Chronic alcoholic hepatitis

Alcoholic hepatitis is an inflammatory process. It occurs against the background of a large consumption of alcoholic beverages. As a consequence, the body is affected by toxins. The chronic form of the disease comes 5-7 years after the onset of the inflammatory process. The scale can be serious, it all depends on the quality of the alcohol consumed and its quantity.

ICD-10 code

For convenience, a special international classification of the disease was created. Thanks to her, you can understand the diagnosed diagnosis anywhere in the world. Simply put, this encoding is used everywhere. Hepatitis is one of the diseases of the digestive system.

K00-K93 Diseases of the digestive system. . K00-K14 Diseases of the oral cavity, salivary glands and jaws. K20-K31 Diseases of the esophagus, stomach and duodenum. K35-K38 Diseases of the appendix (vermiform appendix). K40-K46 Hernias. K50-K52 Noninfectious enteritis and colitis.

K55-K63 Other intestinal diseases. K65-K67 Diseases of peritoneum

K80-K87 Diseases of the gallbladder, bile duct and pancreas. K90-K93 Other diseases of the digestive system

K70-K77 Diseases of the liver.

• K70 Alcoholic liver disease (Alcoholic liver disease, Cirrhosis of the liver).
  • K70.0 Alcoholic fatty degeneration of the liver.
  • K70.1 Alcoholic hepatitis.
  • K70.2 Alcoholic fibrosis and sclerosis of the liver.
  • K70.3 Alcoholic cirrhosis of the liver.
  • K70.4 Alcoholic liver failure (Liver failure).
  • K70.9 Alcoholic liver disease, unspecified
• K71 Toxic liver disease.
• K72 Liver failure, not elsewhere classified. (Liver failure).
• K73 Chronic hepatitis, not elsewhere classified. (Hepatitis chronic).
• K74 Fibrosis and cirrhosis of the liver (cirrhosis of the liver).
• K75 Other inflammatory liver diseases.
• K76 Other liver diseases.
• K77 Liver disorders in diseases classified elsewhere

Causes of chronic alcoholic hepatitis

The name speaks for itself. The main cause of problems with the liver is a large intake of alcohol. Systematic acceptance of alcoholic beverages in increased amounts will sooner or later affect the liver. Alcohol contributes to the disturbance of the oxidative processes of cellular structures. It has a toxic effect and disables the body. In the end, cirrhosis of the liver, which requires its transplantation, may develop.

The minimum amount of alcohol that can lead to inflammation is 20-30 grams regularly. This indicator refers to the female population. For a man, he is slightly higher and is 60-70 grams per day. As you can see from this statistic, a very small amount of alcohol is enough to get serious problems. There are simply no other causes that contribute to the development of inflammation. To all fault alcohol. Therefore, its consumption should be minimized.

[1], [2]

Pathogenesis

The toxic effect of ethanol leads to dependence. Ethanol has a particular effect on the concentration in the blood of acetaldehyde and acetate. Oxidation process increases the level of NAD * H / NAD +. These indicators play an important role in the formation of fatty liver. As soon as the concentration of the first indicator increases, an increase in the synthesis of glycerol-3-phosphate occurs. As a result, fatty acids begin to accumulate actively in the liver.

Acetaldehyde has a hepatotoxic effect. It manifests itself mainly because of the intensification of the processes of lipid peroxidation. In the end, the functions of cell membranes are violated. In the complex, acetaldehyde with proteins leads to a change in the structure of microtubules of hepatocytes. As a result, the formation of alcoholic gialgin occurs. Intracellular transport is disrupted, hepatocyte dystrophy occurs.

Increased formation of acetaldehyde leads to a decrease in the activity of mitochondrial enzymes. As a consequence of this, the synthesis of cytokines is greatly enhanced. Significantly impaired cellular immunity. In the end, the liver is severely damaged. The inflammatory process begins, the functionality is undermined. As a result, alcoholic hepatitis develops, flowing into a chronic form.

There are different points of view regarding the terminology of this type of alcoholic liver damage. LG Vinogradova (1990) gives the following definition: "chronic alcoholic hepatitis" is a term that denotes relapses of acute alcoholic hepatitis that arise against the backdrop of an incompletely completed previous attack of acute alcoholic hepatitis and lead to a peculiar liver damage with traits of chronic hepatitis.

