What is cholestatic hepatitis: symptoms, causes and treatment. What is cholestatic hepatitis? Causes of cholestatic hepatitis

A disease in which the flow of bile is disrupted or completely stops is called cholestatic hepatitis. This type of hepatitis is of the chronic type, in which blockage of the bile ducts occurs, and stagnation of bile in the liver, followed by intoxication of the entire body. The disease leads to extensive damage to the liver tissue and is accompanied by a long-term inflammatory process. With timely diagnosis and proper therapy, the prognosis for recovery is favorable.

Description and etiology of the disease

Cholestatic hepatitis is any form of liver disease that causes liver inflammation and bile flow problems. Identifying the cause of cholestasis and understanding the mechanism of its development serve as the basis for therapeutic or surgical treatment.

The most common cause of cholestatic hepatitis is cholelithiasis, which obstructs the general bile flow. Physical forms of obstruction occur, for example, if general bile duct compresses the tumor, interfering with the proper functioning of the liver or the normal transport of bile through the channels. Very often the cause of the disease is incompletely cured or advanced hepatitis. Obstruction in the flow of bile can occur due to medications, drugs, alcohol, and poisoning. The disease develops due to exposure to Epstein-Barr viruses, cytomegalovirus or mycoplasma infection, autoimmune diseases and some hereditary problems.

The disease is more often observed in older people. The risk of cholestasis increases during pregnancy, and women are more likely to experience atresia ( congenital pathology, absence or disruption of the biliary tract) and drug-induced cholestasis. Newborn babies are more likely to develop cholestasis due to liver immaturity.

Types of cholestatic hepatitis

When the virus enters the liver, infected hepatocytes (liver tissue cells) begin to multiply faster, affecting the bile ducts and intestines. The body's immune system begins to fight the infected hepatocytes, and the liver develops inflammatory process, growing connective tissue, fluid accumulates (infiltrate), consisting of blood plasma and lymph. Sometimes inflammation occurs not inside the liver, but near the bile ducts, so the disease is divided into the following types:

• Intrahepatic - occurs at the cellular level and is associated with damage to hepatocytes (liver tissue cells) and damage to the intrahepatic bile ducts.
• Extrahepatic - occurs due to blockage of the bile ducts or compression from the outside (mechanical damage to the extrahepatic bile ducts).

Symptoms of cholestasis

Already 10-12 days after extrahepatic obstruction (closure of the lumen of a hollow organ), cholestatic hepatitis develops and manifests itself general symptoms. Depending on the stage of development of the disease, symptoms may differ, but the main picture is common for congestive phenomena - nausea, fatigue, itching and severe jaundice, sometimes immunoallergic reactions such as rash, eosinophilia, and fever appear.

Cholestasis causes severe itching of the skin.

The disease can occur in two phases: acute and sluggish. The degree and severity of cholestasis are proportional to changes in clinical indicators, namely with respect to an increase in the concentration of bilirubin, cholesterol, copper levels, etc. Signs of the disease in the sluggish phase are similar to the acute form, although less pronounced and painful. But they cannot be ignored, otherwise the disease will worsen. Acute period accompanied by the following symptoms:

• Severe skin itching, manifested in the form of scratches. The exact cause of the itching is not yet entirely clear.
• Fever.
• Abdominal pain, especially in the upper right part.
• Change in color of urine and feces.
• Yellowish formations on the eyelids (xanthelasmas).
• Yellowness of the skin resulting from higher level serum bilirubin.
• Enlargement and hardening of the liver.

Diagnostics

In order to accurately make a diagnosis and eliminate the possibility of error (to distinguish this pathology, for example, from Botkin’s disease), the patient must undergo full examination body. Diagnosis of the disease is carried out using the following methods:

• Biochemical blood test for enzymes (bilrubin, cholesterol, alkaline phosphatase, gamma-glutamine transferase, B-lipoproteins, etc.).
• Ultrasound of the biliary tract and gallbladder, confirming or excluding extrahepatic cholestasis.
• Liver biopsy.
• Analysis of secretions.
• Liver puncture.
• Laparoscopy.
• The presence or absence of antibodies is determined by enzyme-linked immunosorbent assay (ELISA)
• Polymerase chain reaction (PCR) analysis will help confirm or refute the infectious origin of the disease.

