Alcoholic and viral hepatitis. Alcoholic hepatitis. Manifestation of alcoholic hepatitis

Research has shown that the average resident of Germany consumes about 9.5 liters of alcohol per year, and the average resident of Russia consumes 10 liters. The gap is small, but the amount is very dangerous, because with such active consumption of strong drinks a person risks getting cirrhosis of the liver, which is preceded by alcoholic hepatitis. This disease develops from alcohol consumption, leading to inflammatory damage to the liver, which can develop into cirrhosis. It has many forms, is difficult to diagnose, and requires long-term treatment and recovery.

We will now tell you what alcoholic hepatitis is, what its symptoms and treatment are.

Types of alcoholic hepatitis

Alcoholic hepatitis is divided into several types, depending on the symptoms and course of the disease. Let's consider their signs and features.

Persistent form

With this form of the disease, very few symptoms of alcoholic hepatitis appear, and patients most often complain of the following manifestations:

Nausea and belching.
Pain on the right (in the liver area).
Heaviness in the stomach.

The presence of liver disease is detected by laboratory testing, after which the attending physician prescribes a diet and strongly advises you to give up alcoholic beverages. After just six months, the patient’s condition improves, but the unpleasant consequences of this liver disease accompany the person for 5-10 years. If you do not start treating alcoholic hepatitis in time at this stage, then it flows into the next form - progressive.

Progressive form of the disease

This form is observed in 20% of patients who suffer from alcoholic hepatitis, and it is a harbinger of imminent cirrhosis. Symptoms of alcoholic hepatitis in a progressive form are pronounced:

Jaundice and fever.
Vomiting and diarrhea.
Severe pain in the right hypochondrium.

Non-specific symptoms corresponding to the stage of the disease (mild, moderate, severe) may also appear. If this form of liver disease is left untreated, the patient will die due to acute liver failure.

Forms of the disease and causes of its development

Based on the intensity of the disease, the following types can be distinguished:

Spicy
Chronic.

Features of the acute form

This type of disease is observed in patients who suffer from other liver problems (cirrhosis, hepatitis) but regularly drink alcoholic beverages.

Acute alcoholic hepatitis is accompanied by the following symptoms:

Very strong weakness.
Jaundice.
Pain in the hypochondrium.
Nausea and vomiting.
Weight loss and stool changes.

Acute alcoholic hepatitis can also occur in several forms:

The icteric appearance is the most common, symptoms are weakness, yellowness of the skin, fever, pain.
Cholestatic is characterized by the highest mortality. The manifestation of the disease is accompanied by jaundice, itching, colorless feces and dark urine.
The fulminant form develops very quickly and is difficult to cure. But in the absence of treatment, the patient 14-20 days after the disease enters the acute phase dies from hepatic renal failure.
Latent, characterized by an asymptomatic course and difficult diagnosis.

In all of the above cases, there is a significant enlargement of the liver, and some patients experience anorexia.

Chronic form

Classic chronic alcoholic hepatitis develops with regular alcohol consumption, but without concomitant liver diseases. It is difficult to identify this form of the disease; examination of the liver and its changes, as well as an increase in transaminase levels, will help in making a diagnosis.

Chronic alcoholic hepatitis is practically asymptomatic, and the patient may complain of the following unpleasant sensations:

Decreased appetite and nausea.
Bad dream, in men the mammary glands become enlarged.
Decreased sexual activity.
Pain in the right hypochondrium and enlarged liver.
Spider veins, white nails.

The development of this form of the disease is caused by frequent consumption of alcohol, amounting to 70 g of pure ethanol for men, 20 g for women.

Who is at risk?

Scientists have proven that most of the alcohol, or more precisely the ethanol, that it contains is broken down by the liver. About 20% of ethanol is broken down in the stomach, turning into acetaldehyde. This substance destroys cells and leads to pathological changes in internal organs. Note that alcohol is doubly dangerous for women, because the ability of a woman’s stomach to break down ethyl is two times lower than that of a man.

There is a high probability of developing hepatitis in people who have consumed 100 g or more of pure alcohol daily for several years. 50 ml of vodka contains 20 g of alcohol, it turns out that 250 ml contains 100 g of pure alcohol, and this is already a dangerous dose.

Doctors also highlight following reasons that can accelerate the development of the disease:

Long-term alcohol use (more than 5 years).
Drinking alcohol in large quantities.
Genetic predisposition.
Obesity and bad habits.
Overeating, lack of healthy foods high in protein.

Also, the development of the disease is caused by poor ecology, which weakens the immune system, poor quality food and cheap alcohol made from chemical components. And if the patient takes strong antibiotics and other medications while continuing to drink alcohol, then he also falls into the risk group.

Now let's look at how to treat the disease and recover from it.

How is the disease diagnosed?

Modern laboratory and hardware techniques are used to diagnose the disease. Methods diagnostics depend on the patient’s complaints, clinical picture and form of the disease. For example, if a person suffers from a latent form of the disease, then a biopsy is required, and chronic form will reveal an ultrasound of organs abdominal cavity.

Most often, the patient may be prescribed the following laboratory tests:

General blood and urine analysis.
Blood biochemistry and liver test.
Test to assess blood clotting and cholesterol.

Depending on the nature of the disease, ultrasound, MRI or CT may be prescribed, but these methods are ineffective. The best option diagnosis is a biopsy.

Features of treatment

Treatment usually begins after diagnosis. The main factor in the treatment of alcoholic hepatitis is diet; in these cases, treatment table No. 5 is prescribed, which we will talk about later.

The following medications are used to treat alcoholic hepatitis:

Detoxification therapy may be prescribed, during which medications are administered intravenously. Therapy helps to cleanse the body in a short time, increase its endurance and prepare the patient for drug treatment.
Metabolic and coenzyme therapies aimed at improving metabolism in the body's cells.
Drugs that help liver cells remain active and also promote their rapid regeneration.
Drugs that are analogues of adrenal hormones. This group of drugs suppresses the production of antibodies and inflammatory processes, and prevents tissue scarring.
Naturally, to treat any alcoholic hepatitis, the patient is prescribed a course of vitamins, including vitamins A, B, C, E and others. The disease is accompanied by a deterioration in the absorption of nutrients.

The above drugs are prescribed by a doctor, the dosage and duration of use are calculated individually, depending on the form of the disease, its neglect, and diet. Note that it is necessary to stop using ethyl, otherwise the therapy will be ineffective.

Features of treatment table No. 5

Set of diets for various diseases was developed by the Soviet nutritionist Pevzner, and although they are actively criticized today, their use gives good results in the treatment of various types of alcoholic hepatitis. In particular, for this disease, treatment table No. 5 is used, which helps solve the following problems:

Restoration of liver functions.
Restoration of activity biliary tract.

The diet menu spares the liver, relieves the load on it and improves the functioning of medications. Consider the list of prohibited products:

Very fresh bread and pastries.
All fatty fish and meats.
Strong broths: meat, fish, mushroom, okroshka, cabbage soup.
Any smoked, spicy or too salty foods.
Dairy and dairy products with high fat content.
Eggs, hard-boiled or fried.
Legumes, spicy and fatty sauces.
Ice cream, chocolate and candies, products with cream.

The diet is rich in protein foods (cottage cheese, meat, fish), but all dishes should be low-fat, steamed or in foil in the oven.

The calorie content of the diet is about 3000 kcal, the daily amount of protein is 90 g, carbohydrates 400 g, and fats 80 g, but 30% of them should be vegetable. The patient must consume up to 3-4 liters of liquid per day, reducing the amount of salt to 4 g. Thus, vital unloading occurs. important body, the body is cleansed, and the duration of the diet can be either 14 or 21 days.

How long does treatment take?

If you go to the hospital in a timely manner and promptly refuse bad habit a favorable prognosis can be made. The liver is able to recover, so treatment of alcoholic hepatitis in the initial stages gives good results, and the patient can forget about the unpleasant disease for a long time.

But remember that if the treatment is successful, you must avoid drinking alcohol, otherwise you may end up on a drip again. And in particularly advanced cases, the likelihood of death increases.

How to avoid this disease?

To avoid most liver diseases, simply do not drink alcoholic beverages, exclude fatty foods from your menu, and try to smoke less. But even if you rarely drink alcohol, and the next morning after a feast you feel a nagging pain with right side under the ribs, then do not delay going to the doctor, because these may be manifestations of the first symptoms of alcoholic hepatitis.

If the shape and volume of the patient's liver changes due to alcoholism, a diagnosis of alcoholic hepatitis is made. This is a degenerative disease dangerous risk manifestations of cirrhosis. Required surgical treatment illness, giving up alcoholic beverages and switching to healthy image life. Find out how to recognize hepatitis at home and what symptoms it is characterized by.

What is alcoholic hepatitis

In 1995, the term "alcohol hepatitis" was coined to describe the characteristics of liver damage due to ethanol consumption. This disease is inflammatory and causes cirrhosis. Alcohol toxins enter the liver, where acetaldehydes are formed, damaging cells. The disease becomes chronic after six years with constant use of ethanol. Hepatitis C and alcohol are not directly related, but the development of a toxic disease is promoted by daily intake of 50-80 g of alcohol for men, 30-40 g for women and 15-20 g for adolescents.

Alcoholic hepatitis - symptoms

Depending on the form of manifestation of the disease, the following symptoms of alcoholic hepatitis are distinguished:

Persistent form - occurs hidden, the patient is unaware of the disease. Its signs may include heaviness in the right side under the ribs, nausea, belching, and stomach pain. The type is revealed using laboratory research, is treated by giving up alcohol and following a diet.
Progressive form - it forms in the absence of treatment for persistent hepatitis and is considered a harbinger of cirrhosis. The patient's condition worsens, foci of necrosis are observed in the liver (cells completely die). Signs include: vomiting, diarrhea, fever, jaundice, pain in the right side. Without treatment, the disease threatens death from liver failure.

