Alcoholic hepatitis is an inflammatory disease of the liver caused by long-term drinking of alcoholic beverages. The systematic use of large doses of alcohol leads to this disease. For example, if a person drinks 100 grams of alcohol in terms of pure alcohol every day for 5 years, he will surely have the alcoholic hepatitis.
This disease has also other names: toxic alcoholic hepatitis, steatohepatitis and alcoholic steatonecrosis.
The safe dose of alcohol per day for the organism is considered to be 40 grams of alcohol for men and 20 grams of alcohol for women (ref.: 25 ml vodka contain 10 grams of alcohol).
Women are more prone to the development of the disease, as they have less body enzymes that can neutralize alcohol. Therefore, even a small excess of the norm of alcohol per day can cause liver damage of women. The increased risk of the development of the disease have people who:
• take medications that are harmful to the liver;
• suffer from viral hepatitis B, C, D;
• have low weight;
• are overweighted.
The history case of the alcoholic hepatitis can be very long — it can develop within a few years, without any signs during the early years. Main symptoms and signs of alcoholic hepatitis are similar to those that occur in other types of hepatitis.
Alcoholic hepatitis has the following symptoms:
• discomfort, pain and heaviness in the right hypochondrium;
• weakness, fatigue;
• dramatic weight loss;
• nausea, vomiting;
• regurgitation with a bitter taste;
• diarrhea after eating fatty foods or alcohol;
• dark urine;
• discoloration of feces;
• yellowing of the skin, sclera of eyes and mucous membranes of the mouth;
• increased body temperature to 37°C.
When one have these symptoms onset, he’d rather see a doctor without delay, to identify the disease and have the therapy prescribed timely. Alcoholic hepatitis is diagnosed on the basis of biochemical blood tests that show high concentration of liver enzymes — transaminases and bilirubin pigment. To confirm the diagnosis the liver biopsy is made – the removal of a microscopic fragment of the liver, followed by it examination under a microscope. Such examination provides an opportunity to identify sites of inflammation and destruction of liver cells.
Disastrous effects of alcohol on the liver
Getting into the human body through the digestive tract, alcohol immediately is absorbed into the blood, which delivers the poison to all organs. Of course, it doesn’t benefit to human organism. The alcohol gets detoxified by enzymes alcohol dehydrogenases inside the liver, resulting in forming of acetaldehyde. This substance is a poison to the organism, a few tens of times more powerful than the alcohol itself. The liver starts the detoxication of this decay products of alcohol, forming in the result the non-toxic substances that are excreted in the urine.
With regular use of alcohol the enzymes get deteriorated and are replaced by new ones. But a set of alcohol dehydrogenases has no time to fill the deficit, so alcohol and acetaldehyde are no longer processed by the liver, and toxins do not come out of it. In such a way the alcoholic hepatitis is developed. A definite role in the development of this disease also play the other diseases of the digestive system caused by alcohol abuse — gastritis, cholecystitis, pancreatitis. Once liver resources are depleted, the hepatic cirrhosis and hepatic insufficiency are developing.
Forms and stages of alcoholic hepatitis
There are distinguished the acute alcoholic hepatitis, which progresses rapidly, and chronic hepatitis, which is slowly developing. The form of the disease depends on the quality and the dose of alcohol consumed, as well as the initial state of human health and ones’ other diseases. Usually, alcoholic feels the first signs of the disease after a heavy drinking bout.
In the acute form of hepatitis there develops inflammation of the liver tissue with necrosis of its central lobules. Especially booming inflammatory process is developed if the diseased is binge-drinking and malnourished. The most common variant of the acute alcoholic hepatitis is icteric hepatitis. The sclera of eyes, the skin of the body, arms and legs gets of intense yellow color. The patient feels weakness and strong pain in the liver, the body temperature rises.In some cases, the alcoholic hepatitis has a cholestatic course of a disease, when there is a dyskinesia of the outflow of bile from the liver.
Upon refusal of alcohol, 10-20% of patients with this disease may recover. Those who continue to drink alcohol, get cirrhosis of the liver. Chronic alcoholic hepatitis may develop after acute alcoholic hepatitis, and it occurs gradually. There distinguish an active and persistent chronic hepatitis. General weakness, periodically arising pains in the liver, yellowness of skin and sclera are the characteristics of the chronic form of alcoholic hepatitis, which is dangerous because it can turn into cirrhosis even after complete refusal of alcohol.
The first and the mildest case of alcoholic hepatitis can be detected during medical examination, when a doctor sees the enlargement of the liver, as well as the results of liver function tests. Other symptoms are not felt in the mild stage of the disease.
At the middle stage of the disease an alcoholic feels heaviness inside and recurrent pain in the right hypochondrium. The enlargement of the liver is already sufficiently stable, with the pain arising during palpation. Often there appear the symptoms like ochrodermia or icteric eyes. Patients feel weakness, loose appetite and weight. Hangover at this stage of the disease leads to delirium tremens. The biochemical analysis of liver function samples gives bad results.
In severe cases of alcoholic hepatitis it is already a half way to the liver cirrhosis. In this case, the liver can reach such proportions that it slides into the pelvis cavity. But in acute development of the disease this may not happen, because the liver cells do not have time to grow. However, this doesn’t mean the less severe alcoholic hepatitis. On the contrary — without medication and within continuous taking alcohol the liver begins to decrease rapidly, as if it is going back in the ribs.
