Alcoholic Hepatitis - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Alcoholic hepatitis

Content:

• What is alcoholic hepatitis?
• Causes of alcoholic hepatitis
• Persistent hepatitis and its symptoms
• Progressive form of hepatitis and its symptoms
• Acute alcoholic hepatitis
• Chronic alcoholic hepatitis
• Basic principles of treatment for alcoholic hepatitis
• Prevention of alcoholic hepatitis

In 1995, the term "alcoholic hepatitis" was recognized by official medicine, and the name of the disease was included in the list of the International Classification of Diseases, created by WHO. What degenerative processes occur in the body of a patient with alcoholic hepatitis and how to deal with them?

What is alcoholic hepatitis?

Alcoholic hepatitis is a combination of degenerative and inflammatory processes that occur in the liver and are caused by the regular intake of large doses of ethanol.

There is a whole range of alcoholic liver diseases (ABD), among which alcoholic hepatitis is central. The likelihood of developing ABP directly depends on the volume of consumed ethanol-containing drinks and the regularity of this process. At the same time, the type of alcohol is unimportant: beer, vodka, wine - all this creates a good help for the emergence of ABP.

Alcoholic hepatitis does not develop immediately: with the regular use of critical doses of ethanol, the patient first develops fatty degeneration of the liver and only then alcoholic steatohepatitis. At the final stage, the disease flows into liver cirrhosis.

As a result of studies carried out in Europe by WHO in 1995, it turned out that every European a year consumes about 9.8 liters of alcohol. In the Russian Federation, this figure is slightly higher - 10 liters per person per year. Therefore, alcoholic hepatitis is diagnosed in three citizens out of five thousand of the country's population.

Causes of alcoholic hepatitis

Why does ethanol, which is part of all alcoholic beverages, have such a detrimental effect on the liver? Because the main metabolic processes of this substance occur in the liver.

Only 20% of ethanol consumed is processed in the stomach and converted to acetaldehyde. The rest of the burden of breaking down this substance falls on the liver. A large concentration of acetaldehyde in an organ destroys its cells and leads to a disruption of a number of important biological functions.

In women, the ability of the stomach to secrete alcohol dehydrogenase to break down ethanol is significantly lower than in men. That is why alcohol is doubly dangerous for the health of the fairer sex.

Alcoholic hepatitis is most often found in chronic form in persons who have been abusing alcohol for 5-7 years. The rate of development of the disease is influenced by hereditary factors and the general state of human health. However, it has been experimentally established that even 50 g of alcohol daily for a long time can cause alcoholic hepatitis in a healthy man.

Persistent hepatitis and its symptoms

The persistent form of hepatitis is poor in symptoms. Therefore, the patient may be unaware of his illness for a long time.

From time to time, the patient is worried about:

• feeling of heaviness in the right hypochondrium;
• mild nausea;
• belching;
• stomach discomfort.

This form of alcoholic hepatitis is detected by laboratory tests. If detected early, it can be cured. If you follow a diet and completely stop drinking alcohol, you can notice improvements in health within six months. However, the effects of the disease can be observed for 5-10 years.

If you do not deal with the treatment of persistent alcoholic hepatitis, then it goes into a progressive form.

Progressive form of hepatitis and its symptoms

The progressive form of hepatitis is a harbinger of liver cirrhosis. It is observed in 20% of all patients with alcoholic hepatitis.

This form of the disease is accompanied by a noticeable deterioration in the patient's condition. In the liver, foci of necrosis (complete cell death) begin to form.

Typical symptoms of progressive hepatitis:

• vomiting;
• diarrhea;
• fever;
• jaundice;
• pain in the right hypochondrium.

The intensity of the symptoms depends on the severity of the disease, which can be mild, moderate, or severe. The progressive form of hepatitis without proper treatment ends with the death of the patient from acute liver failure.

Acute alcoholic hepatitis

According to the intensity of the development of the disease, acute alcoholic hepatitis and chronic are distinguished.

Attacks of acute alcoholic hepatitis (AH) are characteristic of persons who have suffered from liver disease (cirrhosis, chronic hepatitis) for a long time, but continue to abuse ethanol.

There are four options for the course of the disease:

• icteric;
• fulminant;
• latent;
• cholestatic.

Icteric alcoholic hepatitis is the most common, accompanied by:

• yellowing of the skin and mucous membranes;
• weakness;
• pain in the hypochondrium;
• nausea;
• vomiting;
• stool disorder;
• noticeable weight loss.

Bacterial infections often develop against the background of icteric OAS.

Exacerbation of latent hepatitis is not accompanied by pronounced symptoms, it can only be detected by laboratory tests: the level of transaminases in the blood increases significantly, the results of biopsy indicate the presence of progressive inflammation of the liver.

The cholestatic course of the disease is diagnosed by the following symptoms:

• itchy skin;
• jaundice;
• discoloration of feces;
• darkening of urine.

The most dangerous is fulminant OAS, which results in hemorrhagic syndrome, renal failure, and hepatic encephalopathy. Without medical attention, as a rule, fulminant OAS leads to hepatic coma and death of a person.

Chronic alcoholic hepatitis

Chronic alcoholic hepatitis (CAH) develops as a result of the systemic use of ethanol. Symptoms of the disease may be mild or absent altogether. In view of this, the diagnosis of CAH is difficult. The presence of alcoholic hepatitis may be indicated by an increased level of transmyases in the blood and morphological changes in the liver.

