, albumine are estimated; after that existence of ascites and hepatic toxic encephalopathy is defined. After assessment of all indicators the cirrhosis class is exposed: And (compensated), In (subcompensated) or About (dekompensirovanny).
Treatment of alcoholic cirrhosis
A number of experts takes part in treatment of the fibrosis of a liver induced by alcoholism: gastroenterologist, hepatologist, therapist, surgeon, psychiatrist and narcologist. If necessary doctors of other profiles are attracted. Absolutely necessary condition for successful treatment of cirrhosis – full refusal of the use of alcohol. To the patient the medical diet (the fifth hepatic table) rich with protein and vitamins, the guarding mode is appointed.
Conservative treatment includes application of gepatoprotektor, medicines of ursodezoksikholevy acid, the main vitamins (And, In, With, E), glucocorticoid hormones. Broad application was given assignment of an ademetionin – this substance is capable to protect cells of a liver from destruction, to stimulate their restoration, to improve bile outflow, to protect a brain from toxins, to neutralize toxins, to eliminate a depression. Inhibitors of proteases interfere with formation of connecting fabric, have anti-inflammatory effect.
Treatment of portal hypertensia includes the medicines limiting a blood-groove in the field of varikozno expanded vessels: hypophysis hormones, nitrates, beta-blockers, diuretics. Besides, surely appoint a laktuloza which improves digestion and improves removal of toxins through intestines. Treatment of ascites is performed by means of antiedematous medicines, intravenous administration of albumine. It will promote moving of liquid to the vascular course and removal of its surplus through kidneys. For the purpose of treatment of hepatic encephalopathy the patient has to receive dezintoksikatsionny infusional therapy, a diet with protein restriction, a laktuloza, antibacterial medicines.
Surgical treatment of cirrhosis consists in change of a donor liver. Statement in waiting list for transplantation requires performance of an indispensable condition: refusal of the use of alcoholic drinks within half a year. Surgical treatment of complications of fibrosis of a liver consists spleens, portosistemny or splenorenalny shunting at a distance; ushivaniye, sklerozirovaniye or alloying of veins of a gullet, balloon tamponada of a gullet Blackmore's probe.
Forecast and prevention of alcoholic cirrhosis
Prevention of fibrosis of a liver at alcoholism consists in full refusal of alcoholic drinks, timely treatment of the begun alcoholic hepatitis, observance of a high-protein diet.
The forecast of a disease at full refusal of alcohol more favorable at young people with normal body weight, at men, at a timely initiation of treatment. The class of defeat of hepatic fabric on a scale of Chayld-Pyyu is higher, the survival is worse. In a class C within half a year a half of patients perishes.