Folk remedies for alcoholic hepatitis. How alcoholic hepatitis manifests itself - effective treatment methods. Drugs for the treatment of alcoholic hepatitis - gallery

Alcoholic hepatitis is a disease that occurs as a result of exposure of liver cells to large doses of ethanol. It is diagnosed when there is inflammation and degenerative changes in the tissues of the organ. This disease is one of the most common causes of death. Therefore, it is important to pay attention to its symptoms in time and immediately begin taking therapeutic measures.

The main cause of this type of hepatitis is frequent alcohol consumption. When it enters the body, only a small part (20%) is neutralized in the digestive tract and excreted by the lungs. The remaining amount of alcohol is processed by the liver. In this organ, alcohol is converted into acetaldehyde (a toxin) and then into acetic acid.

Note! When you abuse alcoholic beverages, acetaldehyde accumulates in the liver cells.

As a result of this, the following happens:

• the process of formation of fatty acids is disrupted;
• the production of tumor necrosis factors increases (inflammation appears);
• the amount of triglycerides increases.

The consequence of all these changes is the replacement of healthy organ cells with connective tissue: liver fibrosis develops. If treatment is not carried out, cirrhosis develops over time.

The following factors increase the likelihood of alcoholic hepatitis:

Alcoholic hepatitis is conventionally divided into types. Criteria according to which its classification is carried out:

Forms of hepatitis

• • Features of manifestation. The disease happens:
    • sharp;
    • chronic.
  • The severity of the pathology. The following degrees are distinguished:
    • light;
    • average;
    • heavy.
  • The nature of changes in the liver. Types of hepatitis:
    • persistent;
    • progressive.

It is impossible to independently determine the form of hepatitis. But if you pay attention to the symptoms of pathology and undergo a timely examination, this will speed up recovery and reduce the likelihood of complications.

Clinical picture

The clinical picture of the disease depends on its form: each of them is characterized by its own course and symptoms.

Acute manifestation

Men who have been drinking alcoholic beverages for 3-5 years are most prone to developing this form of the disease. But there are also cases when it appears suddenly, after several days of drinking alcohol. The severity and speed of symptoms depends on the type of disease development (Table 1).

Table 1 – Forms and manifestations of alcoholic hepatitis.

Symptoms of acute alcoholic hepatitis appear after 3-5 weeks. With this pathology (unlike viral liver damage), an enlargement of the spleen is not observed. There are disturbances in the functioning of the digestive system, but they are minor.

Signs of chronic form

It is not easy to suspect chronic alcoholic hepatitis: its clinical manifestations are mild. Its main symptoms:

The active form of chronic alcoholic hepatitis resembles the clinical manifestation of hepatitis B in the acute period of its course. It is possible to distinguish diseases from each other only by examining liver tissue taken during a biopsy.

Persistent and progressive types

The persistent form of the disease is diagnosed when there is minor damage to liver cells. It is characterized by a latent course, when symptoms appear periodically. Therefore, the patient may not even suspect the presence of hepatitis. Its main features:

This form of alcoholic hepatitis is detected using laboratory diagnostic methods. It can be cured. If pathology is detected in a timely manner and the doctor’s recommendations are followed, six months after the start of therapy, the state of health improves. But it will take another 5-10 years to combat the consequences of the disease.

Note! Progressive alcoholic hepatitis leads to liver cirrhosis. It occurs if the persistent form of the disease is not treated. Pathology develops in 20% of cases.

It is characterized by small foci of necrotic liver damage. But they are the ones who often degenerate into cirrhosis.

You can suspect the presence of this type of hepatitis based on the following symptoms:

• • • vomit;
    • loose stool;
    • high body temperature;
    • pain in the right hypochondrium of high intensity;
    • yellow tint to the skin, whites of the eyes;
    • lethargy.

The severity of symptoms depends on the severity of the disease. If no treatment measures are taken, death is possible.

Alcoholic hepatitis, like other types of this disease, requires immediate treatment.

Its long course threatens the development of such complications:

Diagnostic methods and treatment tactics

Timely diagnosis of the disease and timely treatment can reduce the likelihood of all these complications. To confirm the presence of alcoholic hepatitis and determine treatment tactics, the patient is recommended to undergo a comprehensive examination.

Survey

First, the specialist examines and collects the patient’s medical history, assesses the condition of his liver (by palpation in the right hypochondrium) and skin.

After this, the following are assigned:

• • • Laboratory research. These include:
      • general and extended blood test;
      • lipid profile;
      • test for the presence of markers of viral hepatitis and fibrosis;
      • Analysis of urine;
      • coagulogram;
      • coprogram.
    • Examination using the following instrumental diagnostic methods:
      • ultrasound of internal organs;
      • Magnetic resonance imaging;
      • liver biopsy;
      • fibroesophagogastroduodenoscopy to assess the condition of the veins of the esophagus and stomach.

For alcoholic hepatitis, therapy should be comprehensive and include complete abstinence from any form of alcohol, as well as dietary adjustments and the use of drugs that support liver function. In case of complicated course of the disease, surgical intervention is recommended.

Drug therapy

To cure alcoholic hepatitis, hepaprotectors are prescribed. The most commonly used drugs contain:

If necessary, additionally prescribe:

• • • antibiotics (Kanamycin, Norfloxacin);
    • glucocorticosteroids (Prednisolone, Metipred);
    • drugs that reduce stomach acidity (Omeprazole, Pantoprazole);
    • preparations containing lactulose (Dufalac, Normaze).

