How long do people live with cirrhosis of the liver? Recommendations for prolonging life in different forms of the disease. Signs of alcoholic cirrhosis of the liver, methods of treatment, prognosis

The epidemic of alcoholism in modern society has long been studied by specialists because the problem destroys the human body from the inside and leads to irreversible consequences. One of the varieties of such consequences is precisely the disease of alcoholic cirrhosis of the liver, when the pathology cannot be completely cured.

But still, this disease is not a sentence! If you look at how long people live with such a disease, it becomes clear that they are on constant medical support, undergo regular therapy procedures. They drink certain medicines in whole courses, sit on a special diet to help the liver work without undue stress.

Alcoholic liver cirrhosis - statistics and concept

The concept of alcoholic cirrhosis of the liver is not the only one. This diseased condition is also called “alcoholic liver disease” (abbreviated as ALD), which is characterized by the destruction of liver tissues, malfunctions of its functions due to the constant exposure to ethanol, modern alcohol contained in current alcohol. In the medical reference book, the ICD-10 Classifier, such a disease is classified by a special code - 7 with the designations of the following stages of damage to the liver organ by ethyl alcohol (70):

• K 70.0 - fatty degeneration;
• K 10.1 - inflamed tissues;
• K 70.2 - fibrous tissue, liver sclerosis or alcoholic liver fibrosis;
• K 70.3 - cirrhosis;
• By 70.4 - insufficiency.

The research statistics of the international health organization WHO notes the prevalence of such a phenomenon as alcoholic cirrhosis of the liver with identification (ICD code 10 - 7) by groups - men, women. The results show the following statistics:

1. Among all drinkers, 25% of chronic alcoholics are subject to liver destruction.
2. Most often, men aged 45.7 years and women aged 52 years are affected.
3. Among all patients with cirrhosis of the liver, only 20% of women were identified, the rest were men.
4. The duration of liver-damaging alcohol consumption ranges from 10 to 14.7 years.
5. Among chronic alcoholics, it is cirrhosis that affects an average of 30% of people.
6. If you drink with breaks (3-4 times a week to drink alcohol), then the rate of patients with cirrhosis is reduced by 25%.

Surprisingly, if we take all alcoholics, even non-chronic ones, then in 30% of them no liver damage is observed. Experts say that this is directly related to the strong immunity of such people.
Interesting fact! The inhabitants of Asia of the Mongoloid type cannot even live to see the destruction of the liver due to the fact that they have a congenital deficiency of a specific enzyme produced by the liver - ADH and ACDH. Drinking too much alcohol, Asians immediately experience a severe blow to the nervous and cardiovascular systems, from which most die. At the same time, the liver simply does not have time to decompose.

The main causes of pathology

What symptoms are determined

You can identify the symptoms of alcoholic cirrhosis of the liver by the following signs:

1. A large rounded belly, when a pathogenic fluid accumulates in the abdominal cavity already at the last stage.
2. Bitterness in the morning in the mouth.
3. Dilated veins are visible on the abdomen.
4. The palms turn red.
5. The coating is white with a green tint on the tongue.
6. There may be large redness, spots on the arms, shoulders, and body.
7. Loss of erection in men.
8. Baldness.
9. Signs of jaundice.
10. Deterioration of memory, attention.
11. High body temperature.
12. capillaries on the face may increase.

This is not yet a complete clinical picture, there are many other manifestations affecting neighboring organs that cause specific syndromes (for example, an enlarged spleen or an enlarged umbilical vein may occur). In addition, general painful conditions are observed, such as: weakness, insomnia, a feeling of heaviness, pain in the abdomen, its top, as well as a sharp decrease in weight and loss of appetite.

Diagnosis of the disease and its stages of development

Diagnosis is carried out both by instrumental (partially) methods, and by analyzes on biochemical material. In total, 3 stages (or stages) of the development of the disease are identified:

1. Light. An enlarged liver can only be detected by a physician, the patient himself does not feel anything yet, no pain.
2. Average. Manifestations of the disease without serious difficulties.
3. Heavy. A coma of the organ is detected, sometimes even oncology, as well as disorders of other organs accompanying the disease (for example, pneumonia, varicose veins).

Blood tests show at an early stage that liver enzymes and bile pigments (bilirubin) are quantitatively increased, and albumin protein volume gradually decreases. In total, 4 main diagnostic methods are used:

1. Blood analysis.
2. Biopsy.
3. Gastroscopy.

Thanks to instrumental diagnostic methods, alcoholic cirrhosis of the liver of the last stage can be detected using ultrasound, or CT or MRI. However, in a neglected state, the diseased liver is already enlarged, it can be determined even with a visual and tactile examination of the patient. The most accurate diagnoses are obtained from a liver biopsy.

What treatments are offered by medicine

Not only drugs can be prescribed to a patient with cirrhosis, but also other procedures and lifestyle approaches. As soon as the doctor makes a diagnosis, the patient will be offered:

1. Refusal of alcohol in general.
2. Special Diet.
3. Reception of herbal medicinal preparations with the function of hepatoprotection.
4. Use regular cleansing of the body from toxic substances.
5. Taking special medications that eliminate the inflammatory process - inhibitory enzymes, glucocorticoids.
6. Forced administration of albumin and other components missing in the body.
7. Mandatory intake of vitamins and minerals.
8. Liver transplant operation.

Hepatorprotectors help to function normally in those parts of the liver that have not yet been affected by the process of tissue breakdown. Taking Ademetionine, the patient can get relief in 2-3 weeks, because the liver will be improved, toxins are eliminated from the body faster thanks to this drug.

