Alcoholic hepatitis is a chronic disease in which degeneration of the liver parenchyma occurs, with an accompanying inflammatory process, provoked by prolonged and heavy intake of large doses of ethanol. Late diagnosis, lack of treatment, non-compliance with the diet and continued alcohol intake can lead to hepatic cellular failure, the development of cirrhosis, followed by hepatic coma and death.
Some statistics: per 100 thousand population, 30–40% of hepatitis cases occur in alcoholic hepatitis, of which 25–30% of patients are men over 35 years of age.
Forms, symptoms and treatment of the disease
Alcoholic hepatitis has two forms:
- Progressive or acute form;
- Chronic form.
The progressive form accounts for approximately 1/4 of cases of alcoholic hepatitis. Usually occurs after chronic heavy drinking, and can occur even with a single dose of alcohol. Liver damage is minor, but if the patient continues to drink alcohol, it quickly leads to cirrhosis of the liver.
The acute form of alcoholic hepatitis, in turn, is divided into:
The disease progresses especially quickly in patients who are heavy drinkers, women, and people who are poorly nourished. The fulminant type causes damage to the central nervous system toxins, liver failure, rapid necrosis of liver parenchymal cells.
Death may occur 14 to 21 days after the onset of the disease. With the cholestatic type it is especially noted high level mortality. Complete recovery was observed in only 10–12% of patients.
Symptoms
Characterized by the gradual development of the disease. The manifestation of the first symptoms of the disease is preceded by long-term constant consumption of alcohol for five years or longer.
If the daily dose of alcohol consumed exceeds 50–60 grams of alcohol for men, and 20–30 grams for women, then this is a real risk of developing alcoholic hepatitis.
The chronic form of the disease is of two types:
In the persistent form of alcoholic hepatitis, the course of the disease is stable and even. Since the liver is the only organ of the human body that is capable of regeneration, with proper treatment an almost complete recovery is possible.
At active form In the chronic form of the disease, areas of necrotic tissue appear in the liver with the subsequent development of cirrhosis in them.
The main symptoms of alcoholic hepatitis are:
If any of the above symptoms occur, you should call ambulance. The patient must be completely at rest until the doctor arrives; if he vomits, he must be given water - either plain or mineral, but without gas. For pain, antispasmodics should be used, such as No-shpa, Spazgan, etc.
In narcology, a person suffering from chronic alcoholism is identified by specific stigmas or markers. Stigmas are a set of signs, in external and internal manifestations, characteristic of a particular disease.
For chronic alcoholism The following stigmas are typical:
Women have all the same signs of the disease, but their development is more rapid, which is associated with physiological characteristics body.
Alcoholism in women goes into the chronic stage faster, it is very difficult to cure, and relapses are frequent.
The stigmas characteristic of women with chronic alcoholism also include external sloppiness, rapid aging, deceit, neglect of household duties, the appearance of alopecia or, conversely, male-pattern hair growth, and deepening of the voice.
Treatment
Treatment of a patient with an acute form and active type the chronic form of the disease is carried out by a gastroenterologist, a therapist, if necessary, other specialists and, of course, a narcologist, strictly in a hospital setting.
Only complete abstinence from alcohol can stop the progression of the disease.
Alcoholic hepatitis is one of the deadly diseases from a “bouquet” of diseases in a person suffering from alcoholism. In those who constantly drink alcohol, alcoholic hepatitis is diagnosed in almost 40%. More than 1/3 of patients die within six months after the first symptoms of the disease appear.
Alcoholic hepatitis is inflammatory disease liver disease, which develops as a result of prolonged consumption of alcohol-containing drinks. This condition is a precursor to the development of liver cirrhosis. Based on the name of the disease, it becomes clear that the main cause of its occurrence is alcohol consumption. In addition, gastroenterologists identify several risk factors.
The symptoms of such a disease will differ depending on the form in which it occurs, but the main clinical manifestations include asthenovegetative syndrome, dyspeptic changes, etc.