Treatment of acute alcoholic hepatitis is carried out in a hospital, under the strict supervision of a doctor. An important component of complex therapy for the disease is also abstinence from drinking alcohol. A psychologist and a narcologist help the patient cope with the problem.

Diet therapy

With alcoholic hepatitis, depletion of the body is often observed due to poor nutrition. Following an individually selected diet helps reduce the load on the liver and speed up the healing process.

It is also necessary to limit the consumption of butter, cottage cheese and sour cream, fatty cheeses and sparkling water. The diet must include:

• • • porridge: buckwheat, rice, oatmeal;
    • veal and chicken dishes;
    • figs;
    • dried fruits;
    • lean fish;
    • fresh vegetables and fruits;
    • green tea;
    • skim cheese.

For alcoholic hepatitis, you need to eat in small portions. The frequency of eating is at least 5 times a day. However, you should not mix carbohydrates with proteins. Fruits should be eaten separately.

Surgical intervention

• • • liver failure;
    • damage to the veins of the esophagus (varicose veins);
    • accumulation of fluid in the abdominal cavity.

In such cases, they resort to clipping, paracentesis or liver transplantation. The latter type of operation requires huge financial costs. But the main obstacle that both patients and specialists may face is the lack of a suitable donor. Only a completely healthy person can become one. It is best for this to be a relative of the patient.

Forecasts

Recovery after a liver transplant takes a long time. During the entire rehabilitation period, the patient must take medications to prevent organ rejection (immunosuppressants).

Note! The effectiveness of treatment largely depends on whether the doctor's instructions were followed. For patients with mild to moderate alcoholic hepatitis, if they completely eliminate alcohol intake, the prognosis is good: liver function can be restored.

If the effect of the factor that provokes the development of hepatitis continues, this leads to the development of cirrhosis. This condition of the liver is irreversible: it is the last stage of alcohol damage to the organ. The prognosis in this case is unfavorable: there is a high probability of the formation of hepatocellular carcinoma.

The main thing to do to prevent the occurrence of alcoholic hepatitis is to stop regularly drinking large amounts of ethanol-containing drinks. The optimal daily dose of ethanol for women and men is 20 and 40 g, respectively (1 ml of alcohol contains 0.79 g of alcohol).

Whether drinking alcoholic beverages will lead to the development of hepatitis or not depends on many factors: the dose of alcohol, the frequency of its intake, diet, predisposition and the presence of concomitant diseases.

To reduce the risk of liver pathology, it is recommended to completely abandon bad habits, eat a balanced diet and lead an active lifestyle.

If your health worsens or signs of hepatitis appear, you should immediately consult a doctor.

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?

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

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

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

As a result of studies conducted in Europe by WHO in 1995, it turned out that every European takes about 9.8 liters of alcohol per year. 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 drinks, have such a detrimental effect on the liver? Because the main metabolic processes of this substance occur in the liver.

Only 20% of consumed ethanol is processed in the stomach and converted into 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 disruption of a number of important biological functions.

In women, the stomach's ability 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 a chronic form in people who have abused alcoholic beverages 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 form of hepatitis and its symptoms

The persistent form of hepatitis has few symptoms. Therefore, the patient may not suspect anything about his illness for a long time.

From time to time the patient is bothered by:

feeling of heaviness in the right hypochondrium;

discomfort in the stomach.

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

If persistent alcoholic hepatitis is not treated, it becomes progressive.

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. Foci of necrosis (complete cell death) begin to form in the liver.

Characteristic symptoms of progressive hepatitis:

• pain in the right hypochondrium.

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

Acute alcoholic hepatitis

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

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

There are four possible course of the disease:

icteric;

fulminant;

latent;

cholestatic.

Jaundice alcoholic hepatitis is the most common and is accompanied by:

yellowing of the skin and mucous membranes;

weakness;

pain in the hypochondrium;

nausea;

• bowel dysfunction;

  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 through laboratory tests: the level of transaminases in the blood increases significantly, the results of a biopsy indicate the presence of progressive inflammation of the liver.

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

• stool discoloration;

  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.

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

Signs of CAH:

bloating and rumbling in the stomach;

decreased appetite;

• pain in the right hypochondrium;

  liver enlargement;

  decreased libido;

  hypogonadism (insufficient secretion of androgens);

  gynecomastia (enlargement of the mammary glands in men);

  sleep rhythm disturbance;

  temperature increase;

  Dupuytren's contracture (shortening of the palmar tendons), etc.

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

Basic principles of treatment of alcoholic hepatitis

Whatever form of alcoholic hepatitis is diagnosed, treatment involves complete abstinence from drinking 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 a third of patients diagnosed with alcoholic hepatitis gradually reduce the dose of ethanol consumed, 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.

Quitting 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:

diet therapy;

conservative methods;

operational methods.

Diet food

With prolonged use of alcohol, digestive functions are disrupted, and the patient is in dire need of vitamins, nutrients and microelements. A balanced diet is the basis of a liver restoration program.

The daily amount of calories should be at least 2000 units. The diet must contain protein at the rate of 1 g per 1 kg of body weight. Products are selected in such a way that they contain the maximum amount of folic acid and B vitamins.

Experts advise following diet No. 5 (according to Pevzner) for alcoholic hepatitis. A 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 gentle functioning of the liver.

Features of table No. 5:

Acceptable cooking technology: boiling and baking. It is prohibited to fry foods.

Spicy, too salty, fatty and cold foods are taboo.

Stringy meats and vegetables containing coarse fiber must be wiped.

Fractional meals in equal portions up to 5 times a day.

Coffee, cocoa, soda, grape juice, alcohol are prohibited drinks.

Meat, fish, and mushroom broths are prohibited. Vegetarian vegetable and fruit soups are welcome.