Treatment of cholestatic hepatitis

The first appearance of symptoms is a serious reason to urgently visit a doctor. Self-medication of chronic cholestatic hepatitis is unacceptable. Only a qualified specialist will accurately diagnose and prescribe the correct therapy.

First of all, with cholestatic hepatitis, it is necessary to detect and eliminate its root cause so that there is a positive outcome in treatment. Depending on the stage of hepatitis and the degree of tissue damage, recovery lasts several months, and sometimes even several years. The disease can cause complications, and then you will need to undergo a special health course in a medical sanatorium. If the patient has indolent symptoms, it is advisable to order tests and carry out ambulatory treatment from a hepatologist. For acute cholestatic hepatitis, the following medical prescriptions and prescriptions are carried out:

• Immediate hospitalization to the hepatology or infectious diseases department.
• Maintaining bed rest.
• A diet requiring the complete exclusion of fried, fatty and spicy foods. The menu should include dairy and dairy products, boiled poultry and fish.
• Moderate doses of Prednisolone are prescribed, with a gradual reduction in dosage.
• Severely irritating itching is relieved by “Bilignin” or “Cholesteramine”.
• Lipotropic drugs are prescribed: vitamin A, B12, E, lipoic acid, Essentiale.
• Ursodeoxycholic acid preparations are recommended to improve well-being, reduce jaundice, relieve exacerbations, and reduce ALT activity.
• In case of obstruction of large bile ducts, surgical intervention is performed.

With various diseases of the biliary organs, certain syndromes of liver damage appear. When analyzing data from a biochemical study, four main types of pathologies are distinguished. Each of them determines characteristic changes in the organ - both functional and morphological.

The manifestations of the syndromes differ, but in some cases they may be similar. This makes it difficult to determine various diseases liver. Only a doctor can make a diagnosis. The features of each syndrome and their manifestations should be considered.

Laboratory syndromes for liver diseases

Liver diseases can be accompanied by a number of clinical manifestations. Their knowledge helps to diagnose a certain pathology in a timely manner. As a result, the patient will receive adequate therapy.

With various laboratory syndromes in liver diseases, specific functions of the organ are disrupted. In some diseases, cells are damaged, in others, the flow of bile is reduced. For this reason, liver diseases are diagnosed syndromously.

Often clinical tests help clarify the nature of the detected liver damage. The main disorders are grouped into laboratory syndromes. In this case, indicator tests are taken into account.

If there is a suspicion of a specific disease, the main biochemical syndromes that are characteristic of a particular disease are taken into account. It is based on a special program for examining patients.

Types of syndromes

It is worth considering several types of main syndromes in liver diseases. Each of them indicates a specific pathology.

The following types of syndromes are distinguished:

• Cytolytic – disruption of hepatocyte membranes (up to 80% of the liver mass).
• Liver damage from toxins.
• Cholestasis is a lack of bile production.
• Inflammatory liver syndrome is impaired liver function.
• Hepatocellular failure.

Each of these conditions indicates specific disorders in the liver. They are identified using laboratory research. The main clinical features of certain syndromes vary.

Cytolytic

Cytolytic syndrome indicates that the membranes of hepatocytes (the main cells of the liver) are damaged. This organ response to damage is caused by tissue death. As a result, the constituent elements of the cells enter the blood. There are 2 stages of the syndrome:

• necrobiosis;
• necrobiotic.

At the first stage, organ damage is reversible. Only morphological abnormalities are observed.

If the syndrome is not complicated, the mitochondrial structures are slightly damaged. In advanced cases, liver damage with destruction of organ cells is possible. There is a high risk of developing organ tumors.

Laboratory syndromes in chronic hepatitis include cytolytic, liver failure, liver inflammation and cholestasis.

Cholemia

Cholemia syndrome is the consequences of self-poisoning. It can develop with jaundice. As a result of the tests, the accumulation of bile components in the blood is revealed. The liver suddenly stops performing its detoxification function.