When histologically examined, two forms of chronic alcoholic hepatitis can be distinguished: chronic persistent and chronic active. Morphologically chronic persistent alcoholic hepatitis combines the characteristic features of alcoholic hepatitis with moderate pericellular and subsidized fibrosis in the third zone of the acinar hepatic lobule, portal portal widening, portal fibrosis, and small portal infiltration. In the clinical picture, there is a decrease in appetite, low-intensity pain in the liver, eructation, general weakness, a slight increase in the liver, and an inadequate increase in serum γ-glutamyltranspeptidase activity.

Chronic alcoholic active hepatitis histologically combines the signs of alcoholic hepatitis with active fibrosis and hyaline necrosis in the liver lobules, bridging and multilobular necrosis are possible with high activity of the pathological process. Clinical manifestations are characterized by severe weakness, lack of appetite, pains in the liver, jaundice, enlarged, dense and painful liver, significant changes in functional liver tests, in particular, high serum γ-glutamyltranspeptidase activity, aminotransferases, and elevated blood levels of immunoglobulin A.

Chronic alcoholic hepatitis can progress to cirrhosis of the liver even in conditions of abstinence from alcohol in connection with the attachment of autoimmune mechanisms - sensitization of T-lymphocytes to alcoholic hyaline.

Chronic alcoholic hepatitis is a disease of the liver. Naturally, caused by a large consumption of alcoholic beverages. This disease must be eliminated, because in most cases it flows into cirrhosis of the liver. During the intake of alcoholic beverages, acetaldehyde forms in the liver. It is he who affects the liver cells. It is capable of triggering a number of chemical reactions in the body and thereby leading to organ damage.

Symptoms of chronic alcoholic hepatitis

The clinical manifestation of this disease is limited by scant symptoms. So, the organ can slightly increase in size, thus there are painful sensations. Strong pain, lack of appetite is not ruled out. Over time, symptomatology is supplemented with nausea and vomiting. Physiological data are absent.

Often there is a disturbance in the rhythm of sleep and wakefulness. In humans, there is a decrease in libido, there is an increase in body temperature. A number of other features can be identified. So, the nails become white, vascular asterisks appear, often palmar erythema and ascites develop. These changes are characteristic directly for the chronic form of the disease course. The symptomatology described in the first paragraph is manifested at the initial stage.

Chronic course is characterized by the severity of the symptoms, as well as their variety. They may well manifest simultaneously. If you do not start treatment on time, death can not be ruled out. This is due to the rapid development of cirrhosis of the liver. Severe liver damage requires her transplant. The risk factor is present in people with low weight, jaundice and increased liver density. Alcoholic hepatitis together with these factors is fraught with aggravating consequences.

First signs

The whole danger lies in the fact that for a long time the disease can pass asymptomatically. Signs appear in severe stages. It is possible to suspect that something is wrong with the liver. A person begins to feel weak, he has increased fatigue, worsens appetite, body weight decreases sharply. These are the first signs that you should pay attention to. As a rule, the pain syndrome does not show itself at this stage. Therefore, people often think that his condition is associated with a decrease in immunity and other diseases. He does not hurry to visit the doctor.

Over time, the pain syndrome begins to manifest itself. It is more like discomfort and a feeling of heaviness in the right hypochondrium. Again, this situation does not really bother the person. After all, it's easy to think that low-quality products were used. Alcoholics, as a rule, do not understand that all troubles arise against the background of uncontrolled drinking. Gradually, all the symptoms are accompanied by nausea, vomiting and bitter taste in the mouth. There may be a burp with bitterness. This feature is associated with the consumption of alcohol and fatty foods.

Manifesting himself and jaundice. Appears icteric shade of the sclera and the shell of the oral cavity. As the disease progresses, jaundice of the skin arises. Sometimes this is accompanied by itching, as well as an increase in the liver.

[3], [4], [5]

Effects

If the treatment was started on time, then there can be no consequences. In most cases, everything ends successfully. With all the recommendations and excluding alcoholic beverages, there can be no consequences. Otherwise, the development of cirrhosis and fibrosis of the liver.

Fibrosis is a reversible stage of the process. It can be eliminated by proper treatment. Cirrhosis can not be cured, in this case, it is possible to get rid of the problem by organ transplantation.

If the treatment is started on time, and the transplant has given a positive result, then the prognosis will be favorable. But, under no circumstances should you drink alcoholic beverages. Otherwise, there is a risk of a re-inflammatory process. Therefore, you should always follow all recommendations and do not deviate from them. Otherwise, death is not excluded. Whether or not consequences arise, in most cases depends directly on the patient.

[6], [7], [8], [9], [10]

Complications

It is necessary to understand that this inflammatory process has disappointing complications. The fact is that in most cases hepatitis passes into cirrhosis of the liver. Coping with the problem at the drug level is impossible. Only transplantation is needed here. By its severity, cirrhosis is equated with a malignant tumor.