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

Preparations based on milk thistle, a medicinal plant that supports the active functioning of liver cells.

Preparations based on ademetionine are a substance that protects organ cells from damage, improves the flow of bile and neutralizes toxins.

Preparations containing bear bile, which accelerates regeneration processes.

Preparations containing essential phospholipids - lipids that stimulate the growth and development of new cells.

Organic preparations of animal origin that activate intracellular renewal processes.

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.

Surgical 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.

A transplant performed in Germany will cost the patient approximately 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 transplantation services provided are Israeli clinics, where the operation will cost around 160 thousand euros. You can also contact 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 details must be obtained from state medical institutions.

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

After the transplant there will be a long recovery period, during which the patient will be forced to take immunosuppressive drugs to allow the new liver to take root.

Prevention of alcoholic hepatitis is the only way to avoid a long period of treatment and the associated difficulties. First of all, it involves avoiding regular consumption 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 maintain their health is to stop drinking alcohol altogether.

Whether or not alcoholic hepatitis will develop in a person who periodically drinks alcohol depends on many factors: the volume of drinks consumed, lifestyle, heredity, diet, etc. In any case, it’s not worth the risk: if you don’t have enough strength to overcome alcohol addiction, you need to contact specialists and start complex treatment in a timely manner.

Education: Diploma in General Medicine received from the Military Medical Academy named after. S. M. Kirova (2007). At the Voronezh Medical Academy named after. N. N. Burdenko completed his residency in the specialty “Hepatologist” (2012).

Alcoholic hepatitis is an inflammatory process in the liver that occurs as a result of drinking alcoholic beverages in large quantities. This disease, together with alcoholic fibrosis, is the initial stage of liver cirrhosis. Treatment of alcoholic hepatitis with folk remedies is quite possible in combination with drug therapy. And above all, the patient must stop drinking any alcoholic beverages, follow a diet and believe in his recovery.

Home treatment for alcoholic hepatitis

When deciding to treat a disease using alternative medicine, you must remember that there are many good recipes for healing the liver, but before using any remedy, consultation with a specialist is necessary.

Let's look at several effective recipes to combat hepatitis due to excessive alcohol consumption:

1. For pain in the right hypochondrium, you can apply a warm potato poultice. To prepare it, you need to boil the potatoes in their skins, then mash them with a fork and place them in a piece of cotton cloth. You can also place dry jars in the liver area.
2. Every day you need to drink a cup of a mixture of beet and radish juices, which are taken in a 1:1 ratio.
3. It is recommended to prepare an infusion of dill seeds and drink 1.5 glasses per day. To prepare such an infusion, you need to crush the seeds in a mortar, and then pour a tablespoon of raw material with 1.5 cups of boiling water. Let the product brew.
4. Raw pumpkin restores the liver well. For treatment, you need to eat 0.5 kg of pumpkin pulp daily and drink half a glass of fresh juice.
5. It is recommended to take corn silk infusion instead of tea for six months. To prepare the drug, you need to take only ripe ears of corn.
6. Calendula also has a choleretic and healing effect. A tablespoon of marigold color is poured with 2 cups of boiling water and allowed to brew for 1 hour. It is recommended to drink half a glass of the strained infusion 4 times a day.
7. A decoction of dandelion roots will be no less effective for treating liver diseases. To prepare the decoction, you need to pour a large spoonful of dry crushed rhizomes of the plant with a glass of cold water, which has previously been boiled. Place the mixture on the fire and simmer for an hour. The product is drunk three times a day, 1 tablespoon.

The above recipes for folk remedies are good assistants in the treatment of alcoholic hepatitis. By following the recommended dosages and medical prescriptions, any disease can be overcome.

Health to you!

For quotation: Adzhigaitkanova S.K. Alcoholic hepatitis, basic principles of treatment // Breast cancer. 2008. No. 1. P. 15

“Alcoholic hepatitis” is a term adopted in the International Classification of Diseases (Tenth Revision of WHO, 1995) and in the standardization of nomenclature, diagnostic criteria and prognosis of diseases of the liver and biliary tract. It is used to refer to acute degenerative and inflammatory liver lesions caused by alcohol and which can, in a large number of cases, progress to cirrhosis. Alcoholic hepatitis is one of the main types of alcoholic liver disease; along with alcoholic fibrosis, it is considered a harbinger or the initial and obligatory stage of cirrhosis. This designation does not indicate the time duration of the process. It is advisable to separately consider acute and chronic alcoholic hepatitis.

