home Analyzes Severe liver disease caused by frequent alcohol use. Fat metabolism disorders. The course of alcoholic liver disease

Severe liver disease caused by frequent alcohol use. Fat metabolism disorders. The course of alcoholic liver disease

Our liver is the universal and natural filter of our body. Every day this body performs a huge amount of work, which can increase significantly if a person has bad habits, overweight and a love of unhealthy eating. So with an aggressive effect on the liver with drugs or alcohol, an individual may develop toxic liver damage. Such pathological condition requires extreme care and proper treatment under the supervision of a qualified doctor. Let's talk about the features of alcoholic toxic liver damage in a little more detail.

How is toxic liver damage caused by alcohol manifested? Symptoms

The manifestations of this disease depend on the duration of alcohol consumption by the patient, as well as on the amount of alcohol consumed. So if a person suffers from severe alcoholism, then the first unpleasant sensations begin to disturb him in the age range from thirty to forty years, and after this age more serious disorders may develop.

Alcoholic toxic liver damage often makes itself felt by painful sensations in the area of the affected organ, namely in the right side, while the size of the liver increases. Patients often complain of intense thirst and a feeling of dryness in the mouth. They are worried about the constant feeling of fatigue, and in some cases, jaundice develops on the skin - the skin, mucous membranes and sclera turn yellowish.

Pathological processes are accompanied by loss of appetite, patients often experience nausea, increased swelling in lower limbs. In addition, they are often worried about weight loss. Alcoholic damage to the liver leads to changes in the skin - it turns into abnormally dark or light colors, redness may appear on the limbs, in addition to different areas body formed small spider-like blood vessels of red color, which are often referred to as spider veins. In a number of patients, pathological processes lead to bloody, dark black or tarry stools, some are worried about nosebleeds or noticeable bleeding of the gums, in addition, a certain percentage of patients experience hematemesis, similar in appearance to coffee grounds.

Toxic poisoning of the liver with alcohol also leads to changes in the state of the nervous system, which is expressed in agitation (excessive agitation and irritability), constant mood swings, confusion and hallucinations. In many patients, attention, understanding or concentration periodically decreases. They may also be disturbed by memory impairment, a feeling of pain, numbness or tingling in the limbs. A common symptom of such a pathology is also considered to be lethargy, slowness and apathy. As practice shows, alcoholic liver damage often leads to a decrease in the size of the testicles in males, while their mammary glands increase.

How is toxic liver damage corrected by alcohol? Treatment

Successful treatment of toxic liver damage with alcohol is possible only if the disease was detected on early stage development, in this case the pathological processes are still reversible. Treatment helps stop the progress of the disease and optimize liver activity. However, with the development of alcoholic hepatitis or cirrhosis, all correction measures help only to alleviate the symptoms, prevent deterioration, and also prevent complications.

All patients with a similar diagnosis should stop drinking alcohol. On the very initial stage only this measure may be enough for a cure, in other cases it will help to improve the condition.

Also, patients should adhere to a special diet - their diet should consist of a balanced amount of proteins, vitamin and mineral particles, and also saturate the body with an optimal amount of calories. On benefit will go reception different kind vitamin complexes.

Drug treatment implies carrying out detoxification measures, namely infusion therapy with a glucose solution, etc.). To restore liver function, patients are advised to consume essential phospholipids that can restore the activity of cell membranes and activate the protective properties of hepatocytes, as well as normalize the production of enzymes.

IN severe cases patients are prescribed corticosteroid formulations, but they are not suitable for those patients who suffer from gastrointestinal bleeding and infectious lesions. As a hepatoprotective agent, Ursosan, in other words ursodeoxycholic acid, can be used. This tool also effectively optimizes lipid metabolism and has a choleretic effect. For problems with mental conditions, patients are prescribed S-adenosylmethionine - Heptral.

In cases where the disease is complicated by the occurrence of Dupoitren's contractures, it is recommended that physiotherapeutic treatment be carried out - the use of reflexology, exercise therapy techniques and massage. In some cases, one has to resort to surgical treatment.

If the disease has reached the terminal stage, then doctors recommend a donor liver transplant.

In the early stages of development, toxic liver damage with alcohol is quite treatable.

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Alcohol refers to hepatotoxic products, that is, its components destroy liver cells. Alcoholic liver disease is the changes that ethanol causes in the structure of this organ and associated dysfunction. The liver acts as a kind of filter for the body: it cleans it from toxins that come with air or food. Alcohol-damaged hepatocytes (liver cells) are unable to perform their direct function, and the patient suffers from general intoxication.

Causes of alcoholic liver disease

It is not exactly established how much alcohol can destroy liver tissue. It is believed that the critical dose is 40-80 g of pure ethanol for men and about 20 g for women for 10-12 years.

Among the factors that contribute to the development of alcoholic liver damage, there are several main ones:

the systematic use of alcoholic beverages in high dosage over a long period of time;
female (women are less resistant to pernicious influence ethanol, while liver damage in men may not appear);
a genetic feature due to which the enzymes that destroy alcohol are less active;
at the time of alcohol intake or in history;
metabolic disorders.

Alcoholic liver disease is widespread everywhere, regardless of the level of development of the state. More than 10 million patients have been registered in Russia. Every year, alcoholism leads to lethal outcome more than 10 thousand people.

Alcohol and gender

Women have physiological feature which stimulates the development alcohol disease. In the gastric mucosa, they have a reduced amount of an enzyme necessary for the processing of alcohol. Statistics show that women are less likely to apply for medical assistance with alcoholism, and they are more likely to relapse after the end of treatment. In addition, women are more likely to be diagnosed with cirrhosis of the liver associated with the intake of alcoholic beverages.