This liver syndrome is very similar to cholestasis. The main manifestations include severe jaundice. The size of the liver rapidly decreases due to tissue necrosis. Possible development nervous disorders. Hallucinations may occur. Other consequences:

• cholemic bleeding - manifests itself when blood clotting deteriorates;
• hepatic coma;
• hemorrhagic diathesis is an increased tendency of the body to bleed.

Blood may come from the gums and nose. Patients often fall into depressive states. Sleep is disturbed, the skin begins to itch. The diagnosis can only be made after a blood test.

Cholestasis

Cholestasis is pathological condition liver, in which insufficient bile is produced. This is due to two reasons - either the liver cells stop performing their function, or the flow of bile through the ducts stops.

Important! There are two types of cholestasis - intrahepatic and extrahepatic.

In the first case, the bile canaliculi are affected and the biliary function of hepatocytes is disrupted. In this case, bile components accumulate in hepatocytes. Extrahepatic cholestasis syndrome occurs when it is impossible for bile to flow through the common and hepatic ducts.

This syndrome occurs with biliary hypertension. It is associated with the inability to conduct bile along the drainage pathways. As a result, the interlobular ducts expand.

The clinical signs of this hepatic syndrome include itching, jaundice, dark urine, discoloration of stool and skin pigmentation.

Inflammation in the liver

When diagnosing an inflammatory syndrome, we can talk about the activity of pathology in the biliary organ. Signs that appear during the disease include:

• fever;
• vosculitis is a group of diseases characterized by inflammation of blood vessels;
• arthralgia – joint pain;
• jaundice;
• enlarged spleen.

An inflammatory syndrome occurs as a result of immune inflammation in the liver.

The list of causes for the development of pathology includes liver diseases that occur in both acute and chronic form.

Jaundice

This disease is not independent. Symptoms include yellowing of the skin and sclera. Such signs appear in many pathological processes in the liver. The main reason for this condition of the body is the accumulation of a special substance called bilirubin. It appears after the breakdown of red blood cells.

Adults with the development of this pathology may experience severe skin itching. The stool becomes greyish. The patient loses his appetite and feels severe pain in the right hypochondrium.

Itching with jaundice is an important indicator of the development of the disease. The intensity of the sensation depends on the type of pathology. With obstructive jaundice, the most severe itching occurs. Often the sensation of scabies becomes unbearable, which leads to insomnia and exhaustion of the nervous system.

With hepatic jaundice, the skin does not itch as much. There is a feeling because nerve endings skin becomes irritated as a result of penetration bile acids into the blood.

Consequences of jaundice:

• intoxication of the body with bilirubin;
• brain damage, manifested in hearing impairment, paralysis and convulsive states;
• diarrhea and severe swelling.

Jaundice is a serious pathology that must be treated at the first manifestations.

Portal hypertension

The syndrome develops when it is impossible for blood to pass through the liver, which is directed to it through the splenic and portal veins. In this case, liver edema or cirrhosis develops. The portal vein is compressed by the tumor, the lymph nodes become enlarged.

The following symptoms appear:

• bloating;
• rumbling;
• loss of appetite;
• nausea;
• pain in the navel area.

In the veins abdominal cavity pressure increases significantly. If blood enters the inferior vena cava, hemorrhoidal bleeding occurs. In case of varicose veins of the lower part of the esophagus, bleeding is possible.

If the umbilical veins dilate, blood enters the subcutaneous vessels of the peritoneal wall. A specific pattern of veins is observed in the patient’s shoulders, forearms, and chest.

Pathology develops in accordance with certain stages. Stages of portal hypertension:

• Initial. At this stage of development of the pathology, patients complain of heaviness in the area of ​​the right hypochondrium, general weakness, flatulence.
• Moderate. Symptoms at this stage include flatulence, early satiety, nausea, and a feeling that the stomach is full. At the same time, the spleen and liver enlarge
• Expressed. There is fluid in the abdominal area. All signs of portal hypertension are clearly expressed.
• Complicated. At this stage, varicose veins begin to bleed. Ascites develops (fluid accumulation in the peritoneum), which is very difficult to treat.

Only a doctor can identify such stages of the syndrome, so at the first signs of the disease it is important to seek help.

Among the causes of portal hypertension are:

• thrombosis of the portal and splenic vein;
• squeezing portal vein tumor-like formations;
• increased blood flow in the portal vein.