A correct diagnosis can be made using laboratory and instrumental diagnostic examination methods. Conservative methods predominate in treatment tactics, but when severe course or in advanced cases, a donor liver transplant may be required.
In the international classification of diseases, ailment has its own meaning. ICD 10 code – K77.1.
Etiology
The main cause of the development of this disease is the ingestion of alcohol-containing drinks. This can be caused either by a long-term addiction to such a bad habit or by drinking a large dose of alcohol at once.
In the vast majority of cases, this disease develops after about seven years of regular alcohol consumption. In men, the development of the disease can be caused by drinking from 40 to 60 milliliters of ethyl alcohol per day, in women – 30 milliliters, and in adolescents – 15 milliliters.
10 ml of ethanol is contained in:
The reason for the negative impact alcoholic drinks on the liver is a metabolic disorder in the liver cells, which entails their shrinkage and necrosis. At the same time, the death of hepatocytes under the influence of alcohol occurs much faster than the cells of this organ can recover on their own. This causes scar tissue to form instead.
Gastroenterologists identify the following risk factors that increase the likelihood of developing such a disease:
- drinking large doses of strong drinks at one time;
- daily drinking of alcohol;
- drinking alcohol for more than eight years;
- genetic predisposition;
- transferred earlier ;
- poor nutrition - this means that the diet is dominated by fatty and spicy foods, smoked meats and marinades, sweets and soda, as well as a lack of protein foods in the menu;
- the person is overweight;
- liver infection with hepatitis virus.
The pathogenesis of alcoholic hepatitis is that ethanol is metabolized in the liver to acetaldehyde, which damages hepatocytes. Such a substance triggers a series chemical reactions, which ultimately lead to the death of the cells of this organ. These pathological changes lead to impaired liver function.
Many patients are concerned about the question: is alcoholic hepatitis as contagious as viral hepatitis? The answer to such a question is always negative - this type of liver damage is not transmitted from person to person. Nevertheless, it is possible to give birth to a child with a similar diagnosis, but provided that the mother suffers from such an illness and drinks alcohol during pregnancy.
Classification
According to the form of its course, this disease is divided into:
- acute alcoholic hepatitis - characterized by the fact that the pathological process progresses in less than six months and quite quickly leads to. Repeated drinking of alcohol can significantly worsen a person’s condition;
- chronic alcoholic hepatitis - lasts more than six months and is caused by regular use large amounts of alcohol. More than half of the cases develop cirrhosis of the liver.
The acute form of the disease, or OAS, has its own classification, which is why it can occur in one of the following forms, differing in symptoms:
- latent - occurs without expressing any signs, and a biopsy will be required to confirm the diagnosis;
- jaundice - is the most common type of disease. It differs in that the skin and mucous membranes of a person acquire a yellowish tint;
- cholestatic - expressed in stagnation of bile. It can last for years and appears only in every tenth patient;
- fulminant is a fulminant form of the disease, which in a short period of time leads to a significant deterioration in a person’s condition.
In addition to dividing according to the nature of the course, clinicians distinguish two forms of toxic alcoholic hepatitis:
- persistent - is a relatively stable type of disease, in which it remains possible to stop the pathological process. This can be achieved by completely abstaining from alcohol for the rest of your life and following other recommendations of your doctor. Otherwise, this form will become progressive;
- progressive – expressed in the deterioration of the patient’s symptoms and health, which will ultimately lead to cirrhosis. This form has several degrees of activity - light, moderate and severe.
Symptoms
As mentioned above, each form and nature of the disease has its own characteristic clinical signs.
The persistent form may have virtually no symptoms, but from time to time patients may be bothered by:
- slight discomfort in the area under the right ribs;
- nausea without vomiting;
- belching;
- heaviness in the stomach.
In such cases, if you follow a gentle diet and eliminate bad habits, within six months you will see a significant improvement in your health.