Alcohol and genetics

Data on the maximum allowable doses of alcohol are averaged and may differ in different people by more than 3 times. It has been established that alcohol intake is influenced by the model of behavior and the culture of its use in the family. A genetic predisposition is indicated by the fact that monozygotic twins are more likely to suffer from alcoholism at the same time than dizygotic twins.

5 specific enzymes are involved in the metabolism of ethanol. The degree of its utilization and the amount of acetaldehyde, which will be formed from the unused product and deposited in the body, depend on their activity. It is this substance that has a destructive effect on hepatocytes and becomes the cause of the development of alcoholic disease. These enzymes are present in different people in different amounts, which determines their susceptibility to alcohol. Yes, residents Eastern countries they are inactive, so each intake of ethanol causes sharp rise acetaldehyde levels and deterioration of well-being. This fact may explain the low popularity of alcohol in their culture.

Alcohol and food

Changes in the liver can be triggered by nutrition. In many chronically ill patients, alcoholism was triggered by other diseases associated with inadequate protein intake. To the greatest extent, this applies to disadvantaged segments of the population, whose lifestyle is far from healthy. In this case, protein deficiency causes the first changes in hepatocytes, and alcohol contributes to the development of the disease. However, alcohol disease is possible with a properly balanced diet.

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It is necessary to distinguish between the concepts of alcoholism and alcoholic liver disease (ALD). The first term describes persistent psychological dependence from alcohol, the second - a pathological condition associated with the destruction of liver tissue. The risk of adverse effects increases the frequency of drinking alcoholic beverages. If you take breaks for more than two days a week, the possibility of liver damage is reduced. Among patients with ALD, less than half of them take alcohol in critical doses. Many of the patients previously suffered from various pathologies liver of non-alcoholic etiology, and taking ethanol aggravates the situation.

How much alcohol can you drink?

The question of how much alcohol is considered safe and will not affect liver health is dealt with by doctors different countries. Their indicators differ, but they all agree that the most dangerous is not a single dose of alcohol, but its prolonged use. Data for males and females are different.

Doctors conducted research and calculated how much alcohol can cause changes in liver tissues. Based on these data, relatively safe, dangerous and very dangerous doses can be distinguished. There is no absolutely safe amount of alcohol.

The tables show the dosages of pure alcohol. In alcoholic beverages, its concentration is different: 10 g of ethanol is equivalent to 25 g of vodka, 100 ml of wine or 200 g of beer. The alcohol percentage on the label must be indicated on the product, and it is better not to drink unknown alcoholic drinks and cocktails at all.

Forms of alcoholic liver disease

Ethanol can cause various disorders in the structure of the liver. Depending on the biochemical and pathomorphological changes, several forms of pathology can be distinguished:

fatty degeneration of the liver (steatosis, fatty hepatosis) - accumulation of fat droplets in hepatocytes;
hepatitis - inflammation of tissues in combination with the accumulation of fat;
fibrosis - an abnormal growth of dense connective tissue while maintaining the anatomical integrity of the organ;
cirrhosis - the gradual destruction of healthy cells with their replacement with fibrous tissue and a violation of the structure of the organ;
liver failure (acute or chronic) - damage to liver tissue, which leads to loss of organ function.

The disease can develop in stages and begin with fatty degeneration. However, some patients are diagnosed with the stage of cirrhosis without inflammation (hepatitis).

Pathogenesis - what happens in the body?

In the pathogenesis of alcoholic disease, chronic alcohol intoxication (CHAI) is important. This condition is understood as the systematic consumption of more alcohol than it is utilized in the liver. In this case, the body is looking for alternative routes its processing, therefore, the mechanisms of its catalase and microsomal transformation are activated. During these reactions, a large number of acetaldehyde.

Acetaldehyde

Acetaldehyde is a toxic product of ethanol processing. In patients, there is an increase in its concentration in the blood, but only a small percentage of it leaves the liver. The rest of its amount accumulates in hepatocytes and affects them in several ways:

disrupts the course of redox reactions in hepatocytes;
accelerates lipid peroxidation reactions, which lead to the destruction of liver cells and their premature death;
hinders normal operation intracellular structures: mitochondria, microtubules and nucleus.

During the oxidation of ethanol, there is an increased synthesis of enzymes involved in the processes fat metabolism. As a result, the patient registers fatty infiltration of the liver (replacement of functional cells - hepatocytes with fatty ones) and dyslipidemia (violation of the content fatty substances in blood).

The disease develops in stages. The probability of complete recovery of the patient depends on the timeliness of treatment.

Normally, there are cells in the human liver that accumulate reserves of vitamin A. Under the influence of acetaldehyde, they transform, lose vitamins and begin to produce fibrous tissue. This is a type of connective tissue that begins to grow among hepatocytes and around small capillaries. As a result, liver cells do not receive enough oxygen and nutrients and suffer from hypoxia. Under such conditions, they cannot perform their function and eventually die.

Protein metabolism disorders

In patients, an increase in the amount of protein in hepatocytes is observed, which contributes to fluid retention. This phenomenon may be due to the fact that acetaldehyde enters into chemical reactions with microtubules, on which protein excretion directly depends. Proteins accumulate and, in turn, bind fatty acids, which exacerbates fatty degeneration of the liver.