Another complication may be ascites. He is also caused by hepatitis. The main sign of the problem is a strong bulging of the abdomen. This is due to the fact that there is a large amount of free liquid in the abdominal cavity of a person. The form of ascites is completely determined by the amount of that liquid itself. With a small form it can be 3 liters, the average - more than 3 liters. When the shape is high, the amount of liquid varies up to 20-30 liters. Man is not able to move normally, there are some difficulties.

It should be understood that ascites is an alarm signal. It indicates that the body is not able to filter blood. It is impossible to overlook this moment. After all, otherwise the patient will live no more than 5 years.

[11], [12]

Diagnosis of chronic alcoholic hepatitis

The first step is to collect an anamnesis of the disease and complaints. It is important to find out how long the symptomatology began. Important information is the amount of alcohol consumed and its frequency. It is important to collect an anamnesis of life. Whether the patient has any chronic processes in the body, whether hereditary diseases are noted. The presence of bad habits, tumors and contact with toxic substances is also taken into account.

Then a physical examination is carried out. At survey the shade of integuments, the size of a stomach is considered, and also presence of vascular asterisks on a body. When palpation, a person feels a pain in the abdomen. Thus, you can feel and increase the organ. It is important to assess the mental state of the patient.

If necessary, ultrasound is performed. The complete picture consists of laboratory studies, instrumental and differential diagnostics. Details will be provided below.

[13], [14]

Analyzes

Laboratory research plays an important role. They include a general blood test. Thanks to it you can determine the level of red blood cells, as well as hemoglobin. It is easy, it turns out, to reveal leukocytosis.

In addition to general analysis, a biochemical blood test is performed. It allows you to evaluate the functionality of the liver, pancreas. Biochemical markers. Blood coagulability indicators, gamma-glutamyltranspeptidase activity are checked on them. Aliproprotein A1 is monitored. On it you can determine the condition of the liver. If proline and hydroxyproline are significantly increased in the blood, then liver fibrosis is most likely to occur. This condition is characterized by the growth of scar tissue.

Widely used and coagulogram. It is an analysis of coagulability of blood systems. Lipidogram is a study of fat-like blood substances. Determine the long-term use of alcohol can be on laboratory grounds. In humans, the activity of gamma-glutamyltranspeptidase, immunoglobulins, and aspartate aminotransferase has been significantly increased.

Markers are used to determine the complete picture. These are specific indicators that allow to determine the presence of inflammatory processes in the liver, which were caused by specific viruses. They also give a general analysis of urine. It allows you to determine the general condition of the kidneys and urinary system. There is also a coprogram, in other words, an analysis of stool, for the presence of undigested food and fat in it.

[15], [16], [17],

Instrumental diagnostics

This method of research is diverse. So, most often they resort to ultrasound. This will allow you to assess the condition of the abdominal organs and notice any changes in them.

Esophagogastroduodenoscopy is widely used. It is a diagnostic procedure, during which the specialist manages to assess the condition of the esophagus as a whole. This allows you to determine the pathology. The stomach and duodenum can be examined. The study is carried out using a special tool - an endoscope.

In addition, make a puncture biopsy. For this, a damaged piece of liver is taken and thoroughly examined. This allows us to evaluate the structure of the organ and make the correct diagnosis.

Widely used spiral computed tomography. This method consists in obtaining X-ray images at different depths. The study allows you to obtain an accurate image of the affected area. Magnetic resonance imaging also has a similar effect. This technique is built on the chain of interaction of the human body with the liquid. It allows you to get a clear image of the organ under investigation.

Elastography. This technique allows you to examine liver tissue. Everything is done with the help of a special device, which makes it possible to determine the presence of liver fibrosis. In the process of carrying out the procedure, special compression of the tissue is performed. As a result, you can see the changes. Most often the procedure is used as an alternative to biopsy.

Retrograde cholangiography. This technique is based on contrast management. Usually it is introduced into the Fater nipple. The procedure allows to determine the deterioration of the outflow of bile. Cholangiography is performed in people with severe cholestasis syndrome.

Differential diagnostics

This type of diagnosis includes laboratory studies. Initially, a person needs to give a general blood test, as well as a biochemical blood test. By the level of leukocytes, hemoglobin and erythrocytes, one can determine the presence of abnormalities and inflammatory process. Particular attention is paid to blood clotting.