The progressive form is characterized by the following manifestations:
- nausea ending with vomiting;
- significant increase in temperature and fever;
- jaundice;
- severe pain in the projection of the affected organ.
If the disease is not treated promptly, it will lead to death.
The icteric form of alcoholic hepatitis can manifest itself with the following symptoms:
- yellowing of the skin and visible mucous membranes;
- stool disorder;
- nausea and vomiting;
- weakness and fast fatiguability;
- significant reduction in body weight.
The latent form of the disease is not expressed by any signs, which is why it can be considered chronic. In such cases, the symptoms will be wave-like, that is, the phase of exacerbation and remission will alternate. Thus, the symptoms of chronic alcoholic hepatitis can be considered:
- mild pain in the right hypochondrium;
- decreased appetite;
- decreased sexual desire;
- sleep disturbance;
- enlargement of the mammary glands in males;
- an increase in leukocytes in the blood - will be detected only during laboratory examinations, which can be carried out for preventive purposes or during the diagnosis of a completely different disease;
- slight increase in liver volume.
The symptoms of CALH will be individual in each case.
The cholestatic form of the disease has the highest mortality rate among patients. This variant of the course of alcoholic hepatitis is characterized by the following clinical manifestations:
- darkening of urine;
- stool discoloration;
- pronounced skin itching;
- jaundice;
- increased level bilirubin in the blood.
The lightning-fast variety of OAS is expressed:
- rapid progression of signs of jaundice;
- severe weakness, which leads to decreased performance;
- severe pain in the epigastrium and under the right ribs;
- hemorrhagic manifestations.
This type of toxic alcoholic hepatitis can lead to the death of the patient within two weeks from the onset of symptoms.
Diagnostics
The doctor can decide how to treat alcoholic hepatitis only after familiarizing himself with the data of laboratory and instrumental diagnostic methods. However, before prescribing them, the doctor must:
- conduct a detailed survey of the patient - to obtain complete information regarding what symptoms of alcoholic hepatitis and with what intensity appear. This will make it possible to determine the nature and form of the disease;
- get acquainted with the medical history and life history of the patient - to identify predisposing factors and risk groups;
- perform a thorough objective examination with mandatory palpation in the area of the right hypochondrium and examination of the condition of the skin.
Among the laboratory examinations it is worth highlighting:
- general clinical blood test - will show an acceleration of ESR, the possible presence of anemia, a decrease in the number of red blood cells and platelets;
- blood biochemistry - to control the functioning of the liver and other gastrointestinal organs;
- tests for markers of fibrosis and the presence of viral hepatitis;
- coagulogram;
- lipid profile;
- general analysis urine;
- microscopic examination of stool.
Instrumental methods for diagnosing alcoholic hepatitis include:
In addition, consultations with the following doctors may be required:
- therapist;
- hepatologist;
- surgeon;
- psychiatrist;
- expert in narcology;
- obstetrician-gynecologist - in situations where the patient is a pregnant woman.
Treatment
To eliminate this disease, complex therapy is necessary, which consists of:
- taking medications;
- maintaining a gentle diet;
- surgical intervention.
Diet therapy is based on rules dietary table number five, which is why the basic rules of the diet for alcoholic hepatitis are:
- frequent and small meals;
- avoidance of fatty foods and spicy dishes, smoked meats and carbonated drinks;
- reducing the amount of salt consumed to three grams per day;
- enriching the menu with products with a high protein content;
- preparing dishes by boiling, steaming, stewing and baking;
- eating only warm food;
- thorough chopping and chewing of food;
- abundant drinking regime.
Drug treatment of alcoholic hepatitis means that patients need to take the following medications:
- hepatoprotectors;
- UDCA preparations;
- vitamin complexes;
- ACE inhibitors;
- proteolytic enzyme inhibitors;
- glucocorticoids;
- ademetionine preparations.
The disease can be cured surgically only by transplanting a donor organ or part of the liver.