Fat Metabolism Disorders

Normally, fatty acids enter the liver with food and are then excreted from it. With alcoholism, the level of fatty acids increases markedly. An increase in the amount of fat in the liver may be due to several factors:

increased consumption of them with food;
their intensive synthesis in hepatocytes;
their intake from adipose tissue.

The reasons for the development of fatty degeneration are individual. With a single consumption of a critical dose of alcohol, the level of fatty acids increases due to their intake from adipose tissue. In chronic alcoholism, there is a failure in the mechanism of their metabolism, and they begin to be synthesized in the liver cells in large quantities.

hypermetabolic syndrome

At regular use high doses of alcohol liver cells need a lot of oxygen. Since it is impossible to increase its intake, hepatocytes suffer from hypoxia. This leads to a decrease in their performance, and in the future - to death.

Fibrosis

In some cases, cirrhosis of the liver develops due to fibrosis, bypassing the stage of hepatitis. The mechanism of this phenomenon is not fully understood, but doctors talk about the role of lactic acid in these disorders. Fat-storing Ito cells transform into fibroblasts. There is also an increased synthesis of collagen and its deposition in the liver. Cirrhosis can also develop due to hypoxia, which leads to the destruction of hepatocytes.

Immune pathologies

Alcoholism has an abnormal course immune reactions. In the blood of patients, an increased concentration of cells is found, which are produced only in response to exposure to foreign substances. However, some associate this feature with the action of hepatotropic viruses (those that multiply in the liver tissues) against the background of alcohol intoxication. All these reasons explain the mechanism of the effect of alcohol on the human body and answer the question of whether the liver can hurt after drinking alcohol.

Symptoms of the disease

The first sign of alcoholic disease, which is recorded in 90% of patients, is fatty degeneration of the liver. In some cases, it is asymptomatic, but the following manifestations may occur:

chronic aching pain in the right hypochondrium;
loss of appetite, nausea and vomiting;
yellowness of the skin and visible mucous membranes.

Another option for the development of pathology is alcoholic hepatitis, or inflammation of the liver. Symptoms of the disease can develop quickly and lead to death due to general intoxication. It can be suspected by characteristic clinical signs:

a person periodically hurts the liver (the area under the ribs on the right);
general deterioration, lethargy, apathy;
increase possible general temperature body;
signs of jaundice: yellowing of the mucous membranes and skin.

Alcoholic liver disease may present with cirrhosis. This is a structural degeneration and destruction of cells, which entails irreversible changes.

Cirrhosis of the liver has a number of specific symptoms:

redness of the palms;
the appearance of spider veins on the surface of the skin;
thickening of the last phalanges of the fingers, or drumstick syndrome;
acquisition of an irregular shape of nails;
jellyfish head syndrome, when the veins of the abdominal wall become visible and stand out on the skin around the navel;
in some cases, men have a pathological increase in the mammary glands.

Cirrhosis of the liver is an incurable disease that only progresses over time. Patients change shape auricle, and Dupuytren's contracture is also observed. A painful dense nodule of connective tissue begins to grow on the palm of your hand, which makes it difficult to normal flexion and extension of the fingers.

Alcohol destroys liver cells, making it unable to deal with toxins

Complications of alcoholic disease

Changes in liver tissues significantly increase the risk of developing cancer. In addition, pathologies of this organ can lead to bleeding in the gastrointestinal tract and improper functioning of the kidneys. Toxins that enter the body and cannot be neutralized in the liver cells are deposited in the brain tissues and provoke serious forms of encephalopathy.

Diagnosis of alcoholic disease

A gastroenterologist deals with the diagnosis of alcoholic disease. First of all, he must conduct a survey of the patient. Duration matters alcohol addiction, as well as the amount in which the patient consumed alcohol-containing drinks.

If alcoholic liver damage is suspected, blood should be taken for analysis. Here you can find an increase in the number of leukocytes and monocytes, which indicate the presence of an inflammatory process in the body. Due to reduced function bone marrow at clinical analysis blood thrombopenia (a decrease in the number of platelets) and an increase in ESR (erythrocyte sedimentation rate) will be detected. Some patients show signs of anemia.

Biochemical and immunological blood tests will allow a more detailed assessment of the patient's condition:

increased levels of AsAT, AlAT - specific liver enzymes;
an increase in the concentration of bilirubin due to pathologies of the biliary system;
increased levels of immunoglobulins, especially immunoglobulin A;
iron deficiency may be present.

An ultrasound will show the characteristic symptoms of alcoholic liver disease. It will be enlarged in size, and in its parenchyma will be visible body fat. Good result gives a Doppler study of blood vessels. Thus, an increase in pressure in the portal vein can be detected. MRI makes it possible to track changes in the tissues of the liver and its vessels, and by biopsy it is possible to extract material for histological examination.

Treatment Methods

Treatment of alcoholic liver disease will not be successful at all stages. Its fatty infiltration is a reversible process, but the success of therapy largely depends on the patient himself. In case of cirrhosis of the liver medical measures aimed at alleviating the patient's condition, but we are no longer talking about a complete recovery.

The first condition for treatment is complete failure from alcoholic beverages, otherwise the medicines will not be effective. In most cases, patients have been taking alcohol for many years at the time of initiation of therapy, so it will be difficult to eliminate it from their diet. They may need the help of relatives or a psychologist.

Drug therapy will not work if the patient continues to destroy his own body with alcohol.

The second condition for recovery is diet. With alcoholic disease, people suffer from a deficiency of proteins and vitamins, so it is necessary to saturate the diet with these elements as much as possible. Vitamin preparations should be present not only in food, but also in the composition of supplements.