Signs of alcoholic hepatitis

Depending on the development and course of the disease, special signs of hepatitis are distinguished. The disease can be acute (icteric, latent, fulminant and cholestatic) and chronic. If in the first the symptoms manifest themselves clearly, pronouncedly (the patient may turn yellow, experience pain and worsening of the condition), then in the second the course may be asymptomatic and mildly expressed.

Acute alcoholic hepatitis

OAS, or acute alcoholic hepatitis, is considered a rapidly progressive disease that destroys the liver. Appears after prolonged drinking bouts. There are four forms:

Jaundice – weakness, pain in the hypochondrium, anorexia, vomiting, diarrhea. Men experience jaundice without itching, weight loss, and nausea. The liver is enlarged, thickened, smooth, painful. The patient's hands tremble, ascites, erythema, bacterial infections, temperature increase.
Latent - diagnosed only by laboratory methods, biopsy, hidden course.
Cholestatic - rare, symptoms include severe itching, colorless feces, jaundice, dark urine, and difficulty urinating.
Fulminant - symptoms progress, hemorrhages, jaundice, renal failure and liver encephalopathy are observed. Death occurs due to coma and hepatorenal syndrome.

Chronic alcoholic hepatitis

Chronic alcoholic hepatitis is characterized by the absence of obvious symptoms. It is detected only by laboratory tests - the activity of transaminases and cholestasis syndrome are checked. The indirect development of the disease is indicated by the criteria alcohol addiction:

taking large amounts of alcohol, desire to drink;
withdrawal symptoms;
increasing the dosage of alcohol.

How to recognize hepatitis at home

To correctly recognize hepatitis at home, you need to pay attention to the patient. If he shows at least one sign of an acute course of the disease, medical intervention is necessary. If you observe indirect signs of involvement in alcoholism, you should also contact a specialist to examine the liver and identify abnormalities in its function.

If the disease is not treated in time, complications are possible, including the death of the patient due to liver necrosis:

high blood pressure;
intoxication of the body;
hypertension, varicose veins;
jaundice, cirrhosis.

Is toxic hepatitis contagious?

According to doctors, toxic alcoholic hepatitis is considered a non-contagious disease, because it occurs as a result of poisoning of the body with a chemical substance. It develops against the background of long-term intake of alcoholic beverages in large quantities, affects only the patient’s body. For treatment, it is important to eliminate the destructive factor and increase the functionality of the organs.

How to treat alcoholic hepatitis

To spend effective treatment alcoholic liver hepatitis, you must stop drinking alcohol and consult a doctor. He will appoint complex therapy, including:

detoxification - droppers, intravenous or oral administration of cleansing agents medicines;
visiting a psychologist or narcologist to eliminate a bad habit;
energy diet, it is recommended to consume more proteins;
surgical or drug treatment - you can remove foci of necrosis, take methionine and choline to replenish the lipid function of the organ;
intramuscular injection of vitamins, potassium, zinc, nitrogen-containing substances;
use of corticosteroids for severe disease;
taking hepatoprotectors (Essentiale, Ursosan, Heptral);
elimination of etiological factors;
taking antibiotics for the development of bacterial infections, viral infections or the development of a severe form of the disease.

Doctors prohibit self-treatment, since liver damage can be serious and lead to uncontrollable consequences. If the case is very severe and advanced, a liver transplant may be required; the prognosis for survival is average. As a strengthening treatment, after eliminating the symptoms and acute course, traditional medicine based on corn silk and milk thistle can be used.

To prevent relapse of the disease, these rules are used:

reducing doses of alcohol or completely abstaining from it;
compliance with medications, avoidance of alcohol during treatment;
proper nutrition, complete in terms of calories and nutritional supplements.

Diet for alcoholic liver hepatitis

Most patients with alcoholic-type hepatitis have a clinical history of depletion of the body due to lack of adequate nutrition. To improve health and reduce severity on the liver, you need a special diet. The diet for alcoholic hepatitis includes the following recommendations:

refusal of fatty meat, lard, fish, eggs, canned and smoked foods;
ban on mushrooms, seasonings and sauce, pastries, white bread, strong tea, coffee;
you cannot eat nuts, onions, garlic, sorrel, radishes, confectionery, ice cream;
do not overuse carbonated water, fatty cheeses, cottage cheese, sour cream, butter;
a categorical ban on alcohol, nicotine;
products can be steamed, baked, boiled;
inclusion in the diet of porridge, dried toast, bran, dairy products, veal, lean fish, low-fat cottage cheese, chicken;
It's good to eat vegetables, fruits, green tea, dried fruits, green vegetables, figs;
meals 5-6 times a day, separate - do not mix proteins with carbohydrates in one meal, eat fruits separately.

Alcoholic hepatitis

We will now tell you what alcoholic hepatitis is, what its symptoms and treatment are.

Types of alcoholic hepatitis

Alcoholic hepatitis is divided into several types, depending on the symptoms and course of the disease. Let's consider their signs and features.

Persistent form

With this form of the disease, very few symptoms of alcoholic hepatitis appear, and patients most often complain of the following manifestations:

Nausea and belching.
Pain on the right (in the liver area).
Heaviness in the stomach.

Progressive form of the disease

This form is observed in 20% of patients who suffer from alcoholic hepatitis, and it is a harbinger of imminent cirrhosis. Symptoms of alcoholic hepatitis in a progressive form are pronounced:

Jaundice and fever.
Vomiting and diarrhea.
Severe pain in the right hypochondrium.

Forms of the disease and causes of its development

Based on the intensity of the disease, the following types can be distinguished:

Features of the acute form

This type of disease is observed in patients who suffer from other liver problems (cirrhosis, hepatitis) but regularly drink alcoholic beverages.

Acute alcoholic hepatitis is accompanied by the following symptoms:

Very strong weakness.
Jaundice.
Pain in the hypochondrium.
Nausea and vomiting.
Weight loss and stool changes.

Acute alcoholic hepatitis can also occur in several forms:

The icteric appearance is the most common, symptoms are weakness, yellowness of the skin, fever, pain.
Cholestatic is characterized by the highest mortality. The manifestation of the disease is accompanied by jaundice, itching, colorless feces and dark urine.
The fulminant form develops very quickly and is difficult to cure. But in the absence of treatment, the patient dies from hepatic-renal failure 14-20 days after the disease enters the acute phase.
Latent, characterized by an asymptomatic course and difficult diagnosis.

In all of the above cases, there is a significant enlargement of the liver, and some patients experience anorexia.

Chronic form

Chronic alcoholic hepatitis is practically asymptomatic, and the patient may complain of the following unpleasant sensations:

Decreased appetite and nausea.
Poor sleep, men's mammary glands become enlarged.
Decreased sexual activity.
Pain in the right hypochondrium and enlarged liver.
Spider veins, white nails.

The development of this form of the disease is caused by frequent consumption of alcohol, amounting to 70 g of pure ethanol for men, 20 g for women.

Who is at risk?

Doctors also identify the following reasons that can accelerate the development of the disease:

Long-term alcohol use (more than 5 years).
Drinking alcohol in large quantities.
Genetic predisposition.
Obesity and bad habits.
Overeating, lack of healthy foods high in protein.

Now let's look at how to treat the disease and recover from it.

How is the disease diagnosed?

Modern laboratory and hardware techniques are used to diagnose the disease. Methods diagnostics depend on the patient’s complaints, clinical picture and form of the disease. For example, if a person suffers from a latent form of the disease, then a biopsy is required, and an ultrasound of the abdominal organs will reveal the chronic form.

Most often, the patient may be prescribed the following laboratory tests:

General blood and urine analysis.
Blood biochemistry and liver test.
Test to assess blood clotting and cholesterol.

Depending on the nature of the disease, ultrasound, MRI or CT may be prescribed, but these methods are ineffective. The best diagnostic option is a biopsy.

Features of treatment

Treatment usually begins after diagnosis. The main factor in the treatment of alcoholic hepatitis is diet; in these cases, treatment table No. 5 is prescribed, which we will talk about later.

The following medications are used to treat alcoholic hepatitis:

Detoxification therapy may be prescribed, during which medications are administered intravenously. Therapy helps to cleanse the body in a short time, increase its endurance and prepare the patient for drug treatment.
Metabolic and coenzyme therapies aimed at improving metabolism in the body's cells.
Drugs that help liver cells remain active and also promote their rapid regeneration.
Drugs that are analogues of adrenal hormones. This group of drugs suppresses the production of antibodies and inflammatory processes, and prevents tissue scarring.
Naturally, to treat any alcoholic hepatitis, the patient is prescribed a course of vitamins, including vitamins A, B, C, E and others. The disease is accompanied by a deterioration in the absorption of nutrients.

Features of treatment table No. 5

A set of diets for various diseases was developed by the Soviet nutritionist Pevzner, and although they are actively criticized today, their use gives good results in the treatment of various types of alcoholic hepatitis. In particular, for this disease, treatment table No. 5 is used, which helps solve the following problems:

Restoration of liver functions.
Restoration of bile duct activity.

The diet menu spares the liver, relieves the load on it and improves the functioning of medications. Consider the list of prohibited products:

Very fresh bread and pastries.
All fatty fish and meats.
Strong broths: meat, fish, mushroom, okroshka, cabbage soup.
Any smoked, spicy or too salty foods.
Dairy and fermented milk products with high fat content.
Eggs, hard-boiled or fried.
Legumes, spicy and fatty sauces.
Ice cream, chocolate and candies, products with cream.

The diet is rich in protein foods (cottage cheese, meat, fish), but all dishes should be low-fat, steamed or in foil in the oven.