How can you treat the disease with folk remedies

If treatment of alcoholic cirrhosis of the liver with folk remedies is required, then this is most likely on the recommendation of the attending physician, who considers this component of therapy important. Experts actually find that some herbal preparations, tinctures and extracts can improve the process of drug treatment. Particular attention is paid to:

• milk thistle seeds;
• dry leaves of nettle, strawberry, mint or lemon balm;
• dry corn stigmas (taken with caution during exacerbations);
• chamomile, immortelle, dandelion;
• decoctions of agrimony or artichoke;
• teas on chicory;
• herbal teas with honey.

All these options for drugs can be easily purchased at the pharmacy today. Also, alternative medicine highly recommends switching to natural juices, but not purchased, but freshly prepared at home. Beetroot, pumpkin or carrot juice helps the liver work very well.

What is the best diet to choose?

Patients with cirrhosis of the liver due to an excess of ethanol, all doctors recommend that you immediately stop taking strong drinks and go on a diet number 5, and for the rest of your life. This diet is:

• refusal of fatty foods;
• excluding spicy foods;
• frying products only with subsequent steaming;
• complete rejection of smoked meats and marinades;
• careful consumption of sugars;
• facilitation of the diet by reducing the amount of carbohydrates.

Tea, coffee and sugary sodas will have to be stopped. You can switch to vegetable decoctions or compotes from dry or fresh fruits, berries and even vegetables.

5 basic preventive measures

Among the many factors affecting the liver, special attention should be paid to the normal dosage of alcohol consumed and the norm, which is understood as "regular use", which can lead to liver decomposition. cirrhogenic dose:

• for men - 80 ml;
• for women - 40 ml.

If the dose is translated into a more practical language, it turns out that the liver fails with daily:

• a glass of vodka for men;
• 1 bottle of wine (dry);
• 2 bottles of modern beer.

At the same time, the longer a person stays in binges, the longer in years, the more stable he develops resistance to alcohol intoxication. It becomes more and more difficult to get drunk over the years, you have to drink more strong drinks, from which the blow to the liver is even more destructive and accelerated. For those who think about the question of how long they live with the last stage of alcoholic cirrhosis of the liver, you just need to understand that the disease is not completely cured, but only supported by medications and diets.
In order to prevent the catastrophic state of the health of your liver, you can follow 5 basic rules of prevention:

1. Stop taking strong drinks in general.
2. Replace sparkling wines with homemade wine (preferably old).
3. Follow strictly dosages, avoid dangerous amounts of alcohol.
4. Do not load your body with protein and carbohydrate ("heavy") food at night.
5. The regularity of drinking alcohol of modern production can be allowed no more than a few times a year, and the volume of alcohol consumed at the same time is not more than 2 glasses of vodka, a glass of wine or beer.

It is better not to drink alcohol in a synthetic form at all, and to take “live” drinks (brewed homemade beer or long-aged red wine) strictly adhering to the norm - half a glass at dinner. Any drink that is extremely low in ethanol can even be considered healthy if it does not contain other chemicals - preservatives, dyes and other inorganic compounds that are difficult for the liver to digest. Flavonoids of natural origin in wines are even considered excellent antioxidants.

What is alcoholic cirrhosis of the liver?

- This is an extensive organ damage that develops against the background of long-term use of alcoholic beverages. The process is characterized by the death of liver cells and the replacement of its natural tissues with fibrous fibers with the formation of small scar nodules. As a result, the body ceases to function normally and cope with the tasks assigned to it.

As for statistics, the disease does not develop in all drinkers, but only in 10-30%, although it is chronic alcohol intoxication of the liver that causes 50% of the total number of liver cirrhosis. The disease usually manifests 10 or more years after the person began to abuse alcohol.

How long do people live with alcoholic cirrhosis of the liver?

Predicting how long a person with such a disease can live is quite problematic, since it depends on the state of the body as a whole, on work, on the presence of concomitant diseases, etc. However, the prognosis for alcoholic cirrhosis is the most favorable. This is especially true in cases where the disease was detected in the early stages, the person receives adequate treatment and adheres to a healthy lifestyle. Under such circumstances, the prognosis for survival for more than five years is significantly improved and about 60% of patients avoid an early death. If the patient continues to abuse, then the survival rate will be no more than five years. Only 40% of people do not die within the first five years after diagnosis, if they do not reconsider their attitude to alcohol.

The remaining hepatocytes are able to perform their function, despite the increased load on them. However, medication and other support (in the form of a diet and a healthy lifestyle) is simply necessary for liver cells.

Symptoms of alcoholic cirrhosis of the liver

The insidiousness of the disease lies in the fact that the symptoms occur imperceptibly for the patient himself. Until the moment of the first manifestations on the part of the damaged organ, five or more years may pass. Moreover, all this time, normal liver tissue will be replaced by connective tissue.

Among the signs of the disease can be noted:

Asthenic syndrome, which is expressed in increased weakness, severe drowsiness, decreased appetite, bad mood, low performance;

Pronounced weight loss;

Low systolic pressure, which does not exceed 100;

Formation of spider veins on the body and on the face;

Tachycardia and lesions of the cardiovascular system are often observed;

Temperature, as a rule, keeps on subfebrile marks;

If the patient refuses alcohol in a timely manner, the entire clinical picture undergoes significant changes in a positive direction.

A necessary condition for the treatment of this disease is a complete rejection of the use of alcohol. However, the therapeutic impact does not end there. The patient will necessarily need to adhere to a diet, most often doctors recommend table number 5.

Conservative treatment is reduced to taking medications:

The patient should receive hepatoprotectors that support not yet dead liver cells. These can be synthetic and plant hepatoprotectors, as well as essential phospholipids. Among the most popular means: Allohol, Phosphogliv, Karsil, Essentiale and others. ;

Ademetionine preparations, for example, Heptral. It contributes to the protection of hepatocytes from destruction and stimulates their recovery, improves the outflow of bile, and produces an antidepressant effect;

Reception of vitamin complexes with the obligatory content of C, E, A,. This is a prerequisite for maintaining normal life, since the absorption of all nutrients from food during cirrhosis is disturbed;

UDCA preparations, for example, Ursosan, Ursodez, Ursohol, which prevent the death of hepatocytes;

Glucocorticoids, which reduce inflammation, prevent the formation of scar tissue, prevent the immune system from producing proteins that are harmful to the liver. It is most expedient to use such means as Urbazon, Prednisolone, Metipred;

Drugs - angiotensin-excessive enzyme inhibitors and tissue protease inhibitors, which are aimed at preventing the formation of fibrous tissue.