Such reasons are identified during examination of the patient.

Hypersplenism

This syndrome is characterized by increased spleen function. Often a painful condition occurs when the liver is not functioning properly. It is in this organ that blood components are destroyed. As a result of the development of the disease, the spleen breaks down more platelets, red blood cells and leukocytes. Anemia (anemia) occurs.

An increase in the activity of the spleen is not always associated with an increase in the size of the organ. Therefore, “hypersplenism syndrome” should not be confused with the concept of “splenomegaly syndrome.”

Pathology occurs in patients with cirrhosis and hepatitis. It can also be caused by storage diseases (metallism disorders).

Important! This syndrome is potentially fatal. This is due high risk development of sepsis (general blood poisoning).

Hepatocellular failure

Hepatic cell failure is characterized by impaired liver function. The symptoms of this pathology are very pronounced. The outflow of bile is significantly reduced. The liver does not function sufficiently, and the cells of the organ die. One of the most pronounced clinical manifestations is the development of jaundice. How intensively it proceeds depends on the degree of damage to the biliary tract.

When pathology flows into chronic stage this symptom may not appear. Other symptoms are also observed:

• death of organ tissue;
• fever;
• stool discoloration;
• increased heart rate;
• pressure changes.

Biochemical liver damage also occurs. As the disease progresses, the nervous system. This is due to a violation of the general cleansing function. The patient may be very lethargic and drowsy, or, conversely, excitable. Possible loss of consciousness, cramps of the arms and legs, nausea. The patient complains of fluid accumulation in the peritoneal area.

With the help of modern biochemical blood tests, you can get an estimate pathological process in the liver and identify certain laboratory syndromes. They reflect various processes, occurring in the organ, and allow us to judge its functions. Since the liver is actively involved in metabolism, such conditions should be treated when the first signs appear. This will help avoid serious consequences. If left untreated, some diseases can be fatal.

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Cholestatic liver diseases.

Deciphering and features of the viral load in hepatitis C

Viral hepatitis is the most severe infectious disease, which is capable long time occur secretly in the human body. Thanks to a blood test for hepatitis, it is possible to perform a timely diagnosis of this serious disease. Today there are a large number of varieties of this disease, but they all affect the human liver and create a load on this organ.

• How is blood tested for hepatitis A?
• How is a blood test done to determine hepatitis B?
• How does viral liver damage occur?
• The most common symptoms of hepatitis
• Diagnostic methods for liver inflammation
• Explanation of PCR analysis for hepatitis C

Viral hepatitis has different etiologies, so specialists use separate methods for their rapid detection. The most common diseases that were caused by infectious or viral factors are parotonitis, fever, herpes, cytomegalovirus infection, rubella, and AIDS. In some cases, diseases appear due to a toxic factor or specific autoimmune disease. Often people themselves worsen their health when they drink alcohol, take medications without a doctor’s prescription, and also breathe chemical reagents without proper security measures. These are loads due to which the human body gradually weakens and loses its protective functions.

Best Practices differential diagnosis- This is a blood test. Each doctor selects a research method based on the diagnosis. To do this, you need to listen carefully to the patient and analyze all the classic symptomatic manifestations.

How is blood tested for hepatitis A?

The viral form of the disease presented is infectious disease, which creates stress on the liver. The bacteria themselves immediately enter the intestines with contaminated food or water. Incubation period with this form of hepatitis is about one month, after which the main symptoms appear - dispersion, fever, jaundice.

In some cases, hepatitis A does not need to be treated because it goes away on its own without taking medications. This disease is quite difficult for small children under one year of age, adults and the elderly. It is difficult for the baby’s body to cope with the resulting load on the liver. During treatment, the doctor is faced with the task of removing all harmful substances from the human body and completely cleansing the liver of the viral disease.

Below are the main indications, if identified, a person should immediately seek help. qualified help:

• Any clinical manifestations illness;
• High levels of AST and ALT in the biochemical blood test;
• Presence of cholestasis;
• After contact with a person who has viral hepatitis A.