This is a fact of evidence of the beginning of cirrhosis, an irreversible and incurable disease which is no better than a malignant tumour. Against this backdrop many patients have the liver cancer. Often, in the third stage of alcoholic hepatitis the ascites appears — a strong increase of the abdomen due to accumulation of fluid in the abdominal cavity. Such a belly is very much like a woman’s belly in the last months of pregnancy. The accumulation of the liquid occurs because the liver cells cease to «filter» the blood, it is congesting and liquid components get accumulated in the abdominal cavity. Ascites is a very menacing symptom. It warns that a person is left to live only 3-5 years, not more.
Treatment of alcoholic hepatitis
The treatment of alcoholic hepatitis can lead to success only if the patient completely refuses of alcohol, keeps to a strict diet, and takes vitamins and medicaments for the regeneration of the liver. Only a doctor can appoint the proper treatment of this serious disease. The treatment process is very lengthy and requires a systematic approach. Usually the treatment begins in the hospital, but can end with an outpatient basis.
If alcoholic hepatitis is yet in the initial stage, and the patient has stopped drinking alcohol, keeps to a diet and complies with all the doctor’s appointments, the prognosis for the recovery can be very favourable. The generative and compensatory potential of the liver is such that even with hepatitis with cirrhosis at the initial stage, a complete refusal of alcohol may lead to recovery!
However, the practice shows that no more than 1/3 of all alcoholics are able to completely refuse of alcohol, even when they know they are seriously ill and may die. Therefore the mandatory and even the primary issue in the treatment of alcoholic hepatitis is getting rid of alcohol addiction.
When the patient is curing his liver, but hasn’t not stop drinking alcohol, the result of the treatment will be zero. In terms of alcoholic hepatitis even minimum amount of alcohol may cause liver decompensation, hepatic coma and cause a death of the patient.
The diet for the patients with alcoholic hepatitis is very important. Patients should eat foods rich in protein — such as meat, fish, milk, cheese, beans, etc. The fatty, fried and richly flavoured dishes should be excluded from a ration. The diseased should eat at one and the same time 4-5 times a day, in small portions.
In each case of the alcoholic hepatitis the diet is prescribed by the physician, basing on the stage of the disease and the patient’s state.
People suffering from alcoholism, usually have vitamins’ deficiency. Therefore, in the complex of measures against alcoholic hepatitis there are assigned a variety of vitamins, especially — B vitamins, folic acid, and others.
For the treatment of alcoholic hepatitis the hepatoprotektors are used — the medicines helping to regenerate the damaged liver cells. These are: «Essliver forte», «Heptral», «Heptor», «Karsil» and others.
Currently in the complex treatment of alcohol dependence and alcoholic hepatitis the methods are used that allow to stabilize for the long term such a vital organ as liver and to prevent the development of the fatal liver cirrhosis.
According to specialists, the alcoholic cirrhosis develops in 15-25% of cases of chronic alcoholism. This is facilitated by the systematic abuse of alcohol for 10-20 years. The distinctive feature of alcoholic cirrhosis is the development of fatty liver and the presence of Mallory bodies — alcoholic hyaline. The disease escalates in the period of alcohol ingestion, but the patient’s condition improves at the times of abstinence from alcohol.
Alcoholic cirrhosis has the following symptoms:
1. signs of asthenia — weight loss, often reaching to complete exhaustion. Despite the thinness, the patient’s abdomen is big due to increased liver and splene;
2. hepatic dyspepsia — a change of the feces. The contaminants of ungested fats start to appear in it. The patient feels a bitter taste in the mouth;
3. edama and loss of skin tightness occur due to the loss of protein;
4. polyvitaminic deficiency — a catastrophic deficiency of vitamins A, D, E, K due to the disruption of production of bile acids, necessary for their absorption. Because of hypovitaminosis the bones of the patients become brittle, the wounds heal slowly and the gums are bleeding.
The external symptoms of alcoholic cirrhosis are: an increase in abdominal circumference, the redness of the palms of hands, the appearance of spider veins on the hands at the top of the trunk.
Many organs and systems suffer because of cirrhosis. Thus, the disruption of the central nervous system leads to increased irritability and aggressiveness of the patient, sleep disorders, alcoholic psychosis and delirium. The peripheral nervous system in alcoholic cirrhosis leads to such complications as wasting, pain in the extremities, and the disruption of their sensitivity, peripheral paresis and paralysis. The patient may develop alcoholic myositis — muscle weakness and pain.
Cirrhosis also causes problems with cardiovascular system of alcoholic, and with his pancreas. The diabetes and chronic pancreatitis may also appear.
At the diagnosis of alcoholic cirrhosis, the treatment is, first and foremost, in the elimination of the reason that caused it — the consumption of alcohol, in order to prevent the further damage to the liver cells. The specially appointed dietetic therapy within the drug treatment is used.
The prognosis of the alcoholic cirrhosis depends on the stage and severity of the disease. Deterioration of patients with cirrhosis is caused by the infections of chronic hepatitis B and C, obesity and being female. If cirrhosis «age» is 5 years, only 50% of patients survive.