In addition, prevention and treatment of complications of the disease is important. Among the most common are portal hypertension, ascites, splenomegaly,.

The terminal stage of the disease is the reason for surgical intervention. The only thing a doctor can do is a liver transplant. However, this is a complex operation that requires at least six months of preparation. If, after the transplantation, the patient returns to drinking alcohol again, this ultimately leads to death. According to statistics, up to 80% of sick people start drinking again.

To prevent the development of the disease, you just need to stop drinking alcohol and adhere to a proper balanced diet.

Can alcoholic cirrhosis be cured?

Despite the development of modern medicine, it is not possible to completely get rid of the disease today. The only option for complete healing is a healthy organ transplant from a donor. However, this procedure is very expensive and technically complex, so it is simply inaccessible to the majority of the population.

Nevertheless, the disease detected at an early stage and competent treatment under the guidance of a hepatologist can stop the destructive process and slow down the development of complications. But all currently existing hepatoprotective drugs can only protect existing hepatocytes from destruction, but they cannot restore dead cells. Although this fact is not a reason for refusing therapy. In addition, scientists are developing to create a drug that can cure patients with cirrhosis of the liver.

Diet for alcoholic cirrhosis of the liver

An integral element of the treatment of the disease is diet. The fulfillment of certain rules is necessary for life. They require the avoidance of fried, fatty and spicy foods, which will contribute to the production of digestive juices and bile. By removing such dishes from the menu, it will be possible to minimize the aggressive effect on the diseased organ.

However, the diet for patients with cirrhosis does not involve taking only mashed dishes on an ongoing basis; only coarse fiber and sinewy meat need to be chopped. Although during the exacerbation of the disease, most dishes still need to be brought to a puree state.

You will need to eat at least five times a day, the maximum number of kilocalories per day is 2900. The volume of fluid consumed is equal to 1.5 liters.

Mushroom, meat and fish broths, canned meats and sausages, fatty dairy products and spicy cheeses, hard-boiled eggs, legumes are under an absolute ban. It is not recommended to include in the diet, radishes, sorrel, green and onions, eggplant, pickles, raw berries and fruits, as well as juices.

You can eat vegetarian soups with the addition of cereals and pasta. Useful cereals and slightly dried bread, biscuits. As for meat products, rabbit, turkey, beef, lean fish are allowed. Low-fat dairy products are acceptable, vegetable oil can be seasoned with salads.

Education: Diploma in the specialty "Medicine" received at the Russian State Medical University. N. I. Pirogova (2005). Postgraduate studies in the specialty "Gastroenterology" - educational and scientific medical center.

Alcoholism is a global social and medical problem. According to statistics, men are more likely to get sick. However, there is a trend towards an increase in the number of women and young people who abuse alcohol.

With regular and prolonged alcohol abuse, damage to almost all organs and systems develops. At the same time, the liver suffers especially, since it takes the main “blow” on itself, because it is there that the oxidation and processing of alcohol into components that are safe for the body take place. When the processing function of the liver is disturbed, alcoholic liver disease develops, which goes through three stages. The terminal (last) stage is alcoholic cirrhosis of the liver (ACP) or “cirrhosis of the alcoholic”.

When does "alcoholic cirrhosis" develop?

A measure of alcohol consumption is the amount of consumed ethanol or ethyl alcohol contained in an alcoholic beverage. You can calculate its content in an alcoholic drink using the formula: vol. % x 0.8 = amount of ethyl alcohol in grams per 100 ml of drink. Where about. % or % vol. - volume percentages (degrees) of alcohol (eng. -% vol.), usually indicated on a bottle with an alcohol-containing drink.

According to statistics, alcoholic cirrhosis of the liver develops in 10–20% of people (according to some sources, in a third) who regularly abuse alcohol.

The use by an adult male of a dose of ethanol of 80 ml or more per day for 10–15 years leads to irreversible changes in the liver and the development of cirrhosis. And for women, this amount is even lower - from 40 ml per day. These figures are approximate, since the mechanism of ADC development is influenced by very many factors.

Symptoms of ADC

Clinical signs of alcoholic cirrhosis can be varied: from the absence of symptoms (latent course) to severe manifestations.
There are no specific symptoms of ACP. The relationship between liver damage and alcohol is indicated only by a characteristic history and other manifestations of chronic alcoholism.

External manifestations of chronic alcoholism

In most cases, people who abuse alcohol hide their addiction. However, there are several signs that make it possible to suspect a painful addiction to alcoholic beverages.

The face betrays an alcoholic, this is especially pronounced in women. The skin on the face looks flabby and saggy with bluish bags under the eyes. Reddening of the face (rosacea) is a classic sign of an alcoholic.

There are bruises, dilated blood vessels. Puffiness on the face and torso signals a violation of kidney function.
Enlarged parotid salivary glands ("hamster" symptom).
Due to a violation of the innervation of the hands, a spasm of the tendons develops. The hands acquire a characteristic appearance with crooked fingers (Dupuytren's contracture).
Hand trembling is noted - tremor, unsteady gait and other impaired coordination of movements.

Initial signs of ADC

The first symptoms of alcoholic cirrhosis are usually dyspeptic manifestations:

• Belching with air;
• Decreased appetite, up to anorexia;
• Nausea, especially in the morning;
• Flatulence;
• Stool disorders - diarrhea;
• Heaviness in the right hypochondrium.