Blood is donated in the morning and on an empty stomach. There are times when the analysis takes place in the afternoon. Then patients must refrain from eating for eight hours. If during decoding a titer of anti-HAV IgG is detected, this indicates an acute course of the disease. Hepatitis creates great stress on the liver and the body as a whole, so there is no need to postpone going to the doctor. Various viral forms have negative impact and can develop into a chronic disease.

How is a blood test done to determine hepatitis B?

Hepatitis form B is a serious viral disease that can pose a threat to human life. Infection occurs in several common ways:

• Viral infections enter directly into the blood;
• Sexual contact with a patient;
• A mother infects her baby during childbirth.

Infection can even occur in a nail salon, during piercing, tattooing, and also in medical institutions. Viral hepatitis B penetrates into the blood as quickly as possible through existing lesions in the skin and mucous membranes. After just a few days, a person may feel a moderate load on the liver.

Laboratory diagnosis of the presented disease is possible in two ways - this is the ELISA method and PCR diagnostics. Specialists test the blood for the presence of viral genetic material. The presented methods make it possible to determine even a small amount of virus in the blood. You can get tested in any clinic, diagnostic center, laboratory and other medical institutions.

This disease can change its own genetics and is also subject to various mutations. During the production of the necessary antibodies to specific viruses, new mutations of the pathogen may develop in the human blood. At the same time, the human body experiences severe stress. That is why the immune system cannot always exercise complete control over the production of the required antibody. Viral infections spread very quickly in the blood.

Infection with hepatitis C form occurs through the hematogenous route. Young people and teenagers are at risk. This viral disease Diagnosed only in chronic forms, which can no longer be cured on their own. To determine hepatitis C? it is necessary to donate blood for enzyme immunoassay and polymer chain reaction. Deciphering the analysis for hepatitis C is carried out exclusively by highly qualified specialists.

How does viral liver damage occur?

Once viral particles enter the human body, they will quickly be delivered to the liver. It is subjected to severe stress and testing, so it is best to seek help in a timely manner. Special structures on the surface provide every opportunity for selective attachment of bacteria to the walls of the liver. The next stage of infection is the insertion of genetic material into cells for further reproduction.

In some cases, patients may experience toxic damage to the liver and stress on it. This organ performs a large number of main functions. First of all, it is the deactivation and elimination of toxins from the human body. An increased amount of harmful substances leads to damage. Cells are not able to cope with heavy loads and carry out metabolic processes, so organic substances in the form of fat are gradually deposited in the liver.

Such a negative effect interferes with the normal functioning of liver cells, so after some time the patient experiences a partial loss of functional abilities for the synthesis of protein molecules, transformation and dispatch of proteins.

The most common symptoms of hepatitis

When infected with hepatitis, a person may experience the following symptoms. After this, you must immediately seek qualified help.

All of the above symptoms are common to absolutely all known forms of hepatitis. But for everyone a separate type have their own distinctive features.

Diagnostic methods for liver inflammation

Doctors use ultrasound and laboratory tests to detect hepatitis. Also the most common and in an effective way Virus detection is quantitative analysis.

There are several signs of hepatitis:

1. Elevated transaminase levels. Experts determine the enzymes of a nonspecific inflammatory reaction. They are released in blood vessels during inflammatory reactions of the body. The current state of transaminase levels gives a complete picture of the volume of affected tissues and the load on the body.
2. Elevated bilirubin levels. Today, this indicator is a specific sign for hepatitis. Everyone knows that bilirubin is excreted from the liver in the form of fatty acid. If there is an inflammatory process in the human body, then all liver tissues do not work properly.

Explanation of PCR analysis for hepatitis C

To determine the presence of hepatitis C viruses in the blood and make the most accurate diagnosis, doctors widely use the polymerase chain reaction method. The presented study provides every opportunity to quickly detect small amounts of virus in the blood.

Moreover, such analyzes show high accuracy and are the most effective. PCR research and quantitative method helps determine the presence of hepatitis C even in the early stages, five days after infection. At this time, antibodies have not yet appeared. There are several types of PCR analysis:

A quantitative test for hepatitis C is performed in the following cases:

• When the text showed positive result, since hepatitis C virus is present in the RNA serum.
• To determine as accurately and correctly as possible effective treatment for the patient.
• Prescribing effective treatment tactics for the patient.