A mandatory item is the removal of signs of intoxication. The patient is prescribed infusion therapy (droppers) with the addition of glucose, cocarboxylase or pyridoxine. It is also necessary to accelerate the regeneration of the liver tissue; for this, hepatoprotectors are prescribed. These drugs contain phospholipids necessary to update the number of hepatocytes.

Ursdeoxycholic acid is also needed to repair liver tissue. It has a choleretic effect, normalizes the processes of lipid metabolism. In severe cases of hepatitis, hormonal anti-inflammatory drugs are needed. They are contraindicated in case of infection of the focus of inflammation, as well as in case of suspected gastric bleeding.

With cirrhosis, it is impossible to restore the liver. Drug therapy is aimed at preventing complications (dropsy abdominal cavity bleeding, toxins entering the brain). Liver transplantation can be performed to save the patient's life. It is possible only on condition of a complete rejection of alcoholic beverages for a period of at least 6 months.

Prevention and prognosis

The only preventive measure is the use of alcoholic beverages, especially in the presence of a history of liver pathologies. The success of therapeutic measures depends on the attitude of the patient himself and his desire to be cured. In the first stages (fatty liver, alcoholic hepatitis), the outcome can be favorable if the patient refuses alcohol and follows all the doctor's recommendations. Cirrhosis of the liver, regardless of its origin, is incurable pathology leading to death within 5 years.

Alcoholic liver damage is a pathology that affects a huge number of the world's population. Ethanol itself is not a toxic product and is completely utilized by the body, but with its regular use in high doses, it completely changes the course of metabolic processes in the liver. As a result, there is a risk of developing hepatitis, fatty liver and even cirrhosis. To a greater extent, the frequency of alcohol consumption affects the development of the disease. The success of treatment and prognosis depend on the stage of damage to the liver cells. If you refuse to take ethanol in time, follow all the recommendations of doctors and take the necessary medications, there are chances for a full recovery.

Under alcoholic liver disease is meant the impaired functioning and structural degeneration of this organ, which leads to prolonged and systematic use of alcoholic beverages. People suffering from this ailment experience problems with appetite, nausea, jaundice, dull pain in the right hypochondrium and diarrhea. On late stage the disease begins to develop cirrhosis, as well as hepatic encephalopathy.

to install correct diagnosis , it is necessary to do ultrasound, dopplerography, liver biopsy, scintigraphy. Often, doctors take blood from a patient for biochemical test to do more research.

Treatment of an alcoholic disease primarily requires the rejection of alcoholic beverages, as well as taking necessary medicines, the list of which usually includes sedatives, antioxidants and hepatoprotectors. The liver suffers greatly from alcoholism, and its tissues die off. In particular advanced cases only the transplantation of this vital organ can save the patient.

general information

The development of liver disease takes quite a long time. It appears on condition daily alcohol abuse and for over 10-12 years. In terms of pure ethanol, the minimum average daily dose that can lead to alcoholic liver damage should be forty to eighty grams. ethyl alcohol for men and a little over twenty grams for women.

The main manifestations of this disease are cirrhosis and fatty degeneration. Cirrhosis leads to the fact that the liver tissues die off, and fibrous, that is, connective, appears in their place. Fatty degeneration causes steatosis and fatty degeneration of liver tissue.

Men are more at risk of developing the disease, as male alcoholism is three times more common than female alcoholism. This is due to the fact that, according to statistics, four women, abusing alcohol, there are eleven men suffering from a similar addiction. However, it is worth noting that the development of female alcoholism occurs in a shorter time and requires the use of fewer alcoholic beverages. This feature is explained by gender differences in the absorption, catabolism and excretion of alcohol.

Today, alcoholic liver disease is a serious medical and social problem caused by an increase in the consumption of hard liquor around the world.

Mechanisms of disease development

The bulk of ethyl alcohol (about 85%) entering the human body is affected by the enzymes acetate dehydrogenase and alcohol dehydrogenase. They are produced in the stomach and liver. The rate of breakdown of ethyl alcohol is primarily influenced by genetic features organism.

With prolonged and regular use alcohol-containing drinks, the catabolism of ethanol is accelerated, which leads to the accumulation of toxic products that are formed during its splitting. These substances provide bad influence on liver tissue.

Factors affecting the development of the disease

The following factors influence the development of a disease caused by liver damage to alcoholic beverages:

signs

The very first stage in the appearance of an alcoholic disease is fatty degeneration of the liver. It occurs with regular alcohol abuse for more than ten years in almost 90% of alcoholics. Its course is most often asymptomatic, but some patients often experience decreased appetite and nausea. And also in the right hypochondrium, dull pains can periodically occur. Approximately fifteen percent of patients are diagnosed with jaundice.

Acute alcoholic hepatitis can also occur without identified clinical symptoms, but often it has just a lightning-fast and very severe course, which quickly leads to the death of the patient. However, it is still worth noting the most common symptoms of this disease:

Chronic alcoholic hepatitis torments the sick for a long time alternating periods of remissions and exacerbations. Periodically, the patient may experience mild pain or stomach problems, leading to heartburn, belching, nausea, diarrhea, and constipation. Sometimes patients with a similar diagnosis are affected by jaundice.

With the development of an alcoholic disease, in addition to signs of hepatitis, the patient can reveal symptoms characteristic of the onset of cirrhosis of the liver. These include:

For further development alcoholic cirrhosis characteristic enlargement of the auricles.