The severity of these symptoms is due to the presence of alcoholic lesions of the stomach (gastritis) and pancreas (pancreatitis), which are constant companions of alcoholics.
Sometimes, along with these symptoms, there is an increase in body temperature.

Also, signs of asthenovegetative syndrome are often detected: fatigue, weakness, fatigue, decreased performance, headaches, etc.

At this stage of the disease, an enlarged, dense liver is detected, and sometimes the spleen. There are also characteristic changes in the biochemical parameters of the blood.
With the progression of the disease, signs of liver decompensation appear and complications of ADC develop.

Signs of ADC decompensation

With the onset of decompensation - impaired liver function, manifestations of dyspeptic and asthenovegetative syndromes intensify.
Jaundice is one of the main symptoms of cirrhosis of the liver. Its appearance is associated with a violation of the participation of hepatocytes (liver cells) in the metabolism of bilirubin. Manifested by icteric staining of the skin and mucous membranes, skin itching. It is most pronounced on the trunk and sclera, the limbs are less stained. Due to a violation of bilirubin metabolism, urine darkens, and feces, on the contrary, become light.

The mechanism of development of jaundice may be different in ADC. Most often, jaundice has a parenchymal type, which is associated with a direct damaging effect of alcohol on hepatocytes. However, when joining, for example, pancreatitis, jaundice can also have a mechanical (cholestatic) type. These differences in the mechanism of formation are especially noticeable when determining the fractions of bilirubin in the blood and other biochemical studies.
However, with the development of deep liver failure, the symptoms of jaundice usually disappear.

Skin manifestations of cirrhosis appear:

• Telangiectasias (vascular "asterisks"), which are localized on the forehead, back of the head, shoulders, skin of the chest.
• The palms and soles of the feet acquire a characteristic red color - palmar or plantar erythema.
• The tongue and lips sometimes acquire a bright red or crimson color, have a "varnished" appearance.
• There are multiple hemorrhages (bruising, "bruises") of various shapes and sizes for no apparent reason.
• Leukonychia - the appearance of white spots on the nails, which can be of different sizes. Sometimes total leukonychia occurs - complete staining of the nail in white, occurs more often with ADC and indicates the severity of the process. There are other lesions of the nails.
• Hair fall out. Characterized by the absence or severe thinning of hair in the armpits and on the pubis, and in men - in the area of ​​the mustache and beard.
• "Head of a jellyfish" - a specific expansion of the veins on the anterior abdominal wall with the appearance of ascites.

Due to a violation of the hemostatic function of the liver, a tendency to bleeding, bruising is characteristic.

There are disturbances in the endocrine system. This is most pronounced in the sexual sphere. In men, due to the increase in the content of estrogen (female sex hormone), erectile function is disturbed until it disappears (impotence). There are phenomena of feminization (the acquisition by a man of some external signs of a woman): a characteristic deposition of fat on the hips and abdomen in combination with thin limbs, an increase in the mammary glands, sparse hair growth in the armpits and in the pubic region. In women, the menstrual cycle is disrupted. Both women and men develop infertility.

Most patients develop disorders of carbohydrate metabolism, which eventually leads to the appearance of diabetes mellitus.

Violations of the nervous system are quite diverse and are manifested by symptoms of asthenovegetative syndrome. Night sleep worsens with periods of drowsiness during the day, memory impairment occurs. There is sweating, tremor (trembling) of the hands, skin sensitivity disorders (paresthesia).

Often there is an increase in heart rate (tachycardia) and an increase in blood pressure due to alcohol. It should be noted that with other types of cirrhosis, blood pressure usually decreases.
Symptoms of ACP complications appear.

Complications of ADC

Alcoholic cirrhosis of the liver is the most dangerous for its complications.

The most common of these is the development of portal hypertension - an increase in blood pressure in the portal, or portal, vein system. The main signs of portal hypertension are:

• Enlargement of the spleen - splenomegaly.
• Varicose veins of the esophagus and rectum, from which bleeding often develops, life-threatening.
• The appearance of fluid in the abdominal cavity - ascites. The severity of ascites varies.
• The appearance of the symptom "head of a jellyfish" on the skin of the anterior wall of the abdomen.
• Edema.

The most formidable and prognostically unfavorable complication of ADC is hepatocellular insufficiency (hepatic encephalopathy). The development of its last stage - coma, usually leads to death.

It should be noted that the manifestations of portal hypertension are more pronounced in ADC than in other types of cirrhosis. And early diagnosis of liver failure is somewhat difficult due to the many neurological disorders that occur with alcoholism.
As with other types of cirrhosis, there may be dysfunctions of other organs and systems, as well as the development of primary liver cancer - hepatocellular carcinoma.

ADC Diagnostics

When diagnosing, it is important to take into account the data of the anamnesis, the relationship of the disease with the amount and duration of alcohol consumed.
As already noted, alcoholic cirrhosis of the liver does not have specific external or laboratory manifestations.

laboratory

In the peripheral blood, a decrease in the number of leukocytes, erythrocytes (anemia), and platelets is diagnosed. However, with the addition of a bacterial infection, which is not uncommon in cirrhosis, leukocytes will be increased.

In a biochemical study, there is a sharp increase in the activity of hepatic transaminases - alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and others. However, in the terminal stage of cirrhosis, the activity of these enzymes is within the normal range or slightly increased.

The level of bilirubin is increased. The intensity of the icteric color usually determines the amount of bilirubin in the blood. The increase in the concentration of individual fractions of bilirubin depends on the type of jaundice. In the hepatic (parenchymal) type, both direct and indirect bilirubin fractions increase. And with mechanical (cholestatic) - only a straight line.

A coagulogram allows you to evaluate the blood coagulation system. With cirrhosis, there is an increase in prothrombin time and other changes indicating a decrease in clotting ability.