In addition to this procedure, a biopsy is performed. It allows you to take a fence of the affected tissue and examine it. This technique is the most reliable, but works only in conjunction with blood tests.

To determine the state of the urinary system, a urinalysis is performed. It is important to determine the presence of markers. In addition, a stool test is performed for the presence of coarse dietary fiber or undigested food fragments. It is impossible to get a complete picture of instrumental or diagnostic methods alone. All studies should be conducted in aggregate.

[18], [19], [20], [21], [22]

Treatment of chronic alcoholic hepatitis

First of all, a person should refuse to accept any alcoholic beverages. Naturally, for an alcoholic this is an unbearable burden. Therefore, it is necessary to control it. Because sooner or later all this will flow into cirrhosis of the liver. This is a very serious defeat, which often ends in a fatal outcome.

It is worth visiting a psychologist and an expert in narcology. This will get rid of dependence and understand the severity of the whole process. After all, in most cases, a person can not cope with the problem on his own. All patients should strictly follow the diet number 5. Its goal is to reduce the burden on the diseased organ. That is why the number of forbidden foods include fatty, fried and spicy dishes. It is necessary to abandon the salt, canned goods, sweets and strong teas. Preference is given to food, which includes a lot of fiber, vitamins and minerals.

Naturally, you can not do without medication. True, in this case, you need to be extra careful. Because medications should have a positive effect on the body and do not injure it. Most often, hepatoprotectors are prescribed. This is a group of drugs that can regenerate liver cells and protect it from negative effects. It is generally recommended to use Ursosan, Essentiale N, Heptral and Resalut Pro. The course of treatment does not exceed one month. Details of the medicines will be provided below.

It is important to fill the diet with vitamins and minerals. Useful herbal teas, including on the basis of echinacea and mint. If a person is troubled by an overexcited and stressful condition, it is worth to drink a sedative. Valerian can perform in his capacity, but only in tablets! Tincture should not be used in any case! Enough 2 tablets 3 times a day. With severe liver damage, when there is cirrhosis, it is worth resorting to organ transplantation. Otherwise, a person will not survive.

Medications

As medicines it is recommended to use those whose action is aimed at protecting the liver, as well as the regeneration of its cells. Therefore, most often patients are recommended to use Ursosan, Essentiale N, Heptral and Resalut Pro.

Ursosan. The dosage of the drug is prescribed by the attending physician. In particularly severe cases, 14 mg per kilogram of weight is used. Duration of therapy can be from one month to six months. In some cases, 2 years. Contraindications: hypersensitivity, pregnancy, impaired liver and kidney function. Side effects: pain in the liver, nausea, vomiting, allergic reactions.

Essentiale N. Dosage is 2 capsules 3 times a day. The duration of therapy depends on the condition of a person. Contraindications: hypersensitivity. Side effects: it is extremely rare to have an intestinal disorder.

Heptral. The drug can be used both in the form of tablets and injections. With prolonged therapy, the daily dose should not exceed 4 tablets. If the agent is administered, then enough 400-800 mg. The duration of treatment is determined by the doctor. Contraindications: hypersensitivity. Side effects: heartburn, nausea, sleep disturbance, allergic reactions.

Resalute Pro. The drug is used for 2 capsules, 3 times daily before meals. The duration of treatment depends entirely on the course of the disease. Contraindications: hypersensitivity, antiphosphalipid syndrome. Side effects: diarrhea, allergic reactions.

Alternative treatment

Alternative medicine has a lot of useful recipes. Many herbs, fruits, plants and roots can be used for treatment. True, some of them can be toxic. Therefore, independent use can lead to a lot of unpleasant consequences. Before starting treatment it is worth consulting with a specialist.

Recipe 1. Blueberries. The useful properties of this berry have long been known. In its leaves contain special enzymes that allow you to fight with hepatitis. Many healers recommend using decoctions of blueberries. You can use fruit drinks, juices and just eat berries for food. Even jam will have a positive effect. The leaves are especially strong. They are able to block viruses and protect the organ.

Recipe 2. Pumpkin. It is useful for minerals and vitamins. Its flesh can be used for both treatment and simple nutrition. It is worth noting that it is not recommended to use it for more than 3 months. Alternative healers recommend to use it in fresh form about half a kilogram per day. You can cook gruel, extinguish it, and also eat in the form of candied fruits. A special benefit is a raw pumpkin along with sour cream. You can drink pumpkin juice. Treatment of pumpkin is useful in cirrhosis of the liver.

[23], [24], [25], [26]

Herbal Treatment

Medicinal herbs have a positive effect on many organs and systems. But, it is important to understand which of them can be used and which ones to bypass.