Another specific manifestation of an alcoholic disease that has passed into the thermal stage is Dupuytren's contractures. In this case, dense knots of connective tissues form on the palms above the tendons of the fourth and fifth fingers, the patient may not feel it at all, but sometimes it causes pain. In the future, such a nodule grows in all joints of the hands. At this stage, the patient begins to experience difficulty in trying to bend the ring fingers and little fingers. Such a disease can lead to their complete immobilization.

Complications

Liver drinking man subject to a heavy load, because alcoholic beverages are simply incompatible with this organ and can harm it even in small doses.

Alcoholic liver damage often leads to gastrointestinal bleeding, impaired kidney function, and hepatic encephalopathy. Leads to encephalopathy accumulation of toxic substances in the body formed in the body after the breakdown of ethanol. They are deposited in the tissues of the brain, thereby reducing the functional activity of the whole organism. People with alcoholism are prone to developing liver cancer.

Diagnostics

When diagnosing alcoholic liver damage, an important role is played by determining the duration of alcohol abuse by patients and collecting information about previously transferred and active diseases. A gastroenterologist with special care finds out and groups data on the regularity of taking and the amount of alcohol consumed.

During laboratory tests, a general blood test reveals leukocytosis, accelerated erythrocyte sedimentation rate and macrocytosis. The latter is the result of the toxic effect of alcohol-containing beverages on the bone marrow. Iron deficiency and megablastic anemia may also occur. Decreased platelet count in the blood is determined as a symptom of hypersplenism. First of all, it is associated with a decline in the functioning of the bone marrow and is detected when high blood pressure during cirrhosis in the system of hollow veins.

Biochemical analysis of blood reveals increased activity hepatic transferases ALT and AST. It is also noted increased content bilirubin. Immunological analysis helps to detect an increase in the level of immunoglobulin A. If the patient consumes such an amount of alcohol that more than sixty grams of pure ethanol enters the body daily, then transferrin, depleted in carbohydrates, increases in the blood serum. The amount of serum iron can periodically increase.

For the correct diagnosis of liver damage, careful collection of data on the amount and regularity of alcohol consumption is necessary. It is important to take into account not only the frequency and quantity, but also the type of alcoholic products consumed by the patient. Given the increased likelihood of liver cancer in patients with alcoholism, it is important to determine the content of alpha-fetoprotein in the blood. If its concentration is more than four hundred nanograms per milliliter, the presence of cancer cells. If in the blood increased triglyceride levels this indicates a violation of fat metabolism.

Instrumental methods of diagnosing

Instrumental techniques that help diagnose alcohol disease:

When conducting an ultrasound examination of the affected organ, signs of a change in the shape and size of the liver, as well as its fatty degeneration (the latter is characteristic of tissue hyperechogenicity), are clearly visible.

Doppler ultrasonography helps to detect an increase in blood pressure hepatic vein and portal hypertension.

MRI and CT allow a good view of the liver tissue, as well as its vascular system. Radionuclide scanning determines the production of bile, the rate of secretion of the organ and reveals a diffuse change in the hepatic lobes.

To definitively confirm liver damage for histological analysis a biopsy is performed.

Treatment of liver disease

If an alcoholic disease is detected in time at an early stage of fatty degeneration, while this process is still reversible, it is possible to prevent subsequent progression and even restore the functioning of the organ. If the patient has already developed cirrhosis and alcoholic hepatitis, treatment will include mitigation of symptoms, prevention of complications and further deterioration of the patient's condition.

The main and obligatory condition for fruitful treatment is the complete and final rejection of the use of alcohol-containing products. This measure not only causes an improvement in the general condition of the body, but can also lead to a cure at an early stage of the disease.

For patients with alcoholic liver damage, it is also prescribed special diet. Food has sufficient calorie content and includes proteins, trace elements and vitamins. It is necessary because of protein deficiency and hypovitaminosis, which often develop in people who abuse alcohol. With severe anorexia nutrition to patients is prescribed parenterally or administered by probe.

Drug therapy consists of measures to detoxify the body and includes infusion therapy with solutions of pyridoxine, glucose and cocarboxylase. To regenerate liver tissue, essential phospholepids are used. With their help, it is possible to stimulate the protective properties of cells, the activity of enzymes and restore the functionality and structure of cell membranes.

If the patient's life is threatened by a severe form of alcoholic hepatitis, corticosteroid drugs are mandatory. But there are contraindications to their appointment, such as gastrointestinal bleeding and infections.

Forecast

It should be understood that the forecast alcoholic disease liver primarily depends on the stage of the disease at which treatment was started. And it is also especially important to follow all medical recommendations and completely abandon the use of alcoholic beverages. If necessary therapeutic measures are taken liver function can be normalized within one month and the statosis stage can be reversed. It is important to understand that the development of cirrhosis not only threatens with the occurrence of cancer, but can also have an unfavorable outcome, that is, death within five years.

Comparing the photo of the liver of an alcoholic and healthy person, we can conclude that the main prevention of liver diseases should be considered the rejection of the abuse of alcoholic beverages.

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Alcoholic liver disease is one of the actual problems hepatology due to its wide prevalence in all countries of the world. Alcohol use is a cause of alcoholic liver disease, and occurs in people who drink alcohol in large quantities or those who are addicted to alcohol.

There are two terms "alcoholism" and "alcoholic liver disease". The first is used to refer to a person's condition characterized by mental and physiological dependence on alcohol. These patients are patients of psychiatrists-narcologists. In people with alcoholic liver disease, a pronounced dependence on alcohol is rarely observed, and a severe hangover syndrome rarely occurs, which allows such people to drink alcohol for a long time. Alcoholic liver disease affects more often representatives of certain social groups in which alcohol is an attribute professional activity or relieve emotional stress.