Violations of protein and fat metabolism are revealed. Dysproteinemia is noted with a predominant increase in the level of gamma globulin and a decrease in albumin. Increased cholesterol levels.
The level of immunoglobulins (Ig) of classes A and G increases.

instrumental

Of the instrumental methods of examination, ultrasound (ultrasound), computed and magnetic resonance imaging (CT, MRI) are widely used. These methods make it possible to assess the size and structure of the liver, the presence of pathological inclusions, etc.
Endoscopic examination methods - fibroesophagogastroduodenoscopy (FEGDS) and others are carried out to diagnose ADC complications, in particular, portal hypertension.

To help in establishing the correct diagnosis, as well as to assess the degree of liver damage and the activity of the process, a puncture biopsy of the liver, followed by a morphological (histological) study of the biopsy, can help.

Treatment

Treatment of alcoholic cirrhosis of the liver should begin, first of all, with the complete cessation of alcohol consumption. This is the main condition for recovery.

Diet

Be sure to follow a special dietary food, which has an increased calorie content and an increased protein content. The principle of sparing nutrition is also applied, in which spicy, fried, fatty, rough foods are excluded.
Meals are taken 5-6 times a day. Be sure to enrich the diet with vitamins and minerals.
All these criteria are most fully met by diet No. 5 according to Pevzner.

Conservative treatment

Drug treatment is aimed at maintaining impaired liver functions and correcting disorders of all types of metabolism. Medical and social rehabilitation of alcoholism is also carried out. A narcologist is involved in the treatment.
For this purpose, the following are assigned:

• Hepatoprotectors.
• Preparations of S-adenosylmethionine.
• Ursodeoxycholic acid (UDCA) preparations.
• Vitamin therapy, especially those with antioxidant properties: A, C, E, and also - B.
• Detox therapy.
• Glucocorticoids.
• Anabolic steroids are prescribed according to indications.
• Symptomatic treatment - for example, the use of angiotensin-converting enzyme inhibitors for arterial hypertension, etc.

Treatment is also carried out - symptoms of portal hypertension, concomitant bacterial infection, hepatic encephalopathy.

In the terminal stage of ADC, the only method of treatment and prolongation of life is liver transplantation (transplantation). However, the selection of such patients presents certain difficulties, the main of which is the frequent relapse of alcoholism after treatment.

Therefore, several specific criteria for the selection of patients with alcoholic cirrhosis of the liver for liver transplantation were drawn up:

• Complete abstinence from alcohol for at least 6 months.
• Group C by Child-Pugh.
• Stable socio-economic situation.
• Having a job to which the patient will return after surgery.
• Absence of alcohol damage to other organs.

If necessary, surgical treatment of ADC complications is performed. For example, removal of the spleen (splenectomy) with a pronounced increase in it. As well as surgical treatment of symptoms of portal hypertension - various types of shunting (formation of a bypass path of blood flow) in order to reduce the load on the portal vein system. With the development of bleeding from varicose veins of the esophagus or rectum, they are sutured, bandaged, sclerosed, etc.

Forecast

With ADC, the prognosis is much better than with other types of cirrhosis. The main question is: will the patient be able to overcome his addiction to alcohol? If yes, then according to statistics, more than 60% of patients overcome the five-year survival threshold. In the case of continued alcohol abuse, less than 40% will survive to this date.

Several other factors also influence the decrease in life expectancy with ADC: female gender, advanced age, combination with viral hepatitis B and C, the stage of the disease and the presence of complications.

Alcoholic cirrhosis of the liver is a significant damage to the liver tissue that develops with prolonged consumption of alcohol in large doses. The liver is a multifunctional organ that performs hundreds of vital tasks. The most famous of their list is the formation of blood cells, detoxification, the formation of proteins. The intake of alcohol-containing drinks adversely affects the functioning of the liver, causing not only cirrhosis, but also other, no less dangerous complications. Most often, cirrhosis caused by drunkenness occurs in men aged 40-60 years. Women who drink are more prone to developing liver disease, but they consume ethanol-containing drinks in smaller quantities.

The mechanism of formation of alcoholic cirrhosis

Doctors have established that the approximate threshold for safe alcohol consumption for men is 40-60 g of pure alcohol per day, for women 20 g (50 g and 30 g of vodka, respectively).

The exact dose depends on the state of the body, the presence of diseases, heredity. For someone, even 50 g of ethanol can be fatal.

Alcohol abuse can lead to cirrhosis after 5-10 years. The rate of development of the disease is affected by the frequency of binges, the dose and strength of the drinks consumed. The mechanism of formation of cirrhosis in alcoholism is as follows. With constant drinking, liver cells do not have time to recover from the effects of ethanol breakdown products. Their walls become thinner and overgrown with adipose tissue, which means the first step towards the development of cirrhosis. An alcoholic drinks more, liver cells suffer from oxygen starvation, shrivel and die, being replaced by connective tissue. Violation of protein formation in hepatocytes provokes an increase in the liver, but its performance decreases or stops altogether, which means that an alcoholic has only a few months to live.

Forms of liver cirrhosis

By studying the ability of the liver to cope with its duties, doctors distinguish three forms of alcoholic cirrhosis:

• Compensated - there are reversible changes in the cells of the organ in the absence of symptoms.
• Subcompensated - symptoms of the disease begin to appear (deterioration of well-being, darkening of urine, the appearance of small vessels in the form of asterisks on the face and body).
• Decompensated - liver failure develops: the liver cannot normally neutralize toxins, form protein and bile, etc. The decompensated stage is characterized by accumulation of fluid in the abdomen, bleeding from the veins of the stomach, impaired brain activity.

Depending on the nature of the damage to the tissues of the organ, alcoholic cirrhosis of the liver can be:

• small-nodular - the formation of small foci of scar tissue, up to 3 mm in size;
• macronodular - the presence of large affected areas;
• mixed - connective tissue nodes of different sizes.