The calorie content of the diet is about 3000 kcal, the daily amount of protein is 90 g, carbohydrates 400 g, and fats 80 g, but 30% of them should be vegetable. The patient must consume up to 3-4 liters of liquid per day, reducing the amount of salt to 4 g. Thus, the vital organ is unloaded, the body is cleansed, and the duration of the diet can be either 14 or 21 days.

How long does treatment take?

If you go to the hospital in a timely manner and quickly give up your bad habit, you can make a favorable prognosis. The liver is able to recover, so treatment of alcoholic hepatitis in the initial stages gives good results, and the patient can forget about the unpleasant disease for a long time.

But remember that if the treatment is successful, you must avoid drinking alcohol, otherwise you may end up on a drip again. And in particularly advanced cases, the likelihood of death increases.

How to avoid this disease?

To avoid most liver diseases, simply do not drink alcoholic beverages, exclude fatty foods from your menu, and try to smoke less. But even if you rarely drink alcohol, and the next morning after a feast you feel a nagging pain on the right side under the ribs, then do not delay going to the doctor, because these may be manifestations of the first symptoms of alcoholic hepatitis.

Alcoholic hepatitis

Alcoholic hepatitis– these are pathological changes in the liver, characterized by signs of inflammation, fatty degeneration, fibrosis, the cause of which is the toxic effect of alcohol metabolites on the organ. As the etiological factor continues to act, changes in the liver progress to cirrhosis - irreversible damage. The severity of the disease is determined by both the dose and the quality and duration of alcohol intake. Hepatitis can occur in acute or chronic form. Treatment is aimed at giving up alcohol, providing a sufficiently high-calorie and nutritious diet, and normalizing the functional state of the liver.

General information

Alcoholic hepatitis is a disease that is one of the main manifestations of alcoholic liver disease, which in modern gastroenterology, along with alcoholic fibrosis, is a precursor or initial manifestation of liver cirrhosis. As a rule, this disease develops after five to seven years of regular alcohol use. The pathology progresses with continued consumption of alcoholic beverages.

Alcoholic hepatitis is caused by long-term alcohol abuse. In men, liver damage can develop when drinking 50-80 grams of alcohol per day, in women - 30-40 grams, in adolescents - 15-20. The rate of development and progression of the disease is determined by the amount and frequency of alcoholization, the quality of drinks consumed, the individual characteristics of the body, and the duration of abuse.

The likelihood of developing alcoholic liver damage is higher in individuals who have genetic characteristics of enzymes that metabolize alcohol, in patients who have had viral hepatitis, and also in those with an initial nutritional deficiency.

Alcohol intake is accompanied by its metabolization in the liver to acetaldehyde, which has the property of damaging hepatocytes (liver cells). The cascade of chemical reactions triggered in the body by this substance causes hypoxia of hepatocytes, and ultimately their death. As a result of toxic alcohol damage to the liver, a diffuse inflammatory process develops in its tissue.

Classification

Alcoholic hepatitis can have a persistent or progressive course. The persistent course is a relatively stable form of the disease, and when alcohol consumption is stopped, the damage to liver cells is reversible. Continuation of alcoholization leads to a transition to a progressive form.

The progressive form (divided into mild, moderate and severe degrees according to activity) is characterized by small focal necrotic liver damage, which often develops into cirrhosis. Timely treatment of this form leads to stabilization of the process, residual effects are saved.

Depending on the course, acute and chronic alcoholic hepatitis are distinguished. The acute course is characterized by acute progressive liver damage. About 70% of cases of long-term abuse are caused by acute hepatitis, which in 4% of cases very quickly turns into cirrhosis. This form can occur in the following variants: latent, icteric, cholestatic and fulminant. Severe variants of acute alcoholic hepatitis often develop against the background of existing cirrhosis after heavy drinking.

Symptoms of alcoholic hepatitis

The latent variant of the course does not have characteristic symptoms. Patients feel some heaviness in the hypochondrium on the right, mild nausea. This variant is usually detected by the results of laboratory tests (increased transaminases). A definitive diagnosis requires a biopsy.

The icteric variant of the course is the most common. Characteristic signs are complaints of severe weakness, anorexia, pain in the right hypochondrium, diarrhea, nausea, vomiting, weight loss, yellowing skin, sclera Possible increase in body temperature. The liver is enlarged, smooth (with cirrhosis - lumpy), painful on palpation. The detection of symptoms such as splenomegaly, ascites, palmar erythema (redness of the palms), telangiectasia indicates underlying cirrhosis.

The cholestatic variant of alcoholic hepatitis is less common; its characteristic features are intense itchy skin, discoloration of stool, jaundice, dark urine. This option has a protracted course. The fulminant variant is characterized by rapid progression of hepatorenal, hemorrhagic syndrome, pronounced changes in laboratory markers. Against the background of hepatic coma and hepatorenal syndrome, the outcome can be fatal.

Chronic course alcoholic hepatitis is characterized by moderate severity clinical signs and laboratory markers. The diagnosis is based on characteristic signs revealed by liver biopsy, which indicate the presence of inflammation in the absence of cirrhosis.

Diagnostics

Diagnosis of alcoholic hepatitis can be associated with certain difficulties. A mild course of the disease may not be accompanied by any specific symptoms, and it can only be suspected if changes in laboratory parameters are detected.

Laboratory signs of the acute form are leukocytosis, less often - leukopenia (with the toxic effects of alcohol on the bone marrow), B12-deficiency anemia, accelerated ESR, as well as increased markers of liver damage. Ultrasound examination of the liver reveals an increase in its size, heterogeneity of structure, smooth contours. Magnetic resonance imaging (MRI of the liver) detects collateral hepatic blood flow and associated pancreatic damage.

In the chronic form, an ultrasound examination of the liver reveals a slight or moderate enlargement of the liver, an increase in its echogenicity, and homogeneity of structure. Laboratory parameters were moderately changed. Liver biopsy in case of alcohol damage can reveal specific signs of inflammation, fibrosis, and necrosis. The severity of the damage depends on the form of the disease and its duration.

Identification of signs of liver damage during the examination should be combined with anamnestic data indicating long-term alcohol consumption, as well as the presence of dependence and abuse. This is difficult because the doctor does not always have complete information about the patient. That is why relatives should be involved in collecting a complete history, since patients often significantly reduce the amount of alcohol they drink.

Characteristic external signs of alcoholic illness (alcoholism) are also revealed: puffiness of the face, tremor of the hands, tongue, eyelids, atrophy of the muscles of the shoulder girdle, Dupuytren's contracture (fibrous change in the palmar tendons, leading to their shortening and flexion deformation of the hand), damage to the peripheral nervous system, other target organs (kidneys, heart, pancreas, central nervous system).

Treatment of alcoholic hepatitis

Therapy for this disease must be comprehensive. The main directions of treatment are eliminating the damaging factor, prescribing an appropriate diet, drug therapy. Any form of alcoholic hepatitis first of all requires the cessation of the action of the etiological factor - alcohol. Without alcohol abstinence, progression of the damage is inevitable. In mild forms, this is already enough to reverse the development of changes in the liver.

Alcoholic hepatitis is accompanied by nutritional deficiency in most patients. The more severe the liver damage, the more pronounced the trophic insufficiency. Recommended energy value daily ration about 2000 calories. The protein content should be 1 g per kilogram of weight. Be sure to have a sufficient supply of vitamins and unsaturated fatty acids. In case of anorexia, tube enteral or parenteral nutrition is prescribed. Infusions of amino acids reduce protein catabolism (consumption of interstitial protein reserves) and improve the metabolism of brain tissue.

Drug therapy includes the prescription of essential phospholipid preparations, which reduce fatty liver disease, have an antioxidant effect, slow down liver fibrosis, and accelerate the regeneration of its cells. Also, in case of alcohol damage, especially the cholestatic form, ursodeoxycholic acid preparations, which have a cytoprotective effect, are prescribed. In order to achieve an antioxidant effect, block the production of acetaldehyde, and damage to cell membranes, silymarin-containing hepatoprotectors are prescribed.

Treatment of the acute form includes detoxification therapy, administration of plasma-substituting solutions, and correction of electrolyte disturbances. In severe cases with hepatocellular failure syndrome, glucocorticosteroids are used. Treatment of the chronic form is carried out taking into account the degree of liver damage. The presence of fibrosis requires complete abstinence from alcohol. Drug therapy includes the prescription of drugs that affect the process of fibrosis, γ-interferon, glycine.

Prognosis and prevention

The basis for the prevention of alcoholic hepatitis is to limit alcohol consumption, in order to prevent the progression of existing liver damage - complete abstinence. In patients with mild to moderate alcoholic hepatitis, when the effect of acetaldehyde is completely stopped, the prognosis is good - complete restoration of liver function is possible. Currently, in order to treat this pathology, highly effective drugs are used that can cure the disease or stabilize the patient’s condition for a long time, preventing the transition to cirrhosis of the liver.

Treatment should be carried out by a hepatologist or gastroenterologist together with a psychotherapist and narcologist, since the decisive factor is abstinence from alcohol. If the etiological factor continues to act, the disease is complicated by liver cirrhosis. This is an irreversible condition that is the final stage of alcohol damage. In this case, the prognosis is unfavorable. In such patients high risk development of hepatocellular carcinoma.

Symptoms and treatment of alcoholic hepatitis

Alcoholic hepatitis is pathological changes in the liver, which are accompanied by inflammatory signs and fatty degeneration. The etiology is due to the regular toxic effects of alcohol metabolites on the gland. With alcohol dependence, cirrhosis and primary cancer develop over time.

If cirrhotic processes develop only in experienced alcoholics, then for the development of the alcoholic form of hepatitis, it is enough to consume 50 g of alcohol for a long time - at least five years. According to official statistics, mortality due to acute hepatitis is 20-60%, based on the variant of the disease.

How long do people live with alcoholic hepatitis, what are the symptoms of the pathology, diagnosis and features drug treatment– details in the article.