If a person doesn't have of this disease, then the transcript will completely lack RNA viruses, antibodies and antigens to them. When these substances are present in the blood, this indicates the presence of hepatitis C in chronic or acute form. In some cases, laboratory technicians find RNA viruses during recovery. The presence of HCV RNA in a quantitative analysis indicates the presence of the virus in the blood.

If the wrong research technique was used during blood sampling, or the conditions for transportation and sampling were violated, then the results may be false.

When the deciphering of the quantitative analysis for the determination of hepatitis C gives a positive result, it is necessary to urgently seek help from an infectious disease specialist, as well as a gastroenterologist. He will conduct a thorough examination and determine further diagnosis and treatment.

Hepatitis is an inflammatory liver disease, which in most cases develops as a result of the effects of viruses on the body. Cholestatic hepatitis – quite rare disease, which in terms of detection frequency is no more than 10% among all hepatitis. Most often it occurs in elderly patients, but it can also occur in children. Let us consider the features of the development and treatment of pathology.

To understand exactly how this type of hepatitis differs from others, it is necessary to study the nature of the pathology and the mechanism of its development.

Cholestasis is a disease characterized by a decrease in the flow of bile into the duodenum(this phenomenon is associated with a violation of its formation, excretion and/or excretion).

The pathogenesis of cholestatic hepatitis is based on cholestasis with deterioration of the excretory function of cells and damage to the ducts.

If you observe this process under a microscope, you will notice that individual hepatocides have brownish-green dotted appearances in the cytoplasm (bile, which is not able to get out of the cell). By location this pathology can have two forms:

• intrahepatic (develops in the liver);
• extrahepatic (can develop in the biliary tract).

Cholestatic hepatitis has the following types:

• recurrent;
• progressive;
• aggressive;
• active and inactive;
• long;
• benign.

Cholestatic hepatitis can occur in acute and chronic forms. In its acute form, the disease is characterized by the manifestation of vivid symptoms and can result in recovery, transition to a chronic form, or death of the patient. Chronic hepatitis can lead to serious complications such as cirrhosis or cancer.

Causes

The main reason for the development of cholestatic hepatitis is undiagnosed or undertreated hepatitis. Factors promoting development:

Viruses that can cause cholestatic hepatitis:

• Epstein-Barr virus (a type of virus from the gammaherpesvirus subfamily of the herpesvirus family);
• herpes virus (virus herpes simplex Types 1 and 2, which is transmitted by contact);
• cytomegalovirus (a genus of viruses from the betaherpesvirus subfamily of the herpesvirus family);
• hepatitis viruses class A, B, C, D, E;
• mycoplasma (a genus of bacteria of the Mycoplasma class that do not have a cell wall).

Hepatitis often occurs against the background of other, no less serious diseases, so when the first symptoms appear, you should immediately consult a doctor, since treatment aimed solely at treating the liver may not produce results.

Clinical picture

The manifestations of cholestatic hepatitis are not much different from other liver diseases. It manifests itself with the following symptoms:

The occurrence of all of the above symptoms is a reason to immediately visit a medical facility. Specialists whose help may be needed in this case:

• therapist;
• gastroenterologist;
• hepatologist;
• surgeon.

The disease most often occurs in older children, and girls suffer more severely from it. This pathology develops under the influence of various viruses. The development of chronic cholestatic hepatitis can also be caused by blockage of a gallstone or compression of the bile duct, or cancer of the head of the pancreas.

In most cases, this pathology in patients childhood turns into biliary cirrhosis - this is a disease that develops against the background of damage to the bile ducts, and there is a gradual replacement of liver tissue with fibrous elements.

Examination and fight against hepatitis

Difficulties may arise when diagnosing this pathology, since cholestatic hepatitis without some diagnostic measures is almost impossible to distinguish from Botkin’s disease, and in this case, the main role is played by blood test indicators, because enzymatic indicators are higher in cholestatic hepatitis.

How to determine pathology?

Treatment is prescribed only after the attending physician has carried out the necessary diagnostic measures. List of main diagnostic measures:

Treatment regimen

After confirming the diagnosis, the specialist chooses treatment tactics. In most cases it looks like this:

• the patient is immediately hospitalized in the hepatology or infectious diseases department;
• in order to restore the strength necessary to fight this serious disease, the patient is advised to remain in bed;
• medications are prescribed to help eliminate unpleasant symptoms.