When taken orally, about 90% of alcohol is metabolized in the liver to form acetaldehyde, a substance that affects liver cells - hepatocytes. Alcohol and its metabolites trigger a cascade of chemical reactions in the body, leading to hypoxia of hepatocytes and, ultimately, necrosis of liver cells.
Alcoholic hepatitis is a diffuse inflammatory process in the liver tissue, resulting from toxic damage to the liver by alcohol and its breakdown products. This is usually a chronic disease that develops 5-7 years after the start of regular alcohol consumption.
The severity of alcoholic hepatitis is directly related to the dose, quality of alcohol and duration of its use.
Alcoholic hepatitis manifests itself in two forms:
. Persistent form. A relatively stable form of the disease, the ability to reversible the inflammatory process is retained, subject to the cessation of alcoholism. With continued alcohol consumption, it can develop into a progressive form of alcoholic hepatitis.
. The progressive form (mild, moderate, severe active) is a small-focal necrotic liver lesion, the outcome of which is often liver cirrhosis. Accounts for 15-20% of cases of alcoholic hepatitis. With timely treatment of alcoholism, it is possible to stabilize inflammatory processes while maintaining residual effects.
In mild cases, alcoholic hepatitis is detected only through laboratory tests. There are no specific symptoms: periodically patients feel heaviness in the right hypochondrium, belching, mild nausea, and a feeling of fullness in the stomach. Chronic persistent hepatitis is histomorphologically manifested by pericellular and subsinusoidal fibrosis, Mallory bodies, balloon degeneration of hepatocytes. A similar picture without progression of fibrosis can persist for 5-10 years, even with moderate alcohol consumption.
The progressive form of alcoholic hepatitis may be accompanied by vomiting and diarrhea. Moderate and severe degrees of the course are manifested by jaundice, fever, bleeding, pain in the right hypochondrium, and death from liver failure is possible. Bilirubin, gammaglutamyl transpeptidase, immunoglobulin A, moderate thymol test and blood transaminase activity increase significantly.
Chronic active hepatitis has the above-described histomorphological picture of alcoholic hepatitis with the presence of active fibrosis and sclerosing hyaline necrosis to a greater or lesser extent. Abstain from alcohol for 3-6 months. leads to an improvement in the morphological picture of the type of chronic non-alcoholic hepatitis. Chronic active hepatitis in the presence of autoimmune destruction of the liver parenchyma is characterized by progression of the process with transition to cirrhosis. There are no direct morphological markers of the alcoholic etiology of liver diseases, but there are changes that are quite characteristic of the effects of ethanol on the liver. This is alcoholic hyaline (Mallory bodies), characteristic ultrastructural changes in hepatocytes and stellate reticuloepitheliocytes.
Characteristic ultrastructural changes in hepatocytes and stellate reticuloendotheliocytes reflect the toxic effects of ethanol on the body.
An important diagnostic value for chronic hepatitis (alcoholic, as well as any other etiology) is an ultrasound of the abdominal organs (liver, spleen and other organs), as well as to identify ascites and the size of the portal vein. Doppler ultrasound should be performed to exclude or establish the severity of portal hypertension. Traditionally, radionuclide hepatosplenoscintigraphy continues to be used for diagnostic purposes.
According to the course, acute and chronic alcoholic hepatitis are distinguished.
Acute alcoholic hepatitis (AAH) is an acute progressive degenerative-inflammatory liver disease. Clinically, OAS can be represented by four variants of its course: latent, icteric, cholestatic, fulminant. Long-term alcohol abuse leads to the formation of OAS in 60-70% of cases. In 4%, it relatively quickly transforms into alcoholic cirrhosis of the liver. The course and prognosis of acute alcoholic hepatitis depend on the severity of liver dysfunction. The most severe course of acute alcoholic hepatitis develops after alcoholic excesses against the background of formed alcoholic cirrhosis of the liver.
Clinical variants of acute alcoholic hepatitis usually develop after heavy drinking in patients with pre-existing liver cirrhosis, which causes aggregation of symptoms and significantly worsens the prognosis.
The latent variant, as its name suggests, does not provide an independent clinical picture and is diagnosed by an increase in transaminases in a patient who abuses alcohol. A liver biopsy is required to confirm the diagnosis.
The icteric variant is the most common. Patients experience severe weakness, anorexia, dull pain in the right hypochondrium, nausea, vomiting, diarrhea, weight loss, jaundice; the latter is not accompanied by skin itching. Approximately half of patients have remitting or persistent fever, often reaching febrile levels. The liver is enlarged in almost all cases, compacted, with a smooth surface (lumpy in cirrhosis), and painful. Detection of severe splenomegaly, ascites, telangiectasia, palmar erythema, and asterixis indicate the presence of background cirrhosis. Concomitant bacterial infections often develop: pneumonia, urinary infection, spontaneous bacterial peritonitis, septicemia. The latter, along with hepatorenal syndrome, often act as the direct cause of death.
The cholestatic variant is observed in 5-13% of cases and is accompanied by severe itching, jaundice, discoloration of stool, and dark urine. In the presence of fever and pain in the right hypochondrium, the clinical picture is difficult to distinguish from acute cholangitis. Cholestatic OAS is characterized by a protracted course.
Fulminant OAS is characterized by rapid progression of symptoms: jaundice, hemorrhagic syndrome, hepatic encephalopathy, and renal failure. Hepatic coma or hepatorenal syndrome usually leads to death.
Laboratory indicators. Neutrophilic leukocytosis is characteristic, reaching 20-40 thousand in 1 μl, an increase in ESR to 40-50 mm/h. Changes in red blood usually manifest as macrocytosis. Bilirubin increases mainly due to the direct fraction, reaching especially high levels in the cholestatic form. The activity of transaminases can increase both several times and tens of times, while the AST/ALT ratio exceeds 2. The activity of g-glutamyl-trans-peptidase increases many times, in the cholestatic form, together with alkaline phosphatase. IgA concentrations are usually elevated. In the presence of cirrhosis and severe OAS, biochemical signs of liver failure increase: an increase in prothrombin time (decreased prothrombin index), a decrease in serum albumin concentration, hyperammonemia. At the advanced stage of OAS, as a rule, there are contraindications to liver puncture biopsy. If the latter is nevertheless performed, then histological examination visualizes hepatocytes in a state of ballooning and fatty degeneration. Sometimes you can find Mallory bodies, which, when stained with hematoxylin-eosin, are purple-red cytoplasmic inclusions consisting of condensed intermediate microfilaments of the cytoskeleton. There is more or less pronounced fibrosis with a perisinusoidal arrangement of collagen fibers. The typical sign is massive lobular infiltration with a predominance of polymorphonuclear leukocytes and areas of focal necrosis. Intrahepatic cholestasis is expressed to varying degrees.