Symptoms of the disease

Signs of liver cirrhosis in alcoholics appear several years after the onset of the disease. From the growth of scar tissue (without visible changes in its structure) to the appearance of initial symptoms, an average of 5 years pass. The manifestations of cirrhosis are grouped into several syndromes, that is, stable sets of symptoms that are united by a common development.

• Asthenic syndrome. The patient feels weakness, increased fatigue. He becomes sleepy during the day, during periods of wakefulness a depressed mood appears. Appetite decreases.
• Cachexia - weight loss.
• Arterial hypotension is low blood pressure.
• Hepatocellular insufficiency. Alcoholic cirrhosis of the liver forms spider veins on the face and other parts of the body, the skin on the feet and palms becomes red, hematomas appear. The skin, whites of the eyes and bodily fluids become icteric. White stripes are visible on the nails, the nail plates become larger in size. The salivary glands near the ears are enlarged. The fingertips are enlarged and the tendons of the palm are shortened, resulting in limited flexion function.
• . The patient is concerned about belching, nausea, bloating, vomiting, pain in the umbilical region.
• portal hypertension syndrome. Advanced alcoholic cirrhosis of the liver is characterized by increased pressure in the veins that bring blood from all abdominal organs to the liver. Therefore, the spleen increases, fluid accumulates in the abdominal cavity, and bleeding occurs in the gastrointestinal tract.

In addition to the above signs, the symptoms of liver cirrhosis in men can manifest themselves in the form of acquiring external signs of the female body:

• deposition of fat on the abdomen and thighs;
• breast enlargement;
• loss of armpit and pubic hair;
• testicular atrophy, leading to a serious male problem - erectile dysfunction and infertility.

Alcoholic cirrhosis of the liver, the symptoms of which are manifested in the form of portal hypertension syndrome, often requires surgical intervention (removal of the spleen, portal vein bypass, liver transplantation).

Methods for the treatment of cirrhosis

Since any alcoholic drink is the number one enemy for the liver, the first rule of treatment for cirrhosis is to avoid alcohol.

If the patient cannot stop drinking on his own, but does not want to go to a specialized institution, you can find many proven drugs on the Internet that help get rid of alcohol addiction.

Treatment for alcoholic cirrhosis includes diet, medication, and sometimes surgery. Diet therapy is based on the consumption of products according to the recommendations of table number 5. Food should be taken 5-6 times a day in small portions. Showing foods high in protein, vitamins and minerals. Dishes cooked by frying, smoking, marinating, as well as spicy and fatty are excluded. Coarse fiber and meat should be eaten pureed. Sausages, products with preservatives, the use of strong mushroom, meat, fish broths are prohibited.

The list of medicines must include:

• hepatoprotectors - support healthy cells of the body;
• preparations with ursodeoxycholic acid - prevent the death of hepatocytes;
• adenomethionine agents - normalize the outflow of bile;
• glucocorticoid drugs - eliminate inflammatory processes.

The only solution for decompensated cirrhosis is a liver transplant. If there are complications with it, the patient can live no more than a year without surgery.

Complications and prognosis

Alcoholic cirrhosis of the liver is dangerous with complications that often occur with a rapidly progressive disease.

• Ascites is the accumulation of fluid in the abdominal cavity and its pressure on other organs.
• Peritonitis is inflammation of the peritoneum.
• Gastrointestinal bleeding.
• Hepatorenal syndrome is a severe disorder of the kidneys.
• Hepatic encephalopathy is damage to the brain by the breakdown products of liver cells.
• Hepatocellular carcinoma is a cancerous tumor of the liver.

How long they live with cirrhosis of the liver depends on the stage and severity of the course of the disease. The initial changes in the tissues of the organ can be eliminated, and the patient will live another 15-20 years, only completely giving up strong drinks. Cirrhosis at the stage of subcompensation is an indication for liver transplantation, mortality among such patients is about 30%. Without transplantation, the patient can live 3-5 years. The last stage of the disease is characterized by a reduction in life expectancy to 1-3 years. Liver transplantation at the last stage of cirrhosis ends in the death of the patient in about 80% of cases. Organ transplantation is an expensive operation. Part of the organ for transplantation is most often taken from a relative. Preparation for surgery lasts 6 months. All this time, a patient with cirrhosis should lead a measured life without alcohol.

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Alcoholic cirrhosis of the liver is the most severe form of alcoholic disease. Its essence boils down to the fact that normal working cells (hepatocytes) die off under the toxic effect of alcohol, and in their place an inelastic fibrous tissue is formed, similar to a scar. Toxic cirrhosis of the liver will not develop due to a single use of a small dose of alcohol - it is necessary to systematically take it in large quantities. The disease develops in about 10% of people who take alcoholic beverages uncontrollably, but changes at the stage of cirrhosis are already irreversible.

Causes of the disease

Alcoholic cirrhosis of the liver does not develop in a day or even a year. It is diagnosed in persons who systematically abuse alcohol for 8-12 years. This figure depends on many factors - the frequency of binges, gender, genetic characteristics, as well as the type, strength and quality of alcohol. In especially advanced cases, cirrhosis can develop over several years.

Alcohol and heredity

Identical doses of alcohol can cause different effects, even if other conditions are the same. Doctors associate this fact with the innate activity of enzymes that are responsible for the utilization of ethyl alcohol. In total, there are 5 such enzymes, and it depends on them what proportion of the consumed alcohol will be excreted from the body, and what will turn into toxic acetaldehyde, which will destroy the liver.

In addition to genetic material, the likelihood of developing alcoholic cirrhosis of the liver is affected by the standard of living, the environment of the patient and the culture of drinking alcohol in the family. In addition, statistics indicate that most often monozygotic twins suffer from alcoholism together. This figure is lower among dizygotic twins.