Recipe 1. Dandelion grass. With her help you can eliminate many diseases. Especially those that are associated with hepatic insufficiency. When treating hepatitis, dandelion grass should be eaten fresh. Salads are quite suitable. You can use jam from them. Dandelion has a cholagogue effect. Decoction of it must be consumed before each meal by half a glass. It is prepared simply, take the leaves of a dandelion and pour boiling water. Then the agent should be allowed to stand and cool. To fight hepatitis use the root of the plant. It should be thinned and evaporated for an hour. Then apply on a tablespoon before eating.

Recipe 2. It is necessary to take the herb St. John's wort, calendula flowers, and chicory. All this mix and take just 2 tablespoons of the collection. Then pour them with two glasses of cold water. It is insisted all the whole night, boiled for 5 minutes in the morning and filtered. You can drink the medicine, regardless of the meal. The course of treatment is 2 months.

Recipe 3. Take grass horsetail, yarrow and rose hips. It is important that everything is in equal proportions. After that, everything is mixed and only one tablespoon is taken. The collection is poured into a glass of boiling water and infused for 2-3 hours. You can consume this remedy 3 times a day for 30 minutes before meals. Duration of treatment is 2 weeks. If necessary, the course is repeated one month later.

Homeopathy

Homeopathic remedies were always in demand. True, not all of them are suitable. So, there is both a positive and a negative opinion about them. Among the homeopathic remedies, only a few are able to help. So, special popularity deserved the means: Hepel and Galsten. They have a positive effect, but only if applied under the supervision of an experienced homeopath. The main action of the funds is directed to the regeneration of liver cells and the creation of a protective barrier around it. Therapy with drugs is long. It is worth noting that monopreparations have always been very tropic for liver cells. Among them, it is worth noting the May celandine and milk thistle. These two drugs can destroy most of the symptoms that occur with liver damage. In addition, they support it.

The negative opinion is that not all people resort to the help of homeopathy. More precisely not all of it can help. The fact is that homeopathic remedies do not undergo any clinical tests, so it will be difficult to say whether there will be a positive effect.

Operative treatment

Operative treatment is understood as liver transplantation. This operation is not only complicated, but also expensive. Such an intervention is appropriate only if a person has cirrhosis or the last degree of hepatic insufficiency.

To carry out qualitative transplantation it is possible exclusively in clinics of Germany. As mentioned above, the procedure is really expensive. The complexity of this operation is not only in price, but also in the search for a donor, because finding a person with good physical and mental data is not always that simple. Some people stand in the "queue" for a new body for years and do not always wait for it.

The operation itself is complex. The recovery period is very long. It is necessary to monitor the condition of the person and the body. After all, it takes a long time and it is not always possible. Naturally, it is best not to resort to such an operation. Nobody gives a 100% positive result. That there was no such necessity it is necessary to simply exclude alcohol consumption and in time to treat pathological and inflammatory processes in an organism.

Prevention

Prevention of alcoholic hepatitis is the only way to avoid this problem. After all, treatment is not only long-term, but also complex. And during the recovery period, many difficulties can arise. First of all, you should exclude the consumption of ethanol-containing beverages. In this case, we mean alcoholic beverages, of any percentage significance. The daily intake of intake for a woman should not exceed 20 grams, and for a man of 40 grams. If these rates are significantly higher, the likelihood of developing alcoholic hepatitis increases.

The only way to avoid this problem is a complete refusal of alcohol. If a person consumes it periodically, it is difficult to draw conclusions about his health. The development of alcoholic hepatitis completely depends on the amount drunk, the way of life of a person and the nature of his nutrition. Naturally, a special place is given to the liver. It initially may not be at its best, and alcohol will only aggravate the situation.

Forecast

The prognosis is completely dependent on the condition of the liver and the stage of the development of the disease. The best prognosis is observed in the presence of alcoholic fatty degeneration. This condition is characterized by the presence of fat droplets inside the liver cells. It happens under the influence of alcohol. Eliminate this problem is not so difficult. Therefore, the forecast is usually favorable.

A negative course is observed with cirrhosis of the liver. Removing the problem in this case is possible only through means of transplantation. Medication is unlikely to have the necessary effect. With cirrhosis, the forecast is unfavorable.

Positive flow is possible only if the person completely refuses to drink alcohol and begins timely treatment of inflammatory processes in the body. Young age and normal body weight also affect the prognosis of the prognosis. Finally, the disease proceeds, much more favorably in men, than in women.

[27], [28], [29]