Alcoholic hepatitis – the pathological changes of a liver which are characterized by signs of an inflammation, fatty dystrophy, fibrosis which reason toxic impact on body of metabolites of alcohol is. At continuation of action of an etiologichesky factor of change of a liver pass into cirrhosis – irreversible damage. Disease severity is defined both by a dose, and quality and duration of reception of alcohol. Hepatitis can proceed in a sharp or chronic form. Treatment of injury of a liver is directed to refusal of alcohol, providing rather high-calorie and nutritious diet, normalization of a functional condition of a liver.
Alcoholic hepatitis – the disease which is one of the main displays of an alcoholic liver disease which in gastroenterology along with alcoholic fibrosis belongs to harbingers or initial displays of cirrhosis. Alcohol intake is followed by its metabolization in a liver to the ethyl aldehyde having property to injure hepatocytes (hepatic cells). The cascade of the chemical reactions started in an organism by this substance becomes the reason of a hypoxia of hepatocytes, and as a result – their death. As a result of toxic alcoholic injury of a liver to its fabric diffusion inflammatory process develops. As a rule, this chronic disease which develops in five-seven years of regular application of alcohol.
Reasons of alcoholic hepatitis
Long abuse of alcohol is a cause of illness. At men injury of a liver can develop at the use of 50-80 grams of alcohol a day, women have 30-40 grams, at teenagers – 15-20. Speed of development and progressing of a disease is defined by quantity, alcoholization frequency, quality of the taken drinks, specific features of an organism, abuse duration.
The probability of development of alcoholic injury of a liver is higher at the persons having genetic features of the enzymes metabolizing alcohol at the patients who had viral hepatitis and also at initial deficiency of food.
Symptoms and forms of alcoholic hepatitis
This pathology can have the persistiruyushchy or progressing current. The Persistiruyushchy current is rather stable form of a disease, at the same time in the conditions of the termination of the use of alcohol damage of cells of a liver is reversible. Continuation of alcoholization leads to transition to the progressing form.
The progressing form (it is divided into easy, average and heavy degrees on activity) is characterized by melkoochagovy necrotic damage of a liver which often passes into cirrhosis. Timely treatment of this form leads to process stabilization, the residual phenomena remain.
Depending on a current allocate acute and chronic alcoholic hepatitis. The sharp current is characterized by the sharp progressing damage of a liver. About 70% of cases of long abuse are caused by acute hepatitis which in 4% of cases extremely quickly passes into cirrhosis. This form can proceed in the following options: latent, icteric, holestatichesky and fulminantny. Heavy options of acute alcoholic hepatitis develop against the background of the available cirrhosis after heavy hard drinking more often.
The latent option of a current has no characteristic symptomatology. Patients feel some weight in a podreberye on the right, slight nausea. This option usually by results of laboratory researches comes to light (increase ). Statement of the final diagnosis demands a biopsy.
The icteric option of a current is the most frequent. Characteristic signs are complaints to the expressed weakness, anorexia, pain in the field of the right podreberye, diarrhea, nausea, vomiting, weight reduction, yellowing of integuments, a skler. Temperature increase of a body is possible. The liver is increased, smooth (at cirrhosis – hilly), at a palpation is painful. Detection of such symptoms as a splenomegaliya, ascites, a palmarny eritema (reddening of palms), teleangiektaziya, testifies to the available background cirrhosis.
The Holestatichesky option of alcoholic hepatitis meets less often, its characteristic signs are the intensive skin itch, decolouration a calla, jaundice, urine darkening. This option has a long current.
The Fulminantny option is characterized by bystry progressing of a gepatorenalny, hemorrhagic syndrome, the expressed change of laboratory markers. Against the background of a hepatic coma, a gepatorenalny syndrome the outcome can be lethal.
The chronic course of alcoholic hepatitis is characterized by moderate expressiveness of clinical signs and laboratory markers. Diagnosis is based on the characteristic signs revealed at a liver biopsy which demonstrate existence of an inflammation in the absence of cirrhosis.
Diagnosis of alcoholic hepatitis
Diagnostics has certain difficulties. The easy course of a disease can not be followed by any specific symptoms, and it is possible to suspect it only at detection of changes of laboratory indicators.