With alcohol abuse, almost all organs of the body suffer, but the liver is more affected, due to the fact that it plays a central role in the metabolism (metabolism) of alcohol, which turns into acetaldehyde, which has a direct toxic damaging effect on liver cells (hepatocytes).

Genetic, hereditary factors are involved in the risk of developing alcoholic liver disease. For example, parents who suffer chronic alcoholism, children can inherit low level enzymes that utilize ethanol, and then the problem of alcoholism becomes relevant for them as early as 15-20 years. One of the luminaries of Russian medicine A.A. Ostroumov, demonstrating young man with liver pathology, claimed that "the father 'drank away' his son's liver."

Liver damage from alcohol depends on the amount of alcohol consumed and duration. Most researchers agree that a dangerous daily dose of alcohol is more than 40-80 ml of pure ethanol per day for at least 5 years. A dose of more than 80 g per day for 10-12 years is considered extremely dangerous, alcoholic liver disease easily occurs at such values. This amount of ethanol is contained in 100-200 ml of vodka 40%, in 400-800 ml of dry wine 10%, 800-1600 ml of beer 5%. These data are given in relation to men, the dose of women is 20% ethanol per day.

Alcoholic liver disease is formed only in 20% of those who constantly abuse alcohol, which is influenced by other risk factors - nutrition, gender. It is known that in women with the use of smaller doses of alcohol and for a shorter period of time, even after giving up alcohol, the disease can progress. Alcohol disrupts the processes of digestion, the appearance of dyspeptic phenomena indicates the involvement of the pancreas, intestines in the process, a lack of protein, vitamins, and minerals develops. Nutritional deficiencies contribute to the progression of alcoholic liver disease, and even good nutrition does not prevent alcoholic liver damage. General malnutrition, deficiency nutrients, contribute to the development of liver damage in people who drink alcohol, aggravate the course of the disease and have an adverse effect on other organs and body systems.

Stages of the disease

Alcoholic liver disease goes through four stages:

fatty degeneration (steatosis) of the liver,
alcoholic hepatitis (steatohepatitis),
cirrhosis of the liver,
hepatic carcinoma (hepatoma).

The metabolism of alcohol, the mechanisms of the damaging effect of toxic products of its metabolism on liver cells, especially the most important structural component of cell membranes - phospholipids, the replacement of liver cells with connective (non-functioning) tissue - progressive fibrosis of liver cells - are a complex long-term biochemical process. Each stage of this process determines the stage of liver damage and is a dynamic criterion for diagnostic observation of the patient.

Stage of fatty degeneration of the liver (steatosis)

This stage may be asymptomatic. But clinical observations show that often for several years patients complain of intestinal discomfort: bloating, periodic diarrhea, decreased appetite, mood, nausea, which is already early sign alcoholic damage to the pancreas. At objective examination it is possible to note an increase in the liver, an increase in liver parameters.

Alcoholic hepatitis (steatohepatitis)

The most common in clinical practice is the icteric form (jaundice of the sclera and skin), jaundice is not accompanied by itching of the skin. In addition, patients experience pain and heaviness in the right hypochondrium, nausea, vomiting, weakness, loss of appetite, diarrhea, and rarely fever. But in 5-10% of cases, jaundice can be prolonged and accompanied by skin itching, discolored feces, less often temperature reaction and pain in the right hypochondrium - a cholestatic form of alcoholic liver disease. IN laboratory research liver tests, tests of stagnation of bile in the liver (cholestasis) are sharply violated.

Fulminant alcoholic hepatitis has a rapidly progressive course with jaundice, mental disorders (encephalopathy), liver failure and often ends in death in a hepatic coma. Also, however, as cirrhosis And hepatic carcinoma. So it does not make sense to consider these stages within the framework of this article.

Diagnosis of alcoholic liver disease

Diagnosis of alcoholism is based on a clinical examination, special tests to identify post-intoxication alcohol syndrome and a list of physical signs of chronic alcohol intoxication.

Diagnosis of alcoholic liver disease and its stage is based on a thorough history taking, clinical, laboratory and instrumental examinations.

To recognize alcoholic liver damage, it is very important to know how long and in what quantities alcohol was taken by the patient. Often patients hide their alcohol abuse, so it is very important to talk to family and friends and get tested.

To identify hidden alcohol addiction, special tests are used, the most common is the CAGE questionnaire. The answer "yes" to two or more questions is considered a positive test and indicates a hidden alcohol dependence in a particular patient.

There is a test developed by the World Health Organization, "Identification of Alcohol Use Disorders", with a positive answer to test questions of 8 or more, the test is considered positive.

Identifying Alcohol Use Disorders

Clinical manifestations of alcoholic liver damage are very poor: weakness, heaviness in the right hypochondrium, intestinal discomfort - bloating, loosening of the stool after eating fatty and plentiful food, nausea. Most patients do not present active complaints, and during examination or ultrasound, it is sometimes possible to accidentally detect an increase in the liver, icterus of the sclera and skin is less common and manifests itself in more severe cases.

Laboratory studies, among which, first of all, attention is drawn to the indicators of biochemical blood tests:

ALT and AST and AST/ALT ratio (1.5:2),
gamma-glutamyl transpeptidase exceeding transaminases and has diagnostic value its decrease with the refusal of alcohol,
a relatively new marker of alcohol intoxication is transferrin, the concentration of which increases with the use of more than 60 g or more of ethanol daily,
increase in bilirubin and its fractions,
decreased albumin (a protein synthesized by the liver),
in a clinical blood test - a decrease in hemoglobin, leukocytes, platelets.