List of drugs necessary for the treatment of cholestatic hepatitis:

For obstruction of the biliary tract (large) it is indicated surgical intervention. Proper nutrition in this case it is also not in last place.

The patient must strictly follow the diet and know which foods should be consumed and which should be excluded from the diet.

Products that should be present in the diet:

• dairy and fermented milk products and dishes made from them;
• poultry meat (boiled);
• fish fillet;

It is necessary to exclude:

• dishes prepared by frying;
• spicy dishes;
• fatty meats;
• offal and canned food;
• cocoa;
• baking;
• alcoholic drinks.

Also prescribed for cholestatic hepatitis vitamin complexes(it is especially important to take those that contain vitamins B, A, and E). Decoctions of rosehip and corn silk are also useful.

Complications, prognosis and prevention

Complications that arise as a result of the effects of cholestatic hepatitis on the body are far from harmless, especially in the absence of proper treatment. These are, in particular:

Despite the protracted course, if you seek qualified help in a timely manner, the prognosis is favorable. It is very difficult to protect yourself from this disease, but it is still possible. First of all, you need to follow certain recommendations and follow some rules:

• prevention of viral hepatitis;
• timely treatment of diseases;
• balanced diet;
• giving up bad habits (especially when it comes to drinking alcohol);
• lack of uncontrolled use of medications (many drugs have a negative effect on the liver);
• regular medical examinations (they help not only to detect hepatitis on early stage, but also other, no less dangerous diseases).

Hepatitis is a disease that today spares no one. Bad habits(alcoholism, drug addiction), poor ecology, poor nutrition and other negative factors contribute to the spread of many deadly dangerous diseases. In most cases, a person destroys himself. Therefore, in order to protect yourself from many dangers, you need to know the “enemy in person” and study all the ways to combat it.

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 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:

1. 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 identified through laboratory tests and treated by abstaining from alcohol and following a diet.
2. 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:

1. 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.
2. Latent – ​​diagnosed only laboratory method, biopsy, hidden course.
3. Cholestatic - rare, symptoms include severe itching, colorless feces, jaundice, dark urine, and difficulty urinating.
4. Fulminant – symptoms progress, hemorrhages, jaundice are observed, renal failure and liver encephalopathy. 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 for alcohol dependence:

• 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 acute course illness, 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 consumption of alcoholic beverages in large quantities and 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 effectively treat 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 medications;
• 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, drugs can be used traditional medicine based on corn silk, milk thistle.

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 calories and nutritional value.

Diet for alcoholic liver hepatitis

Most patients with alcoholic type hepatitis have a clinical history of depletion of the body due to the lack of good nutrition. To improve health and reduce severity on the liver, you need a special diet. 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, baked goods, 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.

Video: how toxic hepatitis manifests itself

Toxic liver damage refers to pathological structural changes tissues (reversible and irreversible) under the influence of damaging chemicals. The ICD 10 code for toxic hepatitis is K71.

Etiology

The causes of chronic hepatitis are: medications, alcohol, household, plant and industrial poisons.

• Drug toxic liver damage. Symptoms may occur with a single large dose or long-term use of small, cumulative doses of certain drugs. For example, when using “Tetracycline”, “Paracetamol”. Some substances can inhibit hepatocyte enzymes. These are, for example: Erythromycin, Rifampicin, Clarithromycin, alcohol, smoking, antifungal and antiretroviral drugs, penicillins. The following antiepileptic substances also have a toxic effect: Oxacillin, Flucloxacillin, Amoxicillin, Clavulonate (Amoxiclav), sulfonamides, Co-trimaxazole, Sulfosalazine, Nifurantoin, Isoniaid, Tubazid ", "Ftivazid", anticonvulsants. The general ICD 10 code for toxic hepatitis of drug origin is K71. Further it is designated depending on the morphological changes of the organ.
• Alcohol, narcotic substances. The general ICD 10 code for toxic hepatitis of alcoholic origin is K70.
• Industrial poisons. Pesticides, arsenic, phosphorus, insecticides, phenols, aldehydes, chlorinated hydrocarbons, etc.
• Plant poisons. Gorchak, ragwort, mushroom poisons, etc. The general ICD 10 code for toxic hepatitis caused by chemical or plant poisons is also K71.