Chronic alcoholic hepatitis. Clinical manifestations are the same as with ASP: a moderate increase in transaminase activity with a characteristic predominance of AST over ALT; in some cases, a moderate increase in indicators of cholestasis syndrome is possible. There are no signs of portal hypertension. The diagnosis is verified morphologically - characteristic histological changes corresponding to inflammation in the absence of signs of cirrhotic transformation.
Diagnosis of alcoholic liver damage and, in particular, alcoholic hepatitis is somewhat difficult. It is not always possible to obtain sufficiently complete information about the patient. Therefore, the doctor must know what is included in the concepts of “alcohol dependence” and “alcohol abuse.” The criteria for alcohol dependence are:
. the patient’s consumption of alcoholic beverages in large quantities and a constant desire to drink them;
. spending most of the time purchasing alcohol and drinking it;
. drinking alcohol in life-threatening situations or when it violates the patient's obligations to society;
. alcohol consumption, accompanied by a decrease or cessation of the patient’s social and professional activity;
. continued drinking alcohol, despite the worsening of the patient’s psychological and physical problems;
. increasing the amount of alcohol consumed to achieve the desired effect; the appearance of withdrawal symptoms;
. the need to drink alcohol to reduce withdrawal symptoms.
Alcohol dependence is diagnosed based on three of the above signs. Alcohol abuse is detected when one or two of the following signs are present:
. alcohol consumption, despite the patient’s increasing social, psychological and professional problems;
. repeated use of alcohol in life-threatening situations.
Treatment
Complex treatment of alcoholic hepatitis includes: elimination of the etiological factor, a high-energy diet high in protein, drug treatment, and surgical treatment. Treatment of any form of alcoholic hepatitis involves stopping drinking alcohol. However, it should be taken into account that no more than one third of patients actually completely give up alcohol after reporting the diagnosis; Approximately the same number significantly reduce the amount of alcohol they drink, while about 30% completely ignore the doctor’s recommendations. The last category is mainly represented by patients with alcoholism, who require the joint work of a hepatologist and a narcologist. Their unfavorable prognosis is determined by the inability to convince the patient of the need for abstinence due to alcohol addiction, on the one hand, and the presence of contraindications to the prescription recommended by a narcologist. neuroleptics due to liver failure, on the other. When abstaining from alcohol, jaundice, ascites and encephalopathy may disappear, but if the patient continues to drink alcohol and eat poorly, alcoholic hepatitis may recur. Sometimes these relapses end in death, but more often the symptoms disappear after a few weeks or months.
Endogenous depletion, caused by a decrease in glycogen reserves in the liver, is aggravated by exogenous depletion of patients who replenish the energy deficit with “empty” alcohol calories in conditions of increased need for nutrients, vitamins and microelements. A study carried out in the USA revealed some degree of nutritional deficiency in almost every patient with alcoholic hepatitis, while the severity of liver damage correlated with the severity of trophological deficiency. It should be noted that the average alcohol consumption in the study group was 228 g/day. (almost 50% of the energy received came from alcohol). Therefore, adequate nutritional intake is an important component of treatment.
The energy value of the diet should be at least 2000 calories per day, with a protein content of 1 g per 1 kg of body weight and a sufficient amount of vitamins (especially group B and folic acid, the deficiency of which is most often observed in alcoholics). For anorexia, enteral tube or parenteral nutrition is used. In the large group of patients with OAS mentioned above, a correlation of caloric intake with survival was demonstrated. Among patients who voluntarily took more than 3000 kcal per day, there were practically no deaths, while in the subgroup who consumed less than 1000 kcal/day, they amounted to more than 80%.
The positive clinical effect of parenteral infusions of amino acids is due, in addition to normalizing the ratio of amino acids, to a decrease in protein catabolism in the liver and muscles, as well as an improvement in metabolic processes in the brain. It should also be taken into account that branched chain amino acids are an important source of protein for patients with hepatic encephalopathy who require dietary protein restriction.
In severe forms of alcoholic hepatitis, in order to reduce endotoxemia and prevent bacterial infection, it is advisable to prescribe short courses of antibacterial drugs (preferably fluoroquinolones).
The range of drugs used in the complex treatment of diseases of the hepatobiliary system includes more than a thousand items. Among such a variety of drugs, there is a relatively small group of drugs that have a selective effect on the liver. These are hepatoprotectors. Their action is aimed at restoring homeostasis in the liver, increasing the organ’s resistance to the action of pathogenic factors, normalizing functional activity and stimulating reparative and regenerative processes in the liver.
Polyunsaturated (“essential”) phospholipids have the ability to reduce fatty liver changes, eliminate free radicals and suppress the activation of hepatic stellate cells. These properties have been demonstrated both in animal models and in patients with ALD.
Phospholipids (or phosphoglycerides) belong to the class of highly specialized lipids and are esters of glycerophosphoric acid. Phospholipids are also called essential, which shows their importance for the body as irreplaceable growth and development factors necessary for the functioning of all cells without exception. Their main purpose is that, along with cholesterol, they are the structural basis of cell membranes and organelle membranes. Phospholipids are important components of surfactant in the alveoli of the lungs, lipoproteins in blood plasma and bile. They take part in the functioning of the nervous system - without them the function of excitability and transmission of nerve impulses is impossible. Phospholipids in platelet membranes are essential in the blood clotting process to stop bleeding.
Phospholipids are the basis of biological membranes. Thus, phospholipids perform many functions in the body, but the main one is the formation of a double lipid layer in cell membranes. Biological membranes are the basis on which the most important life processes occur. Impaired functioning of biomembranes can be not only a cause, but also a consequence of the development of pathological processes. According to the currently generally accepted liquid mosaic model, the structure of biomembranes is a liquid crystalline bimolecular layer of lipids with hydrophobic groups on the outside and hydrophilic groups on the inside, in which peripheral and integral proteins move freely. The most common membrane lipids belong to the class of phospholipids; their double layer is stabilized by cholesterol molecules, proteins and glycolipids.