Liver and alcohol

Excessive consumption of alcoholic beverages on a regular basis leads to poisoning human body. Alcohol in large doses is poison for humans. In small quantities, ethanol is produced by the body itself and takes an active part in a number of biological and chemical processes.

A poison is considered to be the amount of alcohol that exceeds the safe limit. daily dose. So, this is more than 30 ml of alcohol of 40% degrees (vodka, whiskey), from 75 ml of 17% alcohol (fortified wine), from 100 ml of 11-13% alcohol (champagne) and more than 250-330 ml of beer.

Moreover, even the situation when a person does not have alcoholism, but he uses the above dosages 4-5 times a week, is called abuse.

After consuming alcoholic beverages, the body tries to get rid of toxic substances - the breakdown process begins in the oral cavity, then 20% of ethanol is neutralized in the stomach. The speed is determined by food intake and the acidity of gastric juice. As a result of gastric reactions, a component is formed - acetaldehyde, which has a toxic effect.

The rest is excreted through the lungs and enters the liver. There, ethanol is first transformed into acetaldehyde, then into acetic acid. The latter does not cause harm, since through several biochemical reactions it breaks down into components in the form of water and carbon dioxide.

Pathogenesis of the disease

With constant alcohol consumption, liver enzyme function deteriorates.

This is based on the fact that acetaldehyde damages liver cells and fatty transformation (steatosis) is observed.

The process goes like this:

Lipid acids are formed in liver cells. When ethanol gets into them, the process is disrupted.
The gland perceives the disruption of the natural process as an inflammatory reaction, so a high concentration of TNF is formed in it.
When TNF levels increase, triglycerides accumulate.

Ethanol also leads to cholestatic syndrome. The patient develops fibrosis initial stage. It is reversible, but if the effect of ethanol is not eliminated, the disease will soon begin to progress.

Forms and varieties of alcoholic hepatitis

Hepatitis can be divided into two large groups - alcoholic and non-alcoholic (this category includes infectious, viral diseases, which can be transmitted from a sick person). The classification is presented in two forms - acute hepatitis - diagnosed with alcoholism in 70% of clinical pictures and a chronic disease.

Acute form and symptoms

Alcoholic hepatitis is a consequence of the negative effects of alcohol; people cannot become infected with this type of disease.

Symptoms of acute alcoholic hepatitis most often appear in men who have suffered from alcohol addiction for 3-5 years. In very rare cases acute course The disease manifests itself after a few days of heavy drinking. This reveals severe intoxication, an inflammatory reaction and destructive processes in the liver.

Often, the alcoholic form of hepatitis appears against the background of existing cirrhosis of the liver (alcohol is not always the cause of the development). Additional provoking factors include smoking, poor nutrition, taking medications that adversely affect the functionality of the liver.

Hepatitis of alcoholic origin first appears after consuming a significant dose of alcohol.

Acute symptoms:

Nausea, vomiting.
Bitterness in the mouth.
Loss of appetite.
Body temperature rises to 38 degrees.
Pain in the area of the liver projection.
Disruption digestive tract.
Increased gas formation.
Weakness.
Mental disorders.

1-3 days after the detection of clinical signs, jaundice is observed - the mucous membranes, whites of the eyes and skin become yellow.

The duration of the acute form varies from 3 to 5 weeks. In mild forms, blood biochemistry is relatively normal; in severe cases, the main indicators of the analysis increase tenfold, and there are signs of hepatic cellular failure. To determine the extent of damage, ultrasound and CT are performed.

Forms depending on the course of acute illness

IN medical practice There is a classification of acute hepatitis of alcoholic origin depending on the course.

Alcoholic hepatitis: acute and chronic, clinical recommendations

Alcoholic hepatitis is considered the main variant of alcoholic organ pathology. It, like alcoholic fibrosis, is an indispensable harbinger of cirrhosis.

Is alcoholic hepatitis contagious?

Some people think that everything serious illnesses livers are contagious. There is some truth in this - hepatitis B and C are transmitted parenterally. It is not uncommon for people to die from these diseases caused by viruses.

Alcoholic hepatitis: how long do you live with it?

Many people who abuse alcohol think that they can do this without any serious consequences for their body. They believe that when the first signs appear liver pathology they will stop drinking and their health will return to normal.

Pathogenesis of the disease

Among all alcoholic liver diseases (ALDs), alcoholic hepatitis occupies a special place. The likelihood of its development is directly dependent on the frequency of drinking alcohol-containing drinks and their volume. It doesn’t matter what a person drinks - beer, vodka, wine or whiskey.

The disease develops slowly: if you regularly consume critical doses of ethanol-containing drinks, fatty liver disease will first occur. After a sufficiently long period of time, fatty degeneration transforms into alcoholic steatohepatitis, and it all ends in cirrhosis of the liver.

Causes and diagnostic methods

For those who have abused alcohol for 5-7 years, experts diagnose a chronic form of alcoholic hepatitis. The rate of disease progression is directly dependent on the presence of hereditary factors and the patient’s health status.

However, according to studies, daily intake of even 50 g of alcohol over a long period of time can become an impetus for the development of alcoholic hepatitis. These data primarily apply to men. In women, the disease occurs 2 times faster, and the dose of alcohol that can provoke its development is also less.

Diagnosing alcoholic hepatitis is not difficult: you just need to find out how long and in what volumes a person drinks alcohol.

If a person weighs 70 kg, and every day for a year he drinks 150-180 ml of vodka, it means that there are already characteristic changes in his liver.
If a person’s alcohol history is more than 3 years, we can safely say that he is the “owner” of chronic liver failure.

Diagnosing alcoholic hepatitis is simple. To do this, it is enough to find out the medical history, examine and question the patient.

Types of alcoholic hepatitis

Persistent form

The persistent form of alcoholic hepatitis most often occurs without pronounced symptoms. For a long time, a person does not even suspect that his liver is sick.

From time to time he feels:

heaviness in the right hypochondrium;
slight nausea and belching;
discomfort in the stomach area.

The persistent form of this disease can be detected using laboratory tests. If detected in time, it responds well to treatment. If you follow the diet prescribed by your doctor and stop drinking alcohol, you will feel better within the first 6 months.

Progressive form

Progressive alcoholic hepatitis is a harbinger of liver cirrhosis. A similar pathology occurs in 20% of patients suffering from alcoholic hepatitis.

In the patient’s liver, cells begin to quickly die, sometimes foci of necrosis form, and the person’s health condition deteriorates sharply.

Characteristic signs of the disease include:

vomiting and diarrhea, indicating toxic damage to the body;
fever;
jaundice;
pain in the right hypochondrium.

Acute form

Alcoholic hepatitis, depending on the intensity of development of the pathology, is divided into acute and chronic.

The acute form of the disease is diagnosed in patients who already have certain liver problems (cirrhosis, chronic hepatitis), but continue to drink alcoholic beverages.

The disease can occur in one of four forms:

icteric;
fulminant;
latent;
cholestatic.

The icteric form of alcoholic hepatitis is one of the most common. In this case, in patients:

the skin and mucous membranes turn yellow;
weakness and nausea appear;
stool is disturbed;
pain occurs in the area of the right hypochondrium;
vomiting begins;
weight decreases.

The acute phase of latent hepatitis does not have pronounced symptoms. The disease can be detected only after certain laboratory tests: a blood test will show a significant increase in transaminase levels, the result of a biopsy will indicate the presence of a developing inflammatory process in the liver.

The cholestatic form of the disease is characterized by the appearance of:

skin itching;
jaundice;
discolored stool;
dark urine.

The fulminant form of acute alcoholic hepatitis is the most dangerous. The result of its progression is the development of hemorrhagic syndrome, renal failure and hepatic encephalopathy.

Chronic form

Alcoholic hepatitis in chronic form is accompanied by:

Bloating and rumbling in the stomach;
Decreased appetite;
Nausea;
Pain in the area of the right hypochondrium;
Enlarged liver;
Decreased libido;
Hypogonadism (insufficient secretion of androgens);
Gynecomastia (increase mammary glands in male patients);
Sleep disturbance;
Increase in temperature;
The appearance of Dupuytren's contracture (shortening of the palmar tendons).

The symptoms of alcoholic hepatitis, as well as the methods of its treatment, are individual in nature. Often, those suffering from chronic alcoholic hepatitis note the presence of only one or two (in rare cases several) characteristic features this liver pathology.

Treatment of alcoholic hepatitis

Treatment of alcoholic hepatitis, like all other liver diseases, is only possible with complete abstinence from drinking. Unfortunately, many people suffering from this pathology simply cannot fulfill this condition: their craving for alcohol is too great.

According to statistics, only 30% of patients are able to stop drinking alcoholic beverages during treatment. Another 30% of patients are ready to gradually reduce the dose of alcohol they drink, and the rest, unfortunately, continue to drink during therapy. Patients included in this category become regular clients not only of hepatologists, but also of narcologists.

By giving up alcohol, you can get rid of not only jaundice, but also a number of other symptoms.

To achieve maximum results, specialists use all methods, including:

diet therapy;
conservative treatment;
surgical intervention.

Long-term use of alcoholic beverages causes disruption to work digestive system. During liver treatment, the patient’s diet must be balanced; vitamins, nutrients and microelements must be supplied to his body regularly and in the required quantities.

With alcoholic hepatitis, the patient must follow a strict diet. Doctors recommend nutrition according to Pevzner (table No. 5).

The Pevzner diet has a number of features:

Dishes must be boiled or baked. Fried foods are prohibited.
Spicy, salty, fatty and cold foods should be excluded from the diet.
Products that contain coarse fiber (stringy meat and vegetables) should be grated before consumption.
Meals should be fractional (at least 5 times a day), portions should be small and equal in volume.
You cannot drink coffee, cocoa, carbonated drinks, grape juice and, of course, drink alcoholic beverages.
Broths made from meat, fish, and mushrooms are prohibited. The priority is soups made from vegetables and fruits.