Signs of CAH:

• bloating and rumbling in the stomach;
• decreased appetite;
• nausea;
• pain in the right hypochondrium;
• enlarged liver;
• decreased libido;
• hypogonadism (insufficient androgen secretion);
• gynecomastia (breast enlargement in men);
• violation of the rhythm of sleep;
• temperature increase;
• Dupuytren's contracture (shortening of the palmar tendons), etc.

Symptoms in each case are highly individual. A patient with chronic alcoholic hepatitis may notice the manifestation of only one or two or several signs of the disease.

Basic principles of treatment for alcoholic hepatitis

Whatever form of alcoholic hepatitis is diagnosed, treatment involves a complete refusal to use ethanol-containing drinks. It is precisely this condition that is most difficult for patients to fulfill: statistics show that only a third of them actually stop drinking alcohol during therapy. Approximately one third of patients diagnosed with alcoholic hepatitis reduce the dose of ethanol consumed gradually, while the rest continue to suffer from alcohol dependence. It is the latter category of patients who are advised to visit both a hepatologist and a narcologist at the same time.

Refusal of alcohol solves many problems: the patient's jaundice and a number of other symptoms disappear.

To achieve the maximum effect of therapy, the doctor also uses for treatment:

• diet therapy;
• conservative methods;
• operational methods.

Diet food

With prolonged intake of alcohol, digestive functions are impaired, and the patient is in dire need of vitamins, nutrients and trace elements. A balanced diet is the backbone of a liver regeneration program.

The daily volume of calories should be at least 2000 units. It is imperative that the diet contains protein in the calculation of 1 g per 1 kg of body weight. The selection of products is carried out in such a way that they contain the maximum amount of folic acid and B vitamins.

Experts advise to adhere to diet number 5 (according to Pevzner) for alcoholic hepatitis. The normal content of proteins and carbohydrates, but at the same time limiting the amount of fat in the diet, allows you to replenish all the energy needs of the body and ensure a gentle mode of liver function.

Features of table 5:

• Acceptable cooking technology: cooking and baking. It is forbidden to fry food.
• Spicy, too salty, fatty and cold foods are taboo.
• Lean meats and vegetables containing coarse fiber should be wiped clean.
• Fractional meals in equal portions up to 5 times a day.
• Coffee, cocoa, soda, grape juice, alcohol are prohibited drinks.
• Meat, fish, mushroom broths are prohibited. Vegetarian vegetable and fruit soups are encouraged.

Drug treatment

In alcoholic hepatitis, hepatoprotectors are predominantly prescribed. This category of medicines can be conditionally divided into 5 types.

• Preparations based on milk thistle - a medicinal plant that supports the active functioning of liver cells.
• Preparations based on ademetionine - a substance that protects organ cells from damage, improves bile outflow and neutralizes toxins.
• Preparations that include bear bile, which accelerates regeneration processes.
• Preparations that include essential phospholipids - lipids that stimulate the growth and development of new cells.
• Organopreparations of animal origin that activate the processes of intracellular renewal.

Read More: List of Best Hepatoprotectors for Liver Repair

In severe forms of hepatitis, a course of antibacterial drugs is also prescribed to avoid infection. For the treatment of alcoholic hepatitis of any stage, detoxification measures are important, which involve courses of injections of specially selected drugs.

Operative treatment

Surgical treatment involves liver transplantation. This operation is rarely performed and is expensive. Such an intervention is resorted to when the patient is diagnosed with the last stage of liver failure.

The transplant performed in Germany will cost the patient about 200 thousand euros. Prices for medical services in this country are the highest, but the success rates of operations are encouraging. In second place in terms of the quality of provided transplant services are Israeli clinics, in which the operation will cost around 160 thousand euros. You can also go to a Turkish clinic - its services will cost about 100 thousand euros. In Russia, there are quotas for free operations at the expense of the federal budget - all the details must be obtained from state medical institutions.

The complexity of this method of treatment is not only in its high cost, but also in the problems of finding a donor. It can be a person who has excellent physical and mental health. Better if it is a relative. During the operation, 60% of the organ is taken from the donor, which then regenerates to its original size.

After the transplant, a long recovery period will follow, during which the patient will have to take immunosuppressants in order for the new liver to take root.

Prevention of alcoholic hepatitis

Prevention of alcoholic hepatitis is the only way to avoid a long treatment period and the associated difficulties. First of all, it implies refusal from the regular use of ethanol-containing drinks.

What is the acceptable daily intake of pure ethanol? For women, this figure is 20 g, for men the threshold is slightly higher - 40 g. Calculations must be made based on the fact that 1 ml of alcohol contains about 0.79 g of ethanol.

The best solution for people who want to keep their health is to stop drinking alcohol altogether.

Whether or not alcoholic hepatitis develops in a person who occasionally consumes alcohol depends on many factors: the volume of drinks drunk, lifestyle, heredity, diet, etc. In any case, there is no need to take risks: if you do not have enough strength to defeat alcohol addiction, you need to contact specialists and start complex treatment in a timely manner.

Author of the article: Kletkin Maxim Evgenievich | Hepatologist

Education: Diploma in the specialty "General Medicine" received at the Military Medical Academy. S. M. Kirov (2007). At the Voronezh Medical Academy. NN Burdenko graduated from residency in the specialty "Hepatologist" (2012).