Laboratory signs of a sharp form are , is more rare – a leykopeniye (at toxic impact of alcohol on marrow), the B12-scarce anemia accelerated by SOE and also increase in markers of injury of a liver. Ultrasound examination of a liver reveals increase in its sizes, heterogeneity of structure, contours equal. The magnetic and resonant tomography (liver MRT) defines a collateral hepatic blood-groove, the accompanying injury of a pancreas.
At a chronic form ultrasound examination of a liver reveals insignificant or moderate increase in a liver, increase in its ekhogennost, uniformity of structure. Laboratory indicators are changed moderately. The liver biopsy at alcoholic damage allows to reveal specific signs of an inflammation, fibrosis, a necrosis. Expressiveness of damage depends on a form of a disease and its duration.
Identification during the conducted examination of signs of injury of a liver has to be combined with the anamnestichesky data indicating long alcohol intake, and also existence of dependence, abuse. It is difficult as not always the doctor possesses full information on the patient. For this reason relatives as patients often considerably diminish amount of the taken alcoholic drinks have to be attracted to collecting the full anamnesis.
Also characteristic external symptoms of an alcoholic disease (alcoholism) come to light: puffiness of the person, a tremor of hands, language, a century, an atrophy of muscles of a humeral belt, Dyupyuitren's contracture (the fibrous change of palmar sinews leading to their shortening and sgibatelny deformation of a brush), defeat of peripheral nervous system, other target organs (kidneys, heart, a pancreas, the central nervous system).
Treatment of alcoholic hepatitis
Therapy of this disease has to be complex. The main directions of treatment is elimination of the damaging factor, purpose of the corresponding diet, performing medicamentous therapy. Any form of alcoholic hepatitis first of all demands cancellation of an etiologichesky factor – alcohol. Smoothly from alcohol progressing of damage is inevitable. At easy forms of it it is already enough for the return development of changes in a liver.
Alcoholic hepatitis is followed at most of patients by deficiency of food. Than injury of a liver is heavier, especially trophic insufficiency is expressed. The power value of a daily diet about 2000 calories is recommended. Protein content has to make 1 g on kilogram of weight. Sufficient intake of vitamins, nonsaturated fatty acids is obligatory. In case of anorexia probe enteralny or parenteral food is appointed. Infusions of amino acids reduce a proteinaceous catabolism (an expenditure of interstitial reserves of protein), improves metabolism of tissues of brain.
Medicinal therapy includes purpose of medicines of essentsialny phospholipids which reduce fatty change of a liver, have antioxidant effect, slow down liver fibrosis, accelerate regeneration of its cages. Also at alcoholic damage, especially holestatichesky form, the medicines of ursodezoksikholevy acid having cytoprotective effect are appointed. For the purpose of achievement of antioxidant effect, blocking of production of ethyl aldehyde, damage of cellular membranes silimarinsoderzhashchy gepatoprotektor are appointed.
Treatment of a sharp form includes performing dezintoksikatsionny therapy, introduction of plazmozameshchayushchy solutions, correction of electrolytic violations. At a heavy current with a syndrome of hepatocellular insufficiency glucocorticosteroids are applied. Treatment of a chronic form is carried out taking into account a liver damage rate. Existence of fibrosis demands full refusal of alcohol. Medicamentous therapy includes purpose of the medicines influencing process of fibrosis, γ-interferon, glycine.
Forecast and prevention of alcoholic hepatitis
Basis of prevention of alcoholic hepatitis is alcohol intake restriction, for the purpose of the prevention of progressing of the available injuries of a liver – full refusal. At patients with a lung and moderate severity of alcoholic hepatitis at complete cessation of effect of ethyl aldehyde the forecast good – perhaps complete recovery of functions of a liver. Now for the purpose of treatment of this pathology highly effective medicines which allow to cure a disease are applied or to stabilize a condition of the patient for a long time, preventing transition to cirrhosis. However the gastroenterologist together with the psychotherapist and the narcologist as the refusal of alcohol, but only a third of patients is decisive factor has to carry out treatment, having heard "alcoholic hepatitis" about the diagnosis, independently stop taking alcoholic drinks.
At continuation of action of an etiologichesky factor the disease is complicated by cirrhosis. This irreversible state which is a final stage of alcoholic damage. In this case forecast adverse. Such patients have a high risk of development of a gepatotsellyulyarny carcinoma.