The effect of alcohol on men and women

The growth of alcoholism among women is associated with the progression of their role in society. Female representatives can consume alcoholic beverages on an equal basis with men, which does not cause condemnation. However, physiologically, their body is unable to absorb ethanol in full. In the gastric mucosa there is an enzyme that is involved in the metabolism of ethyl alcohol, and in women it is inactive. For this reason, it is not processed and excreted from the body, but forms toxins that destroy liver cells.

Women's alcoholism often leads to more serious consequences than men's.

In addition, women rarely seek medical help for alcoholism. Their relatives and relatives also do not sound the alarm, since this disease is more often associated with men. Patients with toxic liver cirrhosis are admitted to the hospital in the last stages, when changes in the tissues are already irreversible. Moreover, after a course of therapy, they are more likely to experience breakdowns than after treatment for alcoholic cirrhosis in men.

Alcoholic cirrhosis and nutrition

Toxic cirrhosis is the last stage of alcoholic liver disease. The rate of its development is influenced not only by the consumed doses of alcohol, but also by other factors. It is noted that the likelihood of this disease is highest with malnutrition, especially with a lack of protein in the diet. The first signs of liver damage appear against the background of a lack of proteins and vitamins, an abundance of fatty, fried foods and fast food. Alcohol intoxication provokes further destruction of hepatocytes.

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Other reasons

• with non-alcoholic hepatitis of any origin;
• with metabolic disorders;
• in inflammatory and ulcerative diseases of the gastrointestinal tract.

While taking any medication, you also need to consider their compatibility with alcohol. In addition to a short-term deterioration in well-being, unacceptable combinations can provoke intoxication of the body and adversely affect the liver.

How much alcohol do you need to drink to get cirrhosis of the liver?

The main factor that plays a role in the development of toxic cirrhosis is the duration of alcohol intake, and not a single use of it. The body is able to cope with incoming ethanol, but the products of its processing tend to accumulate in the liver. Therefore, alcoholic cirrhosis of the liver develops within 10-15 years with daily intake of even a small amount of alcohol.

The allowable amount of alcoholic beverages differs for representatives of different sexes. The critical dose for men is 40-60 g of pure ethanol per day, for women it is 20 g. If the body regularly receives alcohol in larger quantities, it is unable to cope with its processing. Develops fatty degeneration of the liver, hepatitis, and in the end - alcoholic cirrhosis.

Ethanol is present in alcoholic beverages in various concentrations. The table provides data on the permissible number of their various types that will not cause signs of alcoholic cirrhosis.

Ethanol in small amounts does not harm the liver if consumed 1 or 2 times a week. However, the problem with most alcoholics is that they cannot control their dosage. Alcoholism is a disease that requires a lot of self-control. It is best to forego any amount of alcohol and prefer other drinks. Non-alcoholic beer contains a minimum percentage of alcohol and can serve as an alternative to the classic recipe.

Pathogenesis - how does alcohol affect the body?

Alcoholic cirrhosis is the last stage of liver damage caused by ethanol. First, the liver cells have time to produce specific enzymes in sufficient quantities, and it is completely eliminated from the body. If you take it regularly in an irregular amount, the enzymes do not cope with this task, and toxic acetaldehyde is formed during the processing of alcohol. It determines the negative impact of alcohol on the human body.

Cirrhosis is the end stage of alcoholic liver disease.

At the cellular level, acetaldehyde produces a number of negative effects:

• interferes with the normal course of redox reactions in the liver cells;
• increases the susceptibility of hepatocytes to the harmful effects of free radicals;
• provokes lipid peroxidation reactions, which proceed with the destruction of functional cells;
• disrupts the structure of important cellular elements: microtubules, mitochondria and nuclei.

First, fatty degeneration of the liver develops from alcohol. This is a syndrome associated with a lipid metabolism disorder in which fat accumulates in normal cells. Then inflammatory reactions are included in the process, and alcoholic hepatitis develops. If you continue to drink alcohol, the first manifestations of cirrhosis occur: tissues die and are replaced by dense connective tissue.

There is also an alternative option for the development of cirrhosis - fibrosis. In this case, it appears, bypassing the first stages of fatty degeneration and cirrhosis. Doctors believe that lactic acid plays a leading role in this mechanism, which affects specific fat-storing Ito cells. They turn into fibroblasts, which resemble a scar in structure. In addition, increased collagen synthesis is observed in liver tissues instead of normal hepatocytes.

If the disease is detected at the first stage, it can be completely eliminated with medications and diet. An alcoholic is rarely able to realize his problem on his own, so providing him with medical care and monitoring the treatment process is the task of his relatives and relatives. Over time, the task only becomes more complicated, and rarely any of the patients manages to live with cirrhosis of the liver for more than 5 years.

Forms of alcoholic cirrhosis

There is a classification of toxic cirrhosis according to Child-Pugh, which determines the severity of the disease. According to the results of ultrasound and blood tests, as well as clinical manifestations, you can choose from 1 to 3 points on a special scale. Further, the scores are summed up, and on the basis of the obtained value, it is possible to determine the class of the disease. These data make it possible to predict how long different patients live with liver cirrhosis.

Interpretation of results:

• 5-6 points - class A, or compensation stage. This is the first stage, in which life expectancy can be up to 15-20 years.
• 7-9 points - class B, or stage of subcompensation. In this case, the clinical manifestations of cirrhosis are pronounced, there are frequent exacerbations and a bright pain syndrome. The patient's life span is 5-7 years. When lethality is up to 30%.
• 10-15 points - class C, or stage of decompensation. Symptoms of alcoholic cirrhosis of the liver are pronounced, complications develop. With such a diagnosis, the patient can live from 1 to 3 years, the probability of death during liver transplantation is up to 82%.