Medications

Alcoholic hepatitis is treated with hepatoprotectors - medications conventionally divided into 5 categories:

Milk thistle-based products that can support the active functioning of liver cells.
Ademetionine-based products that protect liver cells from damage and help normalize the outflow of bile and remove toxins.
Products containing bear bile, which accelerates recovery processes.
Organic preparations of animal origin that promote the activation of intracellular renewal processes.

If hepatitis is severe, you cannot do without the use of antibacterial agents: they will minimize the risk of infection. A special role in the treatment of alcoholic hepatitis is given to detoxification measures, which consist of courses of injections of special drugs that relieve most of the symptoms of the pathology.

Surgery

Surgical treatment involves a liver transplant. Currently, such operations are rare and quite expensive. Liver transplantation is performed only if the patient is diagnosed with the last degree of liver failure.

It's not just the high cost of the operation. The problem, most often, is finding a donor. Only someone with excellent physical and mental health can become a donor; it is best if the donor is a relative of the patient. The donor will have to donate 60% of his liver: after the operation, the organ will be able to recover to its original volume.

The only way to avoid the tedious and lengthy treatment of alcoholic hepatitis and the difficulties that accompany it is to prevent the disease, which involves stopping drinking alcohol.

Everyone should know the permissible daily dose of ethanol: men experience the first symptoms of alcohol intoxication after consuming 40 g of the substance, while women need 2 times less - 20 g. That is why the fairer sex takes great risks by being overly addicted to alcohol-containing drinks.

The possibility of alcoholic hepatitis in a regularly drinking person is influenced by such factors as the volume of drinks consumed, lifestyle, genetics, dietary habits, etc. However, it is better not to joke with such things: if you cannot cope with the addiction on your own, delay contacting a medical professional the institution is not worth it.

Alcoholic hepatitis is a liver disease in which the inflammatory process in the organ occurs as a result of systematic consumption of large doses of alcohol. The likelihood of developing the disease is extremely high in people who have been drinking 100 g of alcohol in terms of 96% alcohol for a long time (5 years or more) (25 ml of vodka contains 10 g of alcohol). Alcoholic hepatitis usually develops very slowly, and often the disease goes undetected for a long time. As the disease progresses, liver cirrhosis and liver failure develop.

It should be noted that for men the daily safe dose of alcohol in terms of pure alcohol is 40 g, and for women – 20 g.

Due to the anatomical features of the body, women have a higher risk of developing alcoholic hepatitis than men, who produce enzymes that neutralize alcohol in greater quantities. In addition, people taking medications that have a toxic effect on the liver, as well as those suffering from viral hepatitis, are at increased risk. The presence of concomitant diseases of the digestive system, which often develop as a result of alcoholism (, etc.), is also of particular importance.

A person suffering from alcoholic hepatitis does not pose a danger to others, unlike patients with viral hepatitis, which can be contracted through contact with the blood of a sick person.

There are two forms of the disease:

The persistent form is considered a relatively stable form of alcoholic hepatitis, in which the possibility of reverse development of the inflammatory process still remains, but only under the condition of complete abstinence from alcohol. With continued abuse of alcoholic beverages, this form of the disease can become progressive.
The progressive form is characterized by small focal necrotic liver damage, which most often results in cirrhosis. With timely treatment, stabilization of the inflammatory process can be achieved, but residual effects will persist for life.

Symptoms of alcoholic hepatitis

Heaviness and pain in the right hypochondrium in a person who abuses alcohol may indicate a diagnosis of alcoholic hepatitis.

The disease can be asymptomatic for a long time, and only then do signs appear that allow one to suspect problems with the liver:

Asthenovegetative syndrome is manifested by weakness, increased fatigue, loss of appetite, loss of body weight.
The pain syndrome is expressed in the appearance of discomfort, a feeling of heaviness and pain in the right hypochondrium.
Dyspeptic syndrome: nausea, vomiting, bitter taste in the mouth and bitter belching, especially after drinking alcoholic beverages or fatty fried foods.
Jaundice. Usually, at first, icterus (yellow tint) of the sclera and oral mucosa is noted; as the disease progresses, jaundice of the skin is observed. Sometimes there is skin itching all over the body.
Liver enlargement in alcoholic hepatitis is most often slight or moderate.

Treatment of alcoholic hepatitis

First of all, you need to completely abstain from any alcoholic beverages. Without this condition being met, everything therapeutic measures will be practically ineffective. In many cases, when the disease is caused by alcohol addiction, patients need the help of a psychotherapist and a narcologist.

All patients need to follow a diet. For liver diseases, a special therapeutic diet No. 5 is recommended, aimed at maximally sparing the diseased organ with adequate nutrition. Fatty, fried, spicy foods, pickled and canned foods, sweets, strong teas and coffee are excluded from the diet. Preference is given to foods rich in protein, fiber, vitamins and minerals.

Drug therapy

Hepatoprotectors are a group of drugs that promote the regeneration of damaged liver cells and also protect it from the negative effects of external factors. Such drugs include Ursosan, Essentiale N and Essentiale Forte N, Heptral, Rezalut Pro and many others. The course of treatment usually lasts at least a month; some patients are advised to take hepatoprotectors for 2-3 months. Despite the fact that drugs in this group are widely available on the market, you should not self-medicate; treatment should be prescribed by a doctor.

Vitamin therapy is indicated for all patients with alcoholic hepatitis, since the body is usually exhausted during chronic alcohol intoxication. Patients are prescribed multivitamin complexes and intramuscular injections of B vitamins. In addition, natural immunomodulators (echinacea, Schisandra chinensis, eleutherococcus, etc.) are useful.

Liver transplantation is a treatment option that can be used for severe alcoholic hepatitis accompanied by progressive liver failure. But if the patient does not recover from alcohol addiction, then treatment will be pointless.

Which doctor should I contact?

Alcoholic liver disease should be treated by a hepatologist or gastroenterologist. However, without giving up alcohol, there will be no effect from treatment. Therefore, the patient needs the help of a psychiatrist, psychotherapist or narcologist. To diagnose alcoholic hepatitis, ultrasound and endoscopy are used, so doctors of relevant specialties play an important role. Finally, a nutritionist will help you choose the right diet for a patient with alcoholic hepatitis.

Video version of the article:

Alcoholic hepatitis disease is characterized by such symptoms of liver damage as: inflammation, fatty degeneration and fibrosis, and the treatment of this disease is aimed specifically at eliminating these pathologies.

All of them arise from drinking alcohol. Alcohol toxins affect the organ and lead to disease. If, with this diagnosis, a person continues to consume alcoholic beverages, it can progress to the next stage - cirrhosis, which can no longer be cured.

Course of the disease " alcoholic hepatitis“Can occur in acute or chronic form. Therapy for this form of hepatitis includes: stopping alcohol consumption, eating high-calorie foods, and normalizing liver function with the help of medications.

K70.1– code for this disease in ICD-10.

Hepatitis from alcohol

In the international classification of diseases, diagnosis "alcoholic hepatitis" appeared in 1995. It is from this time that the history of this disease can be documented.

The term "alcoholic hepatitis" was given to the disease, which is one of the symptoms of alcoholic liver disease.

Gastroenterology classifies alcoholic liver disease and alcoholic fibrosis as the initial stage of such a serious disease as cirrhosis. How does this happen?

Alcohol, entering the liver, is metabolized in it to acetaldehyde, which triggers in the body chemical reactions, leading first to hypoxia of liver cells, and then to their death. Due to toxic poisoning in the liver tissues, a diffuse inflammatory process develops. The development of this chronic disease usually occurs after 5-7 years of constant alcohol consumption.

Etiology of the disease

The main cause of the disease is drinking alcohol for a long time. Changes in a man's liver begin to occur with regular daily consumption alcohol in a volume of 50-80 grams, in women at 30-40 grams per day, and in the liver of a teenager at 15-20 grams.

Depending on the quantity and quality of alcohol consumed, the duration of consumption, as well as the individual characteristics of the body, this disease progresses at different rates.

The likelihood that a person will develop alcoholic hepatitis increases if the person: is genetically predisposed to the disease, has had viral hepatitis, or has a poor diet.

Forms of alcoholic hepatitis

This disease can be either chronic or progressive. Chronic course manifests itself in a relatively stable form of the disease. If you stop drinking alcohol during this form of the disease, the liver cells will recover. If a person continues to consume alcohol, the disease becomes progressive.

Depending on the extent of the process progressive form can be mild, medium and severe. This form is characterized by the fact that a finely focal necrotic lesion appears in the liver, often turning into cirrhosis. If treatment is started in a timely manner, the development of the disease can be stopped, but residual effects will persist.

During the course of the disease they secrete acute And chronic form. The acute stage of alcoholic hepatitis is characterized by acute progressive liver damage. Acute hepatitis diagnosed in 70% of people who abuse alcohol. In 4% of these patients, the disease rapidly progresses to liver cirrhosis. Acute form this disease happens latent, icteric, cholestatic, and fulminant. After prolonged heavy drinking, serious forms of the disease often develop against the background of liver cirrhosis.

Symptoms

Latent flow Alcoholic hepatitis is not characterized by any distinctive symptoms. A person complains of heaviness in the right hypochondrium and slight nausea. Diagnosis is made when detected in tests increased rate transaminases, and is confirmed by biopsy.

Jaundice the disease manifests itself most often. It is characterized by the following symptoms: anorexia, diarrhea, general weakness, nausea and vomiting, yellowness of the skin and sclera, weight loss. A person may also experience an increase in temperature.

During the examination, the doctor notes enlargement and tenderness of the liver upon palpation. The liver is smooth, while in cirrhosis it is lumpy. The following signs may also indicate background cirrhosis: an enlarged spleen, accumulation of fluid in the abdominal cavity, symmetrical redness of the palms, as well as the appearance spider veins or mesh.