It is known that the role of the lipid component in the system is to create a certain hydrophobic matrix for enzymes, and the liquid state of the membrane itself makes it dynamic. If the enzyme is deprived of the lipid phase, it becomes unstable, aggregates and quickly loses activity, which depends largely on the physicochemical state of the lipid phase of the membrane. Consequently, the viscosity of the lipid bimolecular layer and the composition of lipids are the most important factors on which the activity of enzymes built into membranes depends. Cell membranes are associated with various enzyme systems - adenylate cyclase (cell membrane), cytochrome oxidase (mitochondrial membrane), as well as triglyceride lipase, lipoprotein lipase, cholesterol acyltransferase.
The hepatoprotective effect of essential phospholipids is also based on the inhibition of lipid peroxidation (LPO), which is considered one of the leading pathogenetic mechanisms for the development of liver damage. By restoring the “packaging” of polyunsaturated fatty acids in the hepatocyte membrane, essential phospholipids reduce the access of oxygen to them, thereby reducing the rate of formation of free radicals.
Several drugs of this group are registered on the Russian market, one of the most frequently prescribed is Essliver® Forte. A special feature of the drug is its combined composition: a combination of essential phospholipids and a complex of vitamins, which is especially important in conditions of vitamin deficiency in patients with alcoholic liver disease. In addition, the drug contains not only phospho-ti-dylcholine but also other types of phospholipids that play a great role in the formation of the cell cytoskeleton. Essliver® Forte contains vitamins B1, B2, B6, B12, tocopherol and nicotinamide. Vitamin B1 protects cell membranes from the toxic effects of peroxidation products, i.e. acts as an antioxidant and immunomodulator. Vitamin B2 is involved in the regulation of higher nervous activity. Vitamin B6 is a coenzyme for amino acid decarboxylases and transaminases that regulate protein metabolism. Vitamin B12 ensures the formation of the enzyme necessary for the production of lipoprotein in myelin tissue. Tocopherol is a natural antioxidant that protects polyunsaturated fatty acids and cell membrane lipids from peroxidation and free radical damage. It can perform a structural function by interacting with phospholipids of biological membranes. This composition provides Essliver® Forte with a wide range of therapeutic properties.
The literature describes a comparative multicenter study of the effectiveness of Essli-vera® Forte in patients with alcoholic liver disease in the stage of fatty degeneration and hepatitis. A statistically and clinically significant decrease in the severity of astheno-vegetative syndrome, normalization of the levels of ALT, AST, albumin, GGTP, globulins, total protein, prothrombin and alkaline phosphatase and an improvement in the ultrasound picture (decreased liver size, decreased its echogenicity and the height of the “sound attenuation column” in the liver). Statistically significant positive dynamics were also observed for glucose, total bilirubin and indirect bilirubin fraction, amylase; restoration of the protein-synthetic function of the liver and the synthesis of blood coagulation factors was noted. There was a significant improvement in quality of life assessments. Thus, the fairly high clinical effectiveness of Essliver® Forte is undeniable [Salikhov I.G., 2002].
It has been established that drugs of this group significantly accelerate liver recovery under toxic influences, slow down fibrosis and fatty infiltration of liver tissue, increase the synthesis of RNA and protein by cells, and accelerate regeneration. Phospholipids provide hepatoprotective and epidermis-targeted effects.
Essential phospholipid preparations are compatible with other pharmaceuticals and nutrients. The bioavailability of phospholipids is approximately 90% of the administered amount. In addition, phosphatidylcholine increases the bioavailability of nutrients with which it is coadministered.
Ademetionine - has a detoxifying, regenerating, antioxidant, antifibrinizing, neuroprotective effect, acts as a metabolic substrate for the most important biochemical reactions in the body. The therapeutic effect of ademetionine lies in the intracellular reaction of glutathione synthesis. Glutathione is known to prevent liver damage. With a sufficient amount of glutathione, the hepatocyte is least susceptible to the toxic effects of ethanol metabolites, and under certain conditions even their detoxification can occur. Synthesis of glutathione with the introduction of ademetionine in a daily dose of 800 mg intravenously for 7-14 days, with a transition to administration in tablet form of 400-800 mg (1-2 tablets) for 14 days leads to the restoration of liver function and normalization of clinical symptoms. laboratory signs. Ademetionine, which restores the structure and properties of cell membranes, as well as restoring intracellular glutathione reserves, according to some data, increases survival and delays the timing of liver transplantation in severe forms of acute alcoholic hepatitis.
Plant-based preparations (active principle - silymarin) stabilize the cell membrane, restoring damaged liver cells.
The use of ursodeoxycholic acid is pathogenetically justified, especially in the cholestatic variant of acute alcoholic hepatitis, but there is currently insufficient data on its clinical effectiveness.
The attitude towards glucocorticoids in alcoholic hepatitis remains ambiguous. Data from a meta-analysis of 13 randomized controlled trials indicate a significant increase in immediate survival of patients with severe OAS (with a Maddrey index >32 and/or hepatic encephalopathy). The standard course is 40 mg of prednisolone or 32 mg of methylprednisolone per os per day for 4 weeks. It is important to note that these data relate to survival during the current hospitalization, since the differences between the main and control groups level out after 1-2 years, which is due to decompensation of background cirrhosis and/or repeated episodes of acute alcoholic hepatitis. When prescribing prednisolone, careful monitoring of the patient is necessary due to the increased risk of infectious complications, gastrointestinal bleeding, hyperglycemia and renal failure.
In recent years, accumulated data on the role of pro-inflammatory cytokines in the pathogenesis of alcoholic hepatitis have served as the basis for the introduction of drugs with anti-cytokine properties into clinical practice.
Thus, at present, for the treatment of alcoholic hepatitis, there are modern, highly effective means that can cure the disease or stabilize the condition of the diseased organ and the body as a whole for a long time, preventing the development of cirrhosis of the liver or a tumor process.