Instrumental research methods:

Ultrasound examination of the liver, gallbladder, pancreas and spleen,
endoscopic examination - esophagogastroduodenoscopy,
Elastometry, which allows to clarify the severity of liver fibrosis - a marker of disease progression.

With alcoholic liver disease, patients may feel quite well, even with abnormal laboratory tests and indicators. instrumental methods research. Often they turn to doctors already with severe complications - bleeding from varicose veins of the esophagus and stomach, hepatic encephalopathy, severe jaundice, with fluid retention in the abdominal cavity, etc., requiring treatment in a hospital.

Alcohol acts systemically on various organs and body systems that patients often do not notice is the effect on cardiovascular system, central nervous system, musculoskeletal and other systems, but liver damage is increasing.

Treatment of the disease

Should Alcoholic Liver Damage Be Treated? Yes.

Creating conditions for recovery

The first and prerequisite successful treatment alcoholic damage to the liver is a complete refusal to take alcohol, without which the progression of the disease is inevitable.

Fulfillment of this requirement at the stage of steatosis and hepatitis makes it possible to reverse the development of alcoholic liver damage.

Nutrition is an important and necessary component of the treatment of alcoholic liver damage. Energy value adequate nutrition there should be at least 2000 calories per day with a protein content of 1 g per 1 kg of body weight with a sufficient amount of vitamins, minerals, mainly foods and vitamin-mineral complexes. It is possible to recommend the food of the table 5.

Medical treatment

Alcoholic liver disease is effectively treated drug therapy drugs are used different mechanism actions and are combined into a group of hepatoprotectors.

Essential phospholipids

Essentiale forte, Essentiale-N, Floravit - preparations restore the cellular structure of liver cells, various enzyme systems, normalize the metabolism of proteins and fats in the liver, have a detoxifying effect and prevent the formation fibrous tissue in the liver, stopping the progression of the process. These drugs are prescribed in capsules, 1-2 capsules 3 times a day with meals for 3 months. In - subsequent repeated courses.

Silymarin

Dry extract from the fruits of milk thistle - for example, Karsil, Legalon, Silimar, Gepabene contain flavonoids that have a hepatoprotective and bile-forming effect, stimulating enzyme structures that restore liver cell membranes. The course is 4 weeks, 70-140 mg 2 times a day before meals or during meals. According to indications repeated courses.

Ademetionine

Heptral is a natural substance that is formed from the amino acid methionine and has a hepatoprotective, detoxifying effect. It can be administered intravenously by drip or intramuscular injection of 400 mg with a solvent and in saline in a course of 10-20 days. Heptral can be taken orally in tablets. The form of administration of the drug and the duration is determined by the doctor.

Ursodeoxycholic acid

Ursofalk, Ursosan, etc. - normalizes the activity of aminotransferases (ALT, AST), reduces the formation of fibrosis in the liver. Preparations in capsules, calculated on body weight or individually by a doctor, are prescribed for long time up to several years.

Herbal combined hepatoprotective preparations Lif-52, Hepatofalk, etc.

Lipoic acid (Thiagamma, Thiotacid, etc.) has a hepatoprotective and detoxifying effect, normalizes different kinds metabolism in the liver (energy, carbohydrate, fat, protein, cholesterol). A course of 1 month is prescribed, taking 600 mg orally 1 time per day before breakfast.

Corticosteroids

They are prescribed in severe cases of acute alcoholic hepatitis in a hospital setting.

Alcoholic liver disease. Forecast

It all depends on the rate of progression of fibrosis in the liver cells and, consequently, the formation of cirrhosis of the liver.

The impact on the prognosis is exerted by the cessation of alcohol consumption after the diagnosis of the disease is established.

The most unfavorable are acute alcoholic hepatitis and cholestatic hepatitis (with jaundice).

Aggravate the prognosis may be joined by viral infections of hepatitis B and C.

Frequent use of alcohol leads to multiple work impairments internal organs. On the background long-term use alcoholic beverages, a complex of disorders of the gland develops under the general name - alcoholic liver disease. The increase in alcohol consumption in the world is turning this disease into a serious problem for a society, the search for a solution to which falls on the shoulders of doctors, gastroenterologists and narcologists.

Alcoholic liver disease or ALD is a functional disorder caused by alcohol toxins. The disease affects people who take strong alcoholic drinks for a long time and regularly. The permissible measure of pure alcohol for men is 45-70 grams, and for women - no more than 23 grams. This is equivalent to 100-200 ml of vodka.

On the background systematic reception large doses alcohol gradually develops alcoholic liver damage. Alcoholic liver disease is characterized by cirrhosis, fatty tissue degeneration and hepatitis.

Causes

Under the influence of ethanol, processes are triggered in the liver cells, leading to a violation of the integrity of cell membranes, blocking the mechanisms of cell regeneration. The consequence of constant alcohol intoxication of the liver against the background of alcoholism is the degeneration of tissues - dense adipose tissue is formed in place of the liver cells. It is not able to perform the functions of real hepatocytes (liver cells), therefore, hepatocellular insufficiency develops.

Also, dense adipose tissue interferes with normal blood flow, which increases the pressure in the blood vessels of the gland, increases the volume of the spleen. The end result could be an internal hemorrhage.