Cholestatic variant Alcoholic hepatitis is rarely diagnosed and has a long course. It is characterized by symptoms such as: colorless feces and dark urine, jaundice and severe itching of the skin.

For fulminant course The disease is characterized by intensive development of hemorrhagic and hepatorenal syndromes, as well as pronounced changes in laboratory markers. Possible death due to hepatic coma and hepatorenal syndrome.

For chronic stage The disease is characterized by moderate severity as clinical symptoms, and laboratory markers. Diagnosis is made using a biopsy and is based on distinctive features that, in the absence of cirrhosis, indicate an inflammatory process.

Diagnosing this disease is quite difficult. With a mild course of alcoholic hepatitis, no distinctive signs may be observed. Only changes in the clinical parameters of a person’s blood test can help detect it.

Indicators acute stage diseases in the blood test serves increase (or rarely - decrease) in the number of leukocytes, accelerated ESR, increase markers liver damage, as well as anemia caused by a lack of vitamin B12.

A decrease in the number of white blood cells occurs due to the effect of alcohol toxins on the bone marrow. During an examination of the liver using ultrasound, it is discovered that it is enlarged, has a heterogeneous structure and smooth contours. MRI examination of organs reveals damage to the pancreas such as collateral hepatic blood flow.

Examination of the liver using ultrasound in the chronic stage shows that it is slightly or moderately enlarged, has a homogeneous structure and increased echogenicity. A blood test shows slight changes. Fibrosis, necrosis and inflammation of the liver in alcoholic lesions can be detected using a biopsy. The manifestation of these lesions depends on the duration of the disease, as well as on its form.

If the doctor reveals symptoms of liver damage during the examination, he should question the patient about his drinking habits. The patient himself does not always make himself known full information. In addition, a person who abuses alcohol very often incorrectly estimates the amount of alcohol consumed. In such cases, the doctor must interview not only the patient himself, but also his relatives and only then give recommendations.

Prevention and prognosis

How long can a person diagnosed with alcoholic hepatitis live? If the patient is diagnosed with mild or moderate severity of the disease, and he is ready to completely stop consuming alcohol, then the prognosis is favorable. In this case, the liver can fully recover with appropriate treatment.

Version: MedElement Disease Directory

Alcoholic hepatitis (K70.1)

Gastroenterology

general information

Short description

Alcoholic liver disease is a liver disease caused by long-term intake of toxic doses of ethanol. Alcoholic liver disease unites various disorders parenchyma structures Parenchyma is a set of main functioning elements of an internal organ, limited by connective tissue stroma and capsule.
liver and functional state of hepatocytes hepatocyte - the main cell of the liver: a large cell that performs various metabolic functions, including the synthesis and accumulation of various substances necessary for the body, the neutralization of toxic substances and the formation of bile (Hepatocyte)
caused by systematic consumption of alcoholic beverages.

"Alcoholic hepatitis"- a term adopted in ICD-10 to designate acute degenerative and inflammatory liver lesions resulting from exposure to alcohol and capable of transforming into cirrhosis of the liver Liver cirrhosis is a chronic progressive disease characterized by degeneration and necrosis of the liver parenchyma, accompanied by its nodular regeneration and diffuse proliferation connective tissue and profound restructuring of the liver architecture.
.
Alcoholic hepatitis is one of the main variants of alcoholic liver disease. Just like alcoholic fibrosis, alcoholic hepatitis is considered a harbinger or initial and obligatory stage of cirrhosis.

Alcoholic hepatitis can also be combined with fatty liver disease, alcoholic fibrosis and cirrhosis.

Note. Acute episodes of toxic liver necrosis of alcoholic etiology, along with acute alcoholic hepatitis, are designated as “alcoholic steatonecrosis”, “sclerosing hyaline necrosis of the liver”, “toxic hepatitis”, “acute liver failure of chronic alcoholics”.

Classification

Most clinicians distinguish between acute and chronic alcoholic hepatitis.

General classification of alcoholic hepatitis(Loginova A.S. et al.):

1. Chronic alcoholic hepatitis:
- with moderate activity;
- with pronounced activity;
- in combination with alcoholic hepatitis.

2. Acute alcoholic hepatitis (acute alcoholic liver necrosis):
- in combination with chronic alcoholic hepatopathy;
- developed in an intact liver;
- with intrahepatic cholestasis;
- mild (anicteric) form;
- moderate form;
- severe form.

The degree of severity can also be determined using scales (see section "Prognosis"). In accordance with the score obtained, alcoholic hepatitis can be divided into severe and non-severe.

Etiology and pathogenesis

Etiology

Alcohol is a direct hepatotoxic agent. Its metabolism involves a number of enzymatic systems that convert ethanol into acetaldehyde, and then acetaldehyde dehydrogenase Acetaldehyde dehydrogenase is an enzyme found in the human liver and is responsible for the breakdown of acetaldehyde (converts acetaldehyde into acetic acid).
(ALDH) is metabolized into its acetate.
The main factor in the development of alcoholic liver disease is the high content of acetaldehyde in it. This causes most of the toxic effects of ethanol, including through increased lipid peroxidation, the formation of persistent complexes with proteins, impaired mitochondrial function, and stimulation of fibrogenesis.

The risk of developing alcoholic liver disease occurs when drinking more than 40-80 g of pure ethanol per day. Drinking more than 80 g of pure ethanol for 10 years or more increases the risk of liver cirrhosis. There is no direct correlation between the degree of liver damage and the amount of alcohol taken: according to some data, less than 50% of people who drink alcohol in dangerous doses, have severe forms of liver damage (hepatitis and cirrhosis).

Pathomorphology

1. Acute alcoholic hepatitis. Histological manifestations:
1.1 Mandatory for alcoholic hepatitis structural changes liver:
- perivenular damage to hepatocytes;
- balloon dystrophy and necrosis;
- presence of Mallory bodies (alcoholic hyaline);
- leukocyte infiltration;
- pericellular fibrosis.
1.2 Symptoms that are not necessary for the diagnosis of alcoholic hepatitis:
- fatty liver;
- identification of giant mitochondria, acidophilic bodies, oxyphilic hepatocytes;
- fibrosis of the hepatic veins;
- proliferation of bile ducts;
- cholestasis.

Perivenular damage to hepatocytes
Acute alcoholic hepatitis is characterized by perivenular damage to hepatocytes or the third zone (microcirculatory periphery) of Rappoport's hepatic acini. During the metabolism of alcohol, a more noticeable decrease in oxygen tension is observed in comparison with the norm in the direction from the hepatic artery and portal vein to the hepatic vein. Perivenular hypoxia promotes the development of hepatocellular necrosis, which is found mainly in the center of the hepatic hexagonal lobes.

Balloon dystrophy and Mallory bodies
With balloon degeneration of hepatocytes, swelling of individual hepatocytes is observed with an increase in their size, clearing of the cytoplasm and karyopyknosis Karyopyknosis is the process of shrinkage of the cell nucleus during dystrophic changes in it
.
Mallory bodies (alcoholic hyaline) are detected centrilobularly using Mallory tricolor stain; are formed both in the cytoplasm of liver cells and extracellularly. The detection of alcoholic hyaline characterizes the severity of liver damage.
Alcoholic hyaline can have a fibrillar, fine- and coarse-granular structure. Fibrillary alcoholic hyaline is detected at the height of acute alcoholic hepatitis. Later, when the disease subsides, it transforms into granular material.

Inflammatory infiltration of polynuclear leukocytes with a small admixture of lymphocytes is determined inside the lobule and in the portal tracts. Inside the lobule, leukocytes are detected in foci of hepatocyte necrosis and around cells that contain alcoholic hyaline, which is associated with the leukotoxic effect of alcoholic hyaline. When the disease subsides, alcoholic hyaline is less common.

Pericellular fibrosis is an important feature of alcoholic hepatitis, and its prevalence is the main indicator in predicting the disease. Alcohol and its metabolites (especially acetaldehyde) can have a direct fibrogenic effect. Fibrous tissue is deposited along the sinusoids and around hepatocytes on early stages alcoholic hepatitis. Ito cells, fibroblasts, myofibroblasts and hepatocytes synthesize various types of collagen and non-collagenous proteins.

2. Chronic alcoholic hepatitis:

2.1 Chronic persistent hepatitis: characteristic manifestations of alcoholic hepatitis are combined with moderate pericellular and subsinusoidal fibrosis in the third acinar zone hepatic lobule. In some cases, the portal tracts are enlarged and portal fibrosis is observed. This picture can persist for 5-10 years without progressive fibrosis and transition to cirrhosis, even with continued alcohol consumption.

2.2 Chronic active hepatitis: histological picture of alcoholic hepatitis in combination with active fibrogenesis. Along with significant fibrosis, sclerosing hyaline necrosis is noted in the third zone of the lobule. After 3-5 months of abstinence, morphological changes resemble the picture of chronic aggressive non-alcoholic hepatitis.

In chronic alcoholic hepatitis, progression of the process in some cases is observed even after stopping the use of alcoholic beverages as a result of the addition of an autoimmune destructive reaction.

Epidemiology

Sign of prevalence: Common

Age. Acute alcoholic hepatitis most often develops at the age of 25-35 years after heavy drinking and 10 or more years of alcohol abuse. The age range for all forms of alcoholic hepatitis can vary from 25 to 70 years. IN THE USA average age The patient with alcoholic hepatitis is about 50 years old with the onset of alcohol consumption at the age of 17 years.

Prevalence. According to the most minimal estimates, the number of patients in the population of Western countries is about 1-2%. Due to the asymptomatic course of mild forms of alcoholic hepatitis, in the population of patients who moderately drink and abuse alcohol, the prevalence of the disease (according to biopsy data) is 25-30%.

