Alcoholic liver disease
Alcoholic liver disease – the structural regeneration and dysfunction of a liver caused by systematic long alcohol intake. At patients with an alcoholic liver disease the loss of appetite, dull aches in the right podreberye, nausea, diarrhea, jaundice is noted; in a late stage cirrhosis and hepatic encephalopathy develops. Establishment of the diagnosis is promoted by performing ultrasonography, doppler sonography, stsintigrafiya, liver biopsy, a research of biochemical tests of blood. Treatment of an alcoholic liver disease assumes refusal of alcohol, reception of medicines (gepatoprotektor, antioxidants, sedatives), if necessary - transplantation of a liver.
Alcoholic liver disease
The alcoholic liver disease develops at persons, long time (more than 10-12 years) abusing alkogolsoderzhashchy drinks in average daily doses (in terms of pure ethanol) 40-80 grams for men and more than 20 grams – for women. Displays of an alcoholic liver disease is a fatty dystrophy (, fatty regeneration of fabric), cirrhosis (liver tissue replacement on connecting – fibrous), alcoholic hepatitis.
The risk of developing of an alcoholic disease at men is almost three times higher as abuse of alcohol occurs among women and men in a proportion 4 to 11. However development of an alcoholic disease in women happens quicker and at the use of smaller amount of alcohol. It is connected with gender features of absorption, a catabolism and removal of alcohol. Due to the increase in consumption of hard alcoholic drinks in the world, the alcoholic liver disease represents a serious social and medical problem with which solution the gastroenterology and narcology closely deal.
The bulk of the ethyl alcohol (85%) coming to an organism is affected by enzyme of alcohol dehydrogenase and an atsetatdegidrogenaza. These enzymes are produced in a liver and a stomach. Speed of splitting of alcohol depends on genetic features. At regular long alcohol intake its catabolism accelerates and there is an accumulation of the toxic products which are formed when splitting ethanol. These products make toxic impact on liver tissues.
The factors promoting development of an alcoholic liver disease
- high doses of the taken alcohol, frequency and duration of its use;
- female (activity of alcohol dehydrogenase at women is, as a rule, lower);
- genetic predisposition to the lowered activity of alkogolrazrushayushchy enzymes;
- the accompanying or postponed liver diseases;
- metabolic disorders (metabolic syndrome, obesity, harmful eating habits), endocrine frustration.
Symptoms of an alcoholic liver disease
The first stage of the alcoholic liver disease arising practically in 90 percent of cases of regular abuse of alcohol more than 10 years is fatty dystrophy of a liver. Most often it proceeds asymptomatically, sometimes patients note the lowered appetite and periodic dull aches in the right podreberye, perhaps nausea. Approximately at 15% of patients note jaundice.
Acute alcoholic hepatitis can also proceed without the expressed clinical symptoms, or have the lightning heavy current leading to a lethal outcome. However the most frequent symptoms of alcoholic hepatitis is the pain syndrome (dull ache in the right podreberye), dispepsichesky frustration (nausea, vomiting, diarrhea), weakness, disorder of appetite and weight loss. Also frequent symptom is hepatic jaundice (skin has okhryany a shade). In half of cases acute alcoholic hepatitis is followed by a hyperthermia.
Chronic alcoholic hepatitis proceeds is long with the periods of aggravations and remissions. Periodically there are moderate pains, nausea, an eructation, heartburn, the diarrhea alternating with locks can develop. Jaundice is sometimes noted.
When progressing an alcoholic disease the signs characteristic of the developing cirrhosis join symptoms of hepatitis: a palmarny eritema (reddening of palms), teleangiektaziya (vascular asterisks) on a face and a body, a syndrome of "drum sticks" (a characteristic thickening of disteel phalanxes of fingers), "hour glasses" (pathological change of a form and consistence of nails); "the heads of a jellyfish" (expanded veins of a forward belly wall around a navel). At men sometimes note a ginekomastiya and a gipogonadizm (increase in mammary glands and reduction of testicles).
With further development of alcoholic cirrhosis in patients characteristic increase in auricles is noted. One more characteristic display of an alcoholic disease baking in a terminal stage are Dyupyuitren's contractures: originally on a palm over sinews of the IV-V fingers the dense soyedinitelnotkanny small knot is found (sometimes painful). Further there is its growth to involvement in process of joints of a brush. Patients complain of difficulty in bending of a ring finger and little finger. Further there can be their full immobilization.
Complications of an alcoholic liver disease
The alcoholic liver disease often leads to development of gastrointestinal bleedings, hepatic encephalopathy (toxic substances which collect in an organism as a result of decrease in functional activity, are postponed in brain tissues), violation of work of kidneys. The persons having an alcoholic disease enter into risk group of development of cancer of liver.