According to WHO worldwide statistics, one of the most common causes of alcoholism and diseases caused by an abnormally large amount of alcohol is oppressed mental states. A depressed patient falls into a "vicious circle" - alcohol depresses a person physically and morally, actively depleting the body, but refusing to take alcohol leads to apathy, aggression and mental instability.

signs

Alcoholic liver disease always exhibits a number of characteristic symptoms. The first sign of this pathology is fatty degeneration. External manifestations this disease may be uncharacteristic - depressed appetite, painful conditions in the region of the left hypochondrium, the presence of nausea or yellowing of the skin is possible.

Another sign is alcoholic hepatitis, which does not have clear symptoms. In this case, alcohol poisoning can lead a person to death. chronic hepatitis manifested by regular pain in the side, nausea, shortness of breath.

In some cases, there is diarrhea, heartburn, jaundice. Progressive alcoholic liver disease carries pronounced symptoms of cirrhosis: the patient's palms turn red, characteristic vascular "asterisks" appear on the skin, a clear thickening of the fingers, as well as a change in consistency nail plate. In men in rare cases there is an increase in the volume of the mammary glands and testicles.

At a subsequent stage of worsening of the state of alcoholic cirrhosis, there is an increase in the ears, difficulties in manipulating the little finger and ring finger, and in the future complete absence control over them.

Often alcoholic liver disease leads to extensive hemorrhages from the organs gastrointestinal tract, to hepatic encephalopathy, impaired renal function. Often, against the background of this picture, oncological diseases liver.

Accompanying signs of liver dysfunction are symptoms of a fundamental metabolic disorder. Also, patients may have hypovitaminosis, a lack of zinc, calcium and other macro- and microelements. There is a significant decrease in body weight up to anorexia. Mental disorders are also frequent - depression is a particular factor in the progression of the disease, which only stimulates the patient not to quit drinking alcohol.

Diagnostics

A large number of diagnostic tools are used to determine alcoholic liver disease. In assessing the state of the liver in alcoholism, ultrasound, a biochemical blood test, indicators of the diameter of the main vessels, elastometry, MRI of the liver, radionuclear studies and a biopsy of gland tissues are used.

Attention is drawn to the patient's medical history and anamnesis. Particular attention is drawn to how often and how much the patient consumed certain products. By using biochemical analysis blood determine the content of alpha-fetoprotein - a marker of liver cancer, triglycerides - indicators of violations of fat metabolism.

In a clinical blood test, macrocytosis, accelerated erythrocyte sedimentation rate, leukocytosis, anemia, and platelet suppression are noted. There is also an increase in the activity of hepatic transferases and a high content of bilirubin. There is an excess of immunoglobulin A, transferrin and serum iron in the blood.

With the help of ultrasound, the shape of the liver, the degree of degeneration and hyperechogenicity of the tissue are observed. Doppler sonography provides information about portal hypertension and increasing the pressure of the portal system. MRI allows you to visually assess the condition of the tissue and liver. Radio nucleotide scanning reveals the presence diffuse changes. In addition, resorting to this method, determine the rate of hepatic secretion and bile production.

Confirmation of the assumption about the presence of alcoholic degeneration of the liver is carried out using a biopsy for the purpose of histological analysis.

Treatment

When diagnosing alcoholic liver disease, the patient will have a long-term treatment. Its duration depends on the stage of diagnosis of the disease. The sooner it is detected, the more likely it is to restore the functions of the organ.

The best medicine in the treatment of the liver is a complete ban on the use of alcohol. With the exclusion of this factor, multiple improvements are possible - a return to normal pressure portal vein, changes in the histological picture, stopping cirrhosis.

Due to the fact that patients are characterized by protein deficiency, hypovitaminosis, microelement deficiencies, they are necessarily credited with a balanced, high-calorie diet.

Sufficiently effective in the treatment of pathology are targeted drugs that can detoxify the body and restore liver tissue. Acts as a detoxifier infusion therapy with solutions of pyridoxine, glucose, cocarboxylase. In order to restore the structural integrity and functionality of hepatocytes as soon as possible, they are stimulated with enzymes, as well as drugs that affect the preservation protective functions cells.

In severe cases, simple therapy with pills is not enough. When the life of the patient is threatened, liver medications such as corticosteroids are used.
In the role of hepatoprotectors, ursodeoxycholic acid (ursosan) is used, which has choleretic and regulatory properties. S-adenosylmethionine is a natural substance that plays a key role in liver metabolism. They also use a hepatocyte stimulator and substances that increase the production of natural antioxidants.

In the treatment of ABP, neurotoxic effects are obligatory to be eliminated. "Geptral" exhibits an anti-neurotoxic effect, and also corrects depressive and other states of a disturbed psyche.

Essential phospholipids are able to prevent pathological changes. They do not allow liver cells to degenerate into adipose tissue. In addition, they reduce the degree of oxidative stress and promote the destruction of collagen.
The above described groups of drugs are used for therapeutic purposes in the early and middle stages of the disease, as well as as a maintenance course at the last stage.

In a critical situation, there is only one method that gives hope for recovery - liver transplantation. Complete abstinence from alcoholic beverages for six months - mandatory requirement to carry out this operation.

Forecast

The prognosis for the treatment of this disease is determined by the stage of the disease. It is good that with the exclusion of alcohol, simple alcoholic hepatitis without severe fibrosis can be reversible. Full resolution occurs within six weeks. However, with the development of cirrhosis of the liver and its accompanying complications, the survival of patients is directly related to the continued consumption of alcohol.