Literature
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Systematic and long-term consumption of alcohol leads to the loss of the liver’s ability to neutralize poisons and the occurrence of alcoholic hepatitis. The pathology develops slowly and often goes unnoticed for a long time, and this threatens with serious consequences.

Description of the pathology

Alcoholic hepatitis is an inflammation of the liver resulting from excessive alcohol consumption. Pathology is the most common type of toxic hepatitis.

The likelihood of developing the disease depends on the amount and regularity of drinking alcoholic beverages of any strength.

Special liver enzymes break down alcohol, and in the process, toxic acetaldehyde is formed, which affects liver cells (hepatocytes). Chemical reactions in the liver under the influence of alcohol and acetaldehyde lead to hypoxia, inflammation and necrosis of its cells.

The development of the disease is long, most often the first signs appear after 5–7 years of regular alcohol abuse.

Women are more susceptible to the development of this pathology than men, since their bodies contain fewer enzymes that neutralize alcohol.

Classification

There are several types of alcoholic hepatitis:

1. Persistent. This form of the disease is characterized by the absence of clear symptoms. The person may not be aware of the existence of the problem. He is occasionally bothered by heaviness in the right hypochondrium, mild nausea and discomfort in the stomach, and belching. The disease is discovered accidentally during laboratory tests. Timely diagnosis and treatment, following a diet, and stopping drinking alcohol help get rid of the problem. In the absence of therapy, the pathology moves to the next stage.
2. Progressive. Often precedes liver cirrhosis. In this case, the patient’s health deteriorates significantly, organ cells are destroyed and die. At this stage, the disease is manifested by vomiting, stool disorders, fever, jaundice, and pain in the liver. If left untreated, death from acute liver failure is possible.

Alcohol-induced liver inflammation can be acute or chronic. Signs of the acute form of the disease develop suddenly after heavy drinking. The patient’s health worsens, the patient loses appetite, nausea and vomiting appear, intense pain in the right hypochondrium, the skin turns yellow, and itching occurs. Possible increase in body temperature.

Impaired liver function leads to changes in bilirubin metabolism, as a result of which the urine turns dark and the feces become light. The patient's liver and spleen are enlarged. The acute stage lasts 3–5 weeks, depending on the amount of alcohol consumed.

Depending on the nature of its course, there are several forms of acute alcoholic hepatitis:

1. Latent. It is dangerous because it is asymptomatic. The problem can only be detected through examination.
2. Jaundice. The most common variety, which is characterized by the skin acquiring a yellowish tint, pain in the liver area, loss of appetite, nausea, and vomiting.
3. Cholestatic. In addition to the specific coloring of the skin, the patient experiences severe itching, signs of intoxication increase, the urine darkens, and the feces become light.
4. Fulminant. A rapidly progressing form of the disease that can be fatal. It is characterized by a sharp deterioration in condition, increased body temperature, yellowing of the skin, complete lack of appetite, weakness, severe pain in the right hypochondrium.

In severe cases, the acute form of the disease can result in the death of the patient.

Chronic alcoholic inflammation of the liver is characterized by a long course and moderate clinical manifestations. The patient may feel slight malaise, fatigue, loss of appetite, and periodically experience nausea, vomiting, and abdominal pain. Toxic damage to the nerves leads to polyneuropathy of the lower extremities, the patient's gait is impaired, and aching pain in the legs occurs.

The main signs of chronic alcoholic hepatitis are the appearance of spider veins on the skin, sleep disturbances, purple complexion, and problems in the genital area.

In a chronic course, the pathology often ends in death, since there are no obvious signs of deterioration that could alert the patient.

Reasons for development

The cause of the pathology is the abuse of alcoholic beverages. The speed of its development depends on the quantity and quality of drinks, duration and frequency of use, and individual characteristics of the body.

A safe dose for the male body is considered to be 40 g of alcohol per day, for a female - 20 g.

The risk of developing alcoholic hepatitis increases with:

• simultaneous consumption of large doses of alcohol;
• daily repeated drinking of alcohol;
• long-term alcohol abuse;
• hereditary predisposition;
• irrational and unbalanced nutrition;
• infection with hepatotropic viruses.

Symptoms and signs of the disease

The pathology develops over several years. The symptoms of the disease are similar to those of other forms of hepatitis. The earliest symptoms of alcoholic hepatitis are increased weakness, fatigue, loss of appetite, and weight loss. Later others join:

• feeling of discomfort, pain in the liver area;
• belching with bitterness;
• nausea and vomiting.
• stool disorders after drinking alcohol or fatty foods;
• slight increase in body temperature;
• anemia.

With further progression of the disease, the skin and mucous membranes turn yellow, severe itching occurs, feces become discolored and urine darkens, and the liver increases in volume.