Diagnosis of an alcoholic liver disease
In diagnosis of an alcoholic liver disease the significant role is played by collecting the anamnesis and identification of long abuse of the patient of alcohol. The gastroenterologist carefully finds out how long with what regularity and in what quantities the patient takes alcoholic drinks.
At laboratory researches in the general blood test acceleration of SOE is noted (toxic influence of alcohol on marrow affects), . Megablastichesky and iron deficiency anemia can be noted. The lowered quantity of platelets is connected with oppression of functions of marrow, and also comes to light as a gipersplenizm symptom at increase in pressure in system of a hollow vein at cirrhosis.
At biochemical blood test note increase in activity of nuclear heating plant and ALT (hepatic transferases). Also note the high content of bilirubin. The immunological analysis reveals increase in level of immunoglobulin A. At alcohol intake in an average daily dose more than 60 g of pure ethanol in serum of blood note increase in the transferrin which is grown poor by carbohydrates. Increase in amount of serumal iron can sometimes be noted.
Careful collecting the anamnesis is necessary for diagnosis of an alcoholic liver disease. It is important to consider the frequency, quantity and a type of the consumed alcoholic beverages. Due to the increased risk of development of cancer of liver in patients with suspicion of an alcoholic disease determine the content in blood alpha . At its concentration more than 400 ng/ml assume existence of cancer. Also at patients violation of fatty exchange is noted – in blood the content of triglycerides increases.
Refer ultrasonography of abdominal organs and a liver, dopplerography, liver KT, MPT, a radio nucleinic research and a biopsy of tissue of liver to the tool techniques helping to diagnose an alcoholic disease.
When performing ultrasonography of a liver signs of changes of the sizes and a form, fatty regeneration of a liver (a characteristic giperekhogennost of tissues of liver) are well visible. Ultrasonic dopplerography reveals portal hypertensia and increase in pressure in system of a hepatic vein. The computer and magnetic and resonant tomography well visualizes tissue of a liver and its vascular system. At radionukleidny scanning diffusion changes in hepatic segments come to light, and it is also possible to determine the speed of hepatic secretion and a producing bile. For final confirmation of an alcoholic disease carry out a liver biopsy for the histologic analysis.
Treatment of an alcoholic liver disease
Early detection of an alcoholic disease at a stage of fatty regeneration of a liver (when process is still reversible) allows to prevent the subsequent progressing and to restore functions of a liver. If at the patient alcoholic hepatitis or cirrhosis already developed, further treatment is generally directed to mitigation of symptoms, prevention of further deterioration in a state, prevention of complications.
Indispensable condition in treatment of an alcoholic disease is the full and final refusal of alcohol intake. Already only this measure causes improvement of a state, and at early stages of a steatoz can lead to treatment.
Also sick with an alcoholic liver disease appoint a diet. Food with the sufficient caloric content, the balanced content of proteins, vitamin and minerals as the persons abusing alcohol often suffer from hypovitaminoses and deficiency of proteins is obligatory. Reception of multivitamin complexes is recommended to patients. At the expressed anorexia – food parenterally or by means of the probe.
Medicinal therapy includes actions for desintoxication (infusional therapy by glucose solutions, a pyridoxine, cocarboxylase). Apply essentsialny phospholipids to regeneration of tissue of liver. They restore structure and functionality of cellular membranes and stimulate activity of enzymes and protective properties of cages. At a severe form of acute alcoholic hepatitis, the life-endangering patient, apply kortikosteroidny medicines. A contraindication to their appointment is existence of an infection and gastrointestinal bleedings.
Ursodezoksikholevy acid is appointed as a gepatoprotektor. It also has bile-expelling properties and regulates lipidic exchange. The medicine S-adenozilmetionin is used for correction of psychological state. At development of contractures of Dyupyuitren originally carry out treatment by physiotherapeutic methods (an electrophoresis, reflexotherapy, LFK, massage, etc.), and in the started cases resort to surgical correction.
The developed cirrhosis, as a rule, demands symptomatic treatment and therapy of the arising complications (venous bleedings, ascites, hepatic encephalopathy). In a terminal stage of a disease of the patient transplantation of a donor liver can be recommended. Implementation of this operation requires strict abstention from alcohol not less than within half a year.
The forecast at an alcoholic liver disease
The forecast directly depends on a stage of a disease in which treatment, strict observance of medical recommendations and full refusal of alcohol intake is begun. The stage of a steatoz is reversible and at due therapeutic measures work baking is normalized within a month. Development of cirrhosis in itself has a failure (survival within 5 years at a half of patients), but also threatens with developing of cancer of liver.
Prevention of an alcoholic liver disease is an abstention from abuse of alcohol.