Sex ratio varies in different countries. It is believed that the rate of development of alcoholic hepatitis in women is 1.7 times higher than in men. However, given the predominance of men in the group of drinkers, the significance of the sex ratio in the group of patients remains unknown.

Race. The Caucasian race has a lower rate of development of alcoholic hepatitis than the Negroid and Mongoloid races.

Risk factors and groups

Risk factors for the development and progression of the disease:
- intake of 40-80 grams of ethanol per day for 10-12 years;
- genetically determined phenotypes of enzymes that provide high speed ethanol metabolism and acetaldehyde accumulation;
- infection with hepatotropic viruses;
- excess body weight;
- malnutrition;
- female.

Clinical picture

Clinical diagnostic criteria

Anorexia, nausea, vomiting, weight loss, pain in the upper right quadrant of the abdomen, fever, jaundice, hepatomegaly, splenomegaly, dyspepsia, weakness, nausea, vomiting

Symptoms, course

Anamnesis
Diagnosis of alcoholic hepatitis is associated with certain difficulties, since it is not always possible to obtain sufficiently complete information about the patient.

Criteria for alcohol dependence(diagnosed based on three of the above signs):

The patient consumes alcoholic beverages in large quantities and has a constant desire to consume them;

Spending most of your time purchasing alcohol and consuming 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;

Continuing to drink alcohol despite worsening psychological and physical problems of the patient;

Increasing the amount of alcohol consumed to achieve the desired effect;
- appearance of withdrawal symptoms;

The need to drink alcohol to reduce withdrawal symptoms.

Alcohol abuse(detected by the presence of one or two signs):

Alcohol consumption, despite increased social, psychological and professional problems patient;

Repeated use of alcohol in life-threatening situations.

In doubtful cases, when diagnosing any liver disease or when alcohol abuse is suspected, the use of a special questionnaire is recommended.

Varieties clinical course alcoholic hepatitis:

1. Acute alcoholic hepatitis:

1.1 Asymptomatic or mild course with gradual onset (about 50% of patients). The only complaint is often dyspepsia.

1.2 The clinical picture of acute toxic liver necrosis is classically characteristic:
- fever (40%);
- dyspepsia Dyspepsia is a digestive disorder usually manifested by pain or discomfort in the lower chest or abdomen, which may occur after eating and is sometimes accompanied by nausea or vomiting.
;
- pain in the right hypochondrium (50%);
- diarrhea, nausea, vomiting;
- anorexia;
- weakness;
- weight loss.

1.3 Jaundice variant - determined in the presence of jaundice. The most common variant of acute alcoholic hepatitis (35% of cases). Jaundice is usually not accompanied by itching and is often moderate.

1.4 Cholestatic variant (in 5-13% of cases): symptoms of intrahepatic cholestasis Cholestasis is a violation of the movement of bile in the form of stagnation in the bile ducts and (or) ducts.
(skin itching, jaundice, light-colored stool, dark urine, fever).

1.5 Fulminant acute alcoholic hepatitis: may resemble all clinical variants of acute alcoholic hepatitis (except latent), but is characterized by rapid progression with the development of liver and kidney failure and rapid death.

2. Chronic alcoholic hepatitis: manifestations similar to other etiological forms of hepatitis. Dyspeptic disorders are often observed.

Objective examination
Hepatomegaly is characteristic Hepatomegaly is a significant enlargement of the liver.
. The liver is enlarged in almost all patients, often compacted, has a smooth surface, and is painful. The pain is diffuse.
Possible splenomegaly Splenomegaly - persistent enlargement of the spleen
, cutaneous telangiectasia Telangiectasia is local excessive expansion of capillaries and small vessels.
, palmar erythema Erythema - limited hyperemia (increased blood supply) of the skin
.
Alcoholic and hepatic encephalopathy may occur Encephalopathy is the general name for brain diseases characterized by degenerative changes.
, as well as asterixis Asterixis (symptom of “pop”, falling of the hand) - inability to maintain a fixed posture, fluttering tremor - slow and irregular flexion and extension of the limbs
, as an expression of the latter.
Ascites often develops Ascites - accumulation of transudate in the abdominal cavity
, which, with severe fibrosis and obstruction of the central veins, may be resistant to diuretic therapy.

With alcoholic hepatitis, concomitant bacterial infections are often observed: pneumonia, sinusitis, pyelonephritis Pyelonephritis - inflammation of predominantly interstitial tissue of the kidney and renal pelvis
, active pulmonary tuberculosis, gram-negative septicemia Septicemia is a form of sepsis in which the presence of pathogenic microorganisms in the blood is not accompanied by the formation of metastatic foci purulent inflammation
. Isolated cases of peritonitis are possible Peritonitis is inflammation of the peritoneum.
and abscess Abscess - a cavity filled with pus and delimited from surrounding tissues and organs by a pyogenic membrane
lungs.

Diagnostics

The criterion for diagnosing alcoholic hepatitis is the presence of an alcohol history and specific histological signs (see section “Etiology and Pathogenesis”). Clinical and laboratory parameters play a significant role. Liver imaging plays a lesser role in diagnosis.

Instrumental studies

1. Ultrasound:
- liver parenchyma has a diffuse, hyperechoic structure;
- at the stage of cirrhosis - the corresponding sonographic picture.

2.Color duplex sonography Color duplex sonography is a non-invasive and non-radioactive diagnostic method for analyzing arteries and veins (a combination of Doppler technology with ultrasound imaging)
: identifying the direction of hepatic blood flow, the degree of development collateral circulation, the presence of blood clots in the vessels of the liver.

3.FEGDS FEGDS - fibroesophagogastroduodenoscopy (one of the methods for examining the upper digestive tract, which allows you to examine the inner surface of the esophagus, stomach and duodenum)
carried out to identify the presence and extent varicose veins veins of the esophagus and stomach, to detect portal gastropathy (erosive-hemorrhagic gastritis) and assess the risk of bleeding.
Rectoscopy is used to identify anorectal varicose nodes.

4. Laparoscopy Laparoscopy (peritoneoscopy) is the study of the abdominal organs by examining them using medical endoscopes inserted into the peritoneal cavity through a puncture of the abdominal wall.
with a liver biopsy make it possible to describe the surface of the liver, the size of the regeneration nodes and morphologically confirm the diagnosis. These studies are carried out only in the absence of contraindications to them. For example, percutaneous needle biopsy of the liver is often impossible due to contraindications (primarily coagulopathy) and is associated with a large number of diagnostic errors.

5. When needle biopsy of the liver With histological examination find:
- hepatocytes in a state of balloon and fatty degeneration;
- massive lobular infiltration with a predominance of polymorphonuclear leukocytes and areas of focal necrosis;
- Mallory bodies (sometimes), which, when stained with hematoxylin-eosin, are purple-red cytoplasmic inclusions consisting of condensed intermediate microfilaments of the cytoskeleton;

To varying degrees, pronounced fibrosis with a perisinusoidal arrangement of collagen fibers;
- intrahepatic cholestasis to varying degrees.
At the advanced stage of acute alcoholic hepatitis, as a rule, there are contraindications to needle biopsy of the liver (in these cases, transjugular biopsy can be performed).

6. Magnetic resonance imaging has high sensitivity and specificity in diagnosing hepatic steatosis Liver steatosis is the most common hepatosis, in which fat accumulates in the liver cells
and cirrhosis, but not hepatitis. There are no criteria for proving the alcoholic nature of the detected changes.

Laboratory diagnostics

The diagnosis of alcoholic hepatitis, like any other form of alcoholic liver disease, is made based on evidence of alcohol abuse and evidence of liver disease. Not a single change in laboratory marker has been definitively linked specifically to alcoholic hepatitis. The etiology of liver disease detected by laboratory testing may vary. Additionally, alcohol can be one of a number of factors that cause liver damage. The specific role of alcohol in the development of liver damage may be difficult to assess in a patient with potentially multifactorial liver disease.

Signs of alcohol abuse:
- a sharp increase in the level of gamma-glutamyltransferase in the blood serum and its a sharp decline against the background of abstinence;

Increasing the concentration of carbohydrate-free transferrin;
- macrocytosis (average erythrocyte volume > 100 μm 3), associated with increased blood alcohol content and toxic effects on the bone marrow; the specificity of this sign is 85-91%, sensitivity - 27-52%.

Signs of liver damage:
1. Increase in the level of aminotransferases with a predominance of AST by more than 2 times (in 70% of cases). Increase in AST by 2-6 times. AST levels greater than 500 IU/L or ALT greater than 200 IU/L are uncommon and suggest massive necrosis (fulminant form of alcoholic hepatitis) or other or combined etiology of liver damage (eg, viral hepatitis, acetaminophen use, etc.).

2. Increased alkaline phosphatase levels and hyperbilirubinemia are possible.

In acute alcoholic hepatitis the following is observed:
- neutrophilic leukocytosis up to 15-20 x 10 9 / l, sometimes up to 40 x 10 9 / l;
- increase in ESR to 40-50 mm/h;
- hyperbilirubinemia due to the direct fraction;
- increased levels of aminotransferases (AST/ALT ratio - more than 2);

Multiple excesses of the level of gamma-glutamyltransferase (in 70% of patients with alcoholic liver disease, GGTP activity is within normal values);
- in the cholestatic form - increased alkaline phosphatase;

Increased Ig A.

Differential diagnosis

Differential diagnosis of alcoholic hepatitis with the following diseases is carried out:
- non-alcoholic fatty liver disease;
- viral and infectious hepatitis;
- obstruction of the biliary tract;
- neoplastic formations;
- cholecystopancreatitis;
- chronic pancreatitis.

A correctly collected alcohol history is considered to be the decisive factor. negative tests for infectious agents and visualized patency of the biliary tract. However, in the setting of suspected combined liver damage, it is very difficult to determine the dominant etiological cause. The most reliable diagnostic test in this case is the laboratory determination of CDT (carbohydrate-deficient transferrin).