An alarming sign is a significant enlargement of the abdomen due to excessive accumulation of fluid in the abdominal cavity (ascites). This indicates that the liver does not have time to filter the blood. After the occurrence of such a symptom, a person can live no more than 3–5 years if he does not give up drinking alcohol.

Diagnostics

Diagnosis is complicated by the fact that at the initial stage the pathology does not have any specific manifestations, so its presence can be suspected only after laboratory tests.

First of all, the doctor must determine whether a person has an alcohol addiction, the main criteria of which include:

• drinking large doses of alcoholic beverages. At the same time, a person cannot say with certainty how many days the binge lasted;
• psychological dependence on alcohol. The patient constantly thinks about drinking, cannot control the amount he drinks, drinks alcohol despite awareness of his problem;
• a withdrawal symptom that is relieved (eliminated) only by drinking alcohol again.

The specialist also notes the presence of characteristic external signs of alcoholism: puffiness of the face, the presence of spider veins, yellowness of the skin, tremors of the limbs, atrophy of the muscles of the shoulder girdle, palmar fibromatosis.

After interviewing and examining the patient, the doctor refers the patient for additional studies:

• general blood analysis. With alcoholic hepatitis, the hemoglobin level will be reduced and the number of leukocytes will be increased;
• Analysis of urine. The disease is characterized by an alkaline reaction of urine, traces of protein in it;
• coagulogram. Allows you to evaluate blood clotting;
• lipidogram. Necessary for detecting cholesterol levels;
• Ultrasound of the abdominal cavity. The study allows you to determine the size of the liver and its structure, the presence of inflammation, ascites;
• blood chemistry. Helps determine whether the liver is doing its job. In the presence of the disease, there is an increase in the level of bilirubin, as well as the liver enzymes ALT and AST;
• liver biopsy. During the study, a microscopic fragment of liver tissue is removed and examined in order to detect foci of inflammation or necrosis;
  

  An alternative to biopsy is elastography, in which liver tissue is examined using a special device.

• spiral computed tomography. Such an examination is necessary to obtain a clear image of the organ being examined.

Treatment

Regardless of the form of alcoholic hepatitis, the main principle of treatment is complete abstinence from drinking alcoholic beverages. To achieve maximum effect, therapy must be comprehensive and include diet and medications. In the most severe cases, surgical intervention is resorted to.

Drug therapy

Hepatoprotectors are used to treat alcoholic hepatitis. Such drugs have antioxidant properties, accelerate the process of regeneration of liver cells, restore its functions and provide protection from negative external influences. The course of therapy should last at least a month, in some cases it is recommended to take hepatoprotective medications for two to three months. The patient also needs multivitamin complexes, since as a result of the disease the absorption function of various beneficial substances is impaired.

In the acute phase of the disease, detoxification therapy, administration of plasma-substituting solutions, and correction of electrolyte disturbances are prescribed. In severe cases, the use of glucocorticosteroids and antibacterial drugs may be necessary.

Hepatoprotectors for liver restoration - table

Drugs for the treatment of alcoholic hepatitis - gallery

Liv 52 is a plant-based drug. Helps restore liver cells
Heptral is an effective remedy for withdrawal syndrome, cirrhosis and liver fibrosis
Essentiale forte - contains essential phospholipids that restore the liver by integrating into its structure
Ovesol is an active complex food supplement with anti-inflammatory properties.
Ursofalk is a drug of ursodeoxycholic acid. Restores damaged liver cells

Diet

Long-term abuse of alcohol leads to digestive disorders; the human body does not receive the required amount of vitamins, nutrients and microelements. To restore liver function, a balanced diet is recommended.

The calorie content of the daily diet is at least 2000 calories. The patient needs B vitamins, folic acid and protein. Meals should be fractional - up to five times a day.

Doctors advise if you get sick to follow diet No. 5, which ensures gentle liver function.

It is prohibited to use:

• fried, spicy foods;
• marinades;
• animal fats;
• yeast baked goods, fresh bread, sweets;
• meat, fish, mushroom broths;
• coffee, carbonated drinks, alcohol.

Products prohibited for alcoholic hepatitis - gallery

Alcohol Lean meat and fish
Soy dishes

Surgery

Surgery is necessary if there is significant liver damage when drug treatment does not produce results. Such operations are rarely performed and are very expensive. The difficulty lies not only in the high cost, but also in the problems of selecting a donor, who can only be a person with excellent physical and mental health. Usually part of the organ is transplanted from a relative.

Before surgery, you must avoid drinking alcohol for six months.

The recovery period after surgery is long, during which time the patient needs to take immunosuppressants for the organ to heal. But sometimes, even if all conditions are met, the body rejects the transplanted liver.

Consequences and complications

Complete abstinence from alcohol significantly improves the prognosis for this disease. But it very often happens that those patients who have been diagnosed with a severe form of alcoholic hepatitis continue to drink alcohol, which leads to death in 30% of cases.

And even with a mild course of acute alcoholic hepatitis and timely treatment, as well as complete abstinence from alcohol, there remains a very high risk of further development of cirrhosis.

The most likely complications of alcoholic hepatitis are:

According to statistics, in women the disease is much more complicated, and severe consequences develop more often than in men.

Prevention

Prevention of alcoholic hepatitis involves avoiding regular consumption of alcoholic beverages. The best solution for a person who cares about his health is the complete exclusion of alcohol, as well as a nutritious and balanced diet.

Alcoholic hepatitis is a fairly serious disease that requires serious medical intervention. Correct and timely treatment increases the chance of restoring and maintaining health. It is important to understand that without completely abstaining from alcohol, it will be very difficult to achieve a positive result.