Pathogenesis

One of the functions of the liver is a barrier function. It neutralizes poisonous Chemical substance, forming an inactive form from it.

• When a hepatotoxic substance enters the body, active metabolites are formed in the liver, which can have a direct toxic effect per cell or immune-mediated (determined by the mechanism of hypersensitivity). Both of these processes cause cytolysis and necrosis of the hepatocyte. Acute or chronic hepatitis develops.
• Also, drugs and their metabolites can reduce mitochondrial oxidation in the cell and switch its metabolism to an anaerobic pathway. The synthesis of low-density lipoproteins is disrupted, and triglycerides accumulate in the hepatocyte. The patient develops fatty liver degeneration. A large number of fatty inclusions in the cell leads to its steatonecrosis.
• The functions of enzymes and transport proteins in the cell may also be disrupted without damaging the hepatocyte itself, hyperbilirubinemia and an increase in gammaglutamyl transferase occur. Other liver function tests do not change.
• Blockade of transport enzymes and damage to hepatocytes cause cholestasis, a violation of the synthesis or transport of bile. Bile is formed in the hepatocyte from bile acids, bilirubin, and cholesterol. Then it enters the bile duct. Intrahepatic cholestasis can be intralobular and extralobular. There is also extrahepatic cholestasis, characterized by obstruction of bile flow in the extrahepatic bile ducts.

Thus, a toxic substance can cause acute liver damage with massive death of hepatocytes and chronic damage with repeated administration of small doses of the toxic substance.

• With necrosis of hepatocytes without the occurrence of autoimmune processes and cholestasis, AST and ALT will be increased.
• If hepatocellular cholestasis occurs, then the norms of alkaline phosphatase, ALT, AST, and GGTP rise to 2 levels.
• With ductular cholestasis with cell necrosis, the picture is the same, but alkaline phosphatase increases by more than 2 times the norm.
• In autoimmune processes, there is an increase in immunoglobulins by more than 1.5 times.

Clinic

If liver toxicity occurs, symptoms can develop either acutely or slowly (chronically). The patient complains of pain and heaviness in the right hypochondrium, nausea, lack of appetite, and weakness. There may be itchy skin loose stool, bleeding. The patient is inhibited. Upon examination skin and sclera are icteric in color. With cholestasis, the color of urine darkens, stool becomes light. Enlargement of the liver and spleen is detected. Possible ascites and fever. Symptoms of toxic hepatitis and treatment depend on the activity of the inflammatory process.

Diagnostics

If toxic hepatitis is suspected, the diagnosis is made on the basis of clinical, anamnestic, laboratory, and instrumental data. Appointed general analysis blood and urine, biochemical analysis: liver tests, protein levels, coagulation system, lipid profile are examined. An immunoglobulin test, ultrasound of the abdominal organs, endoscopy, MRI, and liver biopsy are also prescribed.

Treatment

The main drugs used to treat liver damage include:

Assignment algorithm

So, what is toxic hepatitis? What are its symptoms and treatment? Let's add some clarifications. By clinical guidelines for toxic hepatitis, if GGTP and ALP are elevated (there is cholestasis), and AST and ALT are normal or rise no higher than two norms, then UDCA is prescribed at a dose of 15 mg per kg (750 - 1000 mg per day in two doses) for three months and longer. If there are more than two norms (3 - 5), then Heptral is added intravenously at 400 - 800 mg daily for 10 - 15 days.

At normal level ALP (no cholestasis) and an increase in ALT and AST to 5 norms is prescribed UDCA 10 mg per kg. Essentiale and Berlition are prescribed for 2-3 months, depending on the causes of the disease.

If AST, ALT, bilirubin are more than 5 norms, then glucocorticoids are added. Prednisolone is prescribed intravenously up to 300 mg per day for up to 5 days, with subsequent transfer to tablets and a gradual reduction in the dose. UDCA and Heptral are prescribed according to the scheme above (where alkaline phosphatase is increased). Plus vitamins B1, B12, B6, PP are needed.