Complications

Outcomes of alcoholic hepatitis can be:
- fibrosis Fibrosis is the proliferation of fibrous connective tissue, occurring, for example, as a result of inflammation.
and sclerosis Sclerosis is a hardening of an organ caused by the replacement of its dead functional elements with connective (usually fibrous) tissue or a homogeneous hyaline-like mass
liver;
- cirrhosis of the liver;
- hepatic encephalopathy;
- liver cancer.

Infectious complications:
- pneumonia;
- sinusitis Sinusitis - inflammation of the mucous membrane of one or more paranasal sinuses
;
- sepsis;
- liver abscess (rare);
- ICE DIC syndrome (disseminated intravascular coagulation, consumption coagulopathy, thrombohemorrhagic syndrome) is impaired blood clotting due to massive release of thromboplastic substances from tissues.
;
- renal failure;
- peritonitis (rare).

Treatment

General provisions
1. The most important principle in the treatment of alcoholic hepatitis is abstinence from alcohol. The disease can regress quite quickly and completely (compared to hepatitis of other etiologies) with complete abolition of alcohol intake.

2. There are significant discrepancies in drug therapy between Western and CIS recommendations.
3. Many drugs do not have an evidence base (or have a weak one) and are used either traditionally or based on a small number of studies.

4. Treatment approaches change over time. The information set out below reflects the most generally accepted views at the time of writing.
5. Treatment of alcoholic hepatitis depends on many factors:

Form (see section "Classification");
- severity of the process;
- age of the patient;
- presence of concomitant diseases and complications.

Diet
It is important to eat a diet that contains sufficient amounts of protein and calories, as people who abuse alcohol often develop deficiencies of proteins, vitamins and microelements (especially potassium, magnesium and phosphorus).
Shortage folic acid, vitamin B6, vitamin A and thiamine are some of the most commonly found.
Micronutrient levels (eg, selenium, zinc, copper and magnesium) are often altered and, in some cases, are thought to be involved in the pathogenesis of all types of alcohol-related illness.
Difficulties arise in choosing a diet for concomitant diabetes mellitus or obesity, since the spectrum of nutritional disorders in these patients varies widely from malnutrition to obesity. The American College of Gastroenterology (ACG) and the American Association for the Study of Liver Diseases (AASLD) recommend an average of 1.2-1.5 g/kg protein and 35-40 kcal/kg body weight per day (at least 2000 kcal/day for an adult ).
There is evidence of the beneficial effects (when introduced into the diet) of branched-chain amino acids (BCAAs).
Evidence of the effectiveness of introducing polyunsaturated fatty acids into the diet is still doubtful.
As an alternative route for administering nutrients (for nausea, vomiting, changes in psychological status), an endoscopically inserted enteral tube with a programmable pump can be used. Parenteral nutrition (partial or additional) is used extremely rarely.

Physical activity not recommended in the acute phase. In the future, it should be aimed at weight loss (if there is concomitant obesity). Persons with chronic alcoholic hepatitis, which occurs without significant symptoms, usually do not require restriction of physical activity.

Infusion therapy
It is used in the inpatient treatment of severe forms of acute alcoholic hepatitis (including those with severe cholestasis and, especially, liver failure). Infusion therapy is aimed at detoxification, correction of acid-base balance, correction of hypoalbuminemia, correction of the coagulation system. Compound saline solutions, albumin, native plasma, or clotting factors are commonly used in moderate doses. They try to avoid the introduction of colloids.

Medicines

US and UK recommendations
1. Systemic corticosteroids (prednisolone, methylprednisolone) - prescribed only for severe forms of concomitant liver failure for a course of up to 4 weeks, 40 mg/day. (32 mg/day for metipred), sometimes with a progressive dose reduction by 2 times over the next 2-3 weeks until complete withdrawal. Cause side effects.
2. Pentoxifylline - 400 mg orally 3 times a day, if there are contraindications to systemic corticosteroids.
3. Antioxidant therapy (vitamins C and E and other antioxidants) - currently has no solid evidence of effectiveness in the treatment of alcoholic hepatitis. Of course, vitamin deficiency identified during blood serum testing is subject to drug correction, if it is impossible to correct it with a balanced diet.
4. Antibacterial therapy carried out only in the event of the development of infectious complications.
5. Drugs such as thalidamide, misoprostol, adiponectin and a group of probiotics have shown good effects in preliminary studies, but are not yet standard therapy.

1. Systemic corticosteroids (prednisolone) - 40 mg/day, for 4 weeks.
2. Ademethionine (heptral).

3. Silymarin.
4. Essential phospholipids (in the absence of cholestasis), for example, essentiale.
5 Ursodeoxycholic acid.
6. Antibacterial therapy for prophylactic purposes, a short course (fluoroquinols).
7. Colchicine.

Summary. Measures aimed at giving up alcohol, normalizing nutrition, detoxification corrective infusion therapy, as well as prescribing systemic corticosteroids (in severe cases) are generally accepted. In the absence of a clear evidence base, other medications should be prescribed by a doctor based on the patient’s capabilities and his or her personal experience and judgments.

Surgery. Liver transplantation.

Forecast

Mild alcoholic hepatitis is a benign disease with negligible short-term mortality. However, when alcoholic hepatitis is severe enough (development of hepatic encephalopathy, jaundice, coagulopathy), mortality can be significant.

The overall 30-day mortality rate in patients hospitalized with alcoholic hepatitis is about 15%, but in patients with severe forms it approaches or exceeds 50%.
In patients without encephalopathy, jaundice, or coagulopathy Coagulopathy - dysfunction of the blood coagulation system
The 30-day mortality rate is less than 5%.
Overall, the one-year mortality rate after hospitalization for alcoholic hepatitis is about 40%.

Used to predict mortality Maddray coefficient(MDF): 4.6 x (difference between prothrombin time in the patient and control) + serum bilirubin in mmol/l.
If the coefficient is more than 32, the probability of death during the current hospitalization exceeds 50%.
Some studies suggest that MDF may not be an accurate predictor of mortality in patients with alcoholic hepatitis, especially those receiving glucocorticoids.

Other factors that correlate with poor prognosis include elderly age, impaired renal function, encephalopathy and an increase in the number of leukocytes in the first 2 weeks of hospitalization.

Alternative prognosis scales(not widely used):
- The Combined Clinical and Laboratory Index of the University of Toronto;
- Model for end-stage liver disease (MELD);
- Glasgow alcoholic hepatitis score (GAHS);
- Asymmetric dimethylarginine (ADMA).
The last two scales have shown the highest predictive accuracy in some studies.

Hospitalization

Hospitalization for alcoholic liver disease can be carried out both emergency and planned. Patients without signs of severe inflammation, liver failure, or complications can be treated on an outpatient basis.

Prevention

Primary prevention. Avoiding alcohol abuse.

Prevention of complications
Patients recently discharged from hospital after an acute attack of alcoholic hepatitis should generally be monitored intensively for 2 weeks. Subsequent periodic visits to the doctor are necessary at intervals of weeks to several months.
The purpose of monitoring patients is to determine whether they are responding to therapy (including monitoring electrolyte levels and liver test results), as well as monitoring alcohol cessation and encouraging sobriety.
It should be borne in mind that complete abstinence from alcohol is observed in no more than 1/3 of patients, 1/3 of patients significantly reduce their alcohol consumption and the remaining third ignores the doctor’s recommendations. The latter patients require joint work of a hepatologist and a narcologist.

In patients with alcoholic hepatitis who have evidence of cirrhosis (especially those with concomitant chronic viral hepatitis B or C), periodic surveillance is necessary to screen for hepatocellular carcinoma. The general screening algorithm includes serum alpha-fetoprotein (AFP) testing every 6 months and ultrasound every 12 months.

Immunizing patients with alcoholic liver disease against common infectious pathogens, including hepatitis A virus, hepatitis B virus, pneumococci, and influenza A virus, appears to be a very reasonable approach.

Information

Sources and literature

The Merk manual. Guide to Medicine. Diagnostics and treatment /ed. Beers Mark H./trans. from English edited by Chuchalina A.G., M.: Litterra, 2011
Damianov I. Secrets of pathology / translation from English. edited by Kogan E. A., M.: 2006
"Pentoxifylline for alcoholic hepatitis" Kate Whitfield, Andrea Rambaldi, Jørn Wetterslev, Christian Gluud, Cochrane Hepato-Biliary Group, The Cochrane Library, published online: oct, 2009
"The epidemiology and clinical characteristics of patients with newly diagnosed alcohol-related liver disease: results from population-based surveillance" Sofair AN, Barry V, Manos MM, Thomas A. etc., "Journal of Clinical Gastroenterology", No. 44(4 ), 2010
"Treatment of alcoholic liver disease" Thomas H. Frazier, Abigail M. Stocker, Nicole A. Kershner, Luis S. Marsano, "Therapeutic Advances in Gastroenterology", No. 4(1), 2011
"Use of serum carbohydrate-deficient transferrin values to exclude alcoholic hepatitis from non-alcoholic steatohepatitis: a pilot study" Ohtsuka T., Tsutsumi M., Fukumura A., "Alcoholism: Clinical and Experimental Research", No. 29, 2005
"Alcoholic liver disease" Bueverov A.O., Mayevskaya M.V., Ivashkin V.T.
1. http://www.rmj.ru/ - Russian medical journal. Independent publication for medical practitioners - No. 9, 2002
"Alcoholic hepatitis: Basic principles of treatment" Adzhigaitkanova S.K.
1. http://www.eurolab.ua/encyclopedia/565/46022/
"General principles treatment of acute alcoholic hepatitis" Bueverov A.O.
1. http://www.rmj.ru/ - Russian medical journal. Independent publication for medical practitioners - No. 1, 2004

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