It is also customary to classify the disease according to the extent of damage to liver tissues. He can be:

• small-nodular - small areas of cirrhosis form in the parenchyma;
• large-nodular - large cirrhotic foci;
• mixed, if cicatricial foci of different sizes are formed.

Cirrhosis is distinguished from fibrosis by the severity of liver damage. If its structure is preserved during fibrosis, then cirrhosis destroys the normal structure in the form of lobes and lobules.

Symptoms of the disease

Signs of cirrhosis of the liver in alcoholics do not appear immediately. For several years, the replacement of normal tissue with scar tissue may occur imperceptibly. Then the body can not cope with the toxins that enter the body, and the first symptoms appear.

Jaundice is a symptom that occurs when there is a violation of the outflow of bile.

General symptoms

Intoxication affects all organ systems and causes a general deterioration in the patient's well-being. The first signs will not be specific, but will only indicate the presence of a pathological process in the body:

• permanent increase in body temperature by 0.5-1 ᴼС;
• insomnia and other sleep disorders;
• fatigue, decreased performance;
• weight loss
• frequent mood swings.

The patient may experience pain in the right hypochondrium, but the liver is not visually enlarged in size. An accurate diagnosis at this stage can only be made based on the results of ultrasound and blood tests.

liver failure syndrome

Over time, symptoms appear that indicate cirrhosis of the liver:

• pain in the right hypochondrium;
• an increase, and over time, a decrease in the volume of the organ;
• nausea, flatulence, vomiting of intestinal contents;
• jaundice - yellowing of the skin and mucous membranes;
• the appearance of spider veins on the skin;
• "drumsticks" - thickening of the joints of the terminal phalanges of the fingers on the hands;
• Dupuytren's contracture - an anomaly of the tendons of the hands, which lead to a violation of their mobility;
• enlargement of the salivary glands.

Some patients develop encephalopathy associated with the entry of toxins into the brain. It is manifested by a loss of orientation in space and time, a change in mood. If the disease progresses, there is a possibility of hepatic coma.

portal hypertension

This term refers to increased pressure in the portal vein system. The walls of blood vessels weaken, internal bleeding may occur. Clinically, this phenomenon is manifested by characteristic symptoms:

• vomiting with blood impurities in gastric and intestinal bleeding;
• black stool with bleeding from the intestinal veins;
• stool with impurities of bright blood (bleeding from hemorrhoidal veins);
• ascites - dropsy of the abdominal cavity;
• jellyfish head syndrome - the stomach is swollen due to the presence of fluid, veins are clearly visible on it;
• enlargement of the spleen.

Treatment at this stage will no longer be effective. The disease is accompanied by constant pain in the liver and interferes with the normal life of the patient.

A characteristic symptom of liver cirrhosis is the accumulation of free fluid in the abdominal cavity.

Cardiovascular insufficiency

Cirrhosis of the liver affects all organ systems, including the cardiovascular system. The walls of blood vessels become brittle, the heart can not cope with the stress. The patient is diagnosed with:

• lowering blood pressure;
• tachycardia;
• shortness of breath when moving;
• heart rhythm abnormalities;
• pain in the region of the heart.

Increased vascular permeability is manifested by swelling. The symptom intensifies when it is impossible to carry normal physical activity.

Diagnostics

In many cases, the diagnosis can be made on the basis of characteristic clinical features as well as patient interviews. First of all, you need to determine the fact of drinking alcohol for a long time. The doctor also examines the medical history to identify possible comorbidities. Past liver diseases of various origins are important.

Diagnosis can be confirmed by ultrasound and blood tests. These diagnostic methods will reveal;

• an increase in the liver, a change in its structure;
• enlargement of the spleen;
• in the blood - increased activity of liver enzymes (ALT, ALT), bilirubin levels, erythrocyte sedimentation rate; decrease in the number of red blood cells.

The main thing is to find out the etiology of toxic cirrhosis. The fact of alcohol intake may be silent by patients, but it is especially important in the diagnosis. The accompanying patient can provide this information to the doctor.

Treatment Methods

At the stage of cirrhosis, there are few ways to cure the disease. In some cases, transplantation is performed from a healthy donor, but this method also has contraindications. During surgery, mortality can reach 80%. Before surgery, it is necessary to completely exclude alcohol for a period of 6 months or more.

The only way to prevent the disease is a healthy lifestyle and compliance with the rules of alcohol consumption.

In other cases, it does not make sense to treat the disease. All manipulations are aimed at prolonging life and relieving symptoms, but not at full recovery. The patient is prescribed:

• infusions for detoxification;
• hormonal anti-inflammatory drugs;
• hepatoprotectors;
• diuretics to relieve swelling.

Diet is important. Alcohol in any dose is contraindicated for the patient throughout life. Fatty and fried foods, salty and smoked foods, carbonated water and drinks should also be excluded. The diet should contain large amounts of protein, vitamins and minerals.

Prevention and prognosis

The only measure to prevent the disease is the proper use of alcohol. At the same time, it is worth paying attention not only to the amount of alcohol, but also to the quality of drinks. You can also prevent liver disease if you follow your diet. The diet should contain a sufficient amount of protein, vitamins and trace elements. You should reduce the consumption of fatty, fried foods, carbonated non-alcoholic drinks. In the case of the development of cirrhosis, treatment will not imply a complete recovery. Therapy is aimed at maintaining the life of the patient and delaying death. In different cases, the patient can live from 1 to 15 years with such a diagnosis.

Toxic cirrhosis of the liver develops at the last stage of alcoholic disease. This is a dangerous pathology, which is characterized by complete destruction of the organ, intoxication of the body, disruption of the work of all systems. It is completely impossible to cure it, but some patients undergo a liver transplant. This operation allows you to prolong his life and get rid of the symptoms of cirrhosis, but it is not available to all patients. Treatment of alcoholic cirrhosis of the liver in any case implies a complete rejection of alcoholic beverages, otherwise the prognosis will be disappointing.