Complications
Possible asymptomatic course, ignoring clinical signs or late treatment of alcoholic hepatitis can lead to the development of a large number of complications, namely:
- cirrhosis of the liver;
- ascites;
- hepatocellular carcinoma;
- hepatic encephalopathy;
- infertility;
- menstrual irregularities;
- renal failure.
Prevention
Specific preventive measures There is no such disease. To avoid problems with toxic alcoholic hepatitis, you must follow simple rules, including:
- lifelong cessation of bad habits;
- proper and balanced nutrition;
- compliance with precautions when working with poisons and toxins;
- early treatment and prevention viral hepatitis;
- maintaining normal body weight;
- undergoing an annual preventive examination.
How long people live with this disease and its prognosis - such factors are individual in nature. In some cases, it is enough for patients to follow a diet and give up alcoholic beverages forever, but often the only way out is a healthy organ transplant.
Alcoholic hepatitis is a terrible name that fully justifies itself. This name refers to the cause of a serious illness, in many cases fatal. Medication measures in the early stages provide a good opportunity for recovery and increase life expectancy. Let's look at the causes, symptoms, methods of treatment of this insidious disease, which speaks of itself not from the first days of damage to one of the main, multifunctional organs of the human body, namely the liver.
In the International Classification of Diseases, the term "Alcoholic hepatitis" was registered in 1995. The term “Alcoholic hepatitis” is the medical characteristics of inflammatory, degenerative changes, and liver damage. The cause of the disease is primarily alcohol abuse. The disease is alcoholic hepatitis, which progresses to cirrhosis of the liver, liver failure, failure of the liver to function normally in the body as a whole.
Cirrhosis, a liver disease caused by alcoholic hepatitis.
Liver cirrhosis - The last stage of the chronic form of one of the hepatitis, in in this case alcoholic. In liver cirrhosis, replacement occurs connective tissue liver, the liver becomes overgrown with fatty tissue and degrades.
Alcoholism is, first of all, the abuse of alcoholic beverages in any form. All alcohol contains ethanol. Ethanol is quite a toxic substance, and when it enters the body in systematic excessive doses, it affects the liver and destroys other organs. People who consume a lot of alcohol suffer from a lack of protein and vitamin foods, since they get 40% of their calories from alcohol-containing drinks and systematically disrupt their normal diet. It is impossible not to mention alcoholic gastritis, which a person dependent on alcohol has. Alcoholic gastritis – poor absorption of vitamins; the vitamins that enter the body do not actually play a positive role, since they “pass” by important systems.
Acetaldehyde is a substance formed in the cells and tissues of the liver and is directly related to liver damage. This is a whole mechanism that triggers a series of chemical reactions that damage liver cells.
Alcoholic hepatitis, a process of constant inflammatory processes, a chain reaction of liver damage by toxins and accompanying breakdown products of alcohol. Alcoholic hepatitis, as a rule, remains in a chronic form for many years, developing after 6-7 years after alcohol abuse began.
Violation of such norms on alcohol consumption ( daily norm), lead to liver cirrhosis.
- Men - 80 g per day.
- Women – 30 – 40 g per day.
- Teenagers – 15 – 20 g per day.
Exceeding these standards, a man, woman, or teenager is already doomed to develop cirrhosis of the liver.
Manifestation of alcoholic hepatitis
Alcoholic hepatitis has two forms.
Progressive:
- Light form;
- Medium shape;
- Severe form.
The progressive form has small focal liver damage, developing into cirrhosis of the liver. 15–20% is alcoholic hepatitis. With timely drug treatment, a stabilization effect is achieved, which allows stabilizing the processes of inflammation, with residual effects of the disease that persist throughout life.
Persistent:
Stable form of the disease. In most cases, complete reversibility of inflammatory processes in the liver can be observed with complete cessation of alcohol consumption. If you continue to drink alcohol without giving it up, the reversibility stage passes into the stage of progressive alcoholic hepatitis.
Rare cases of alcoholic hepatitis can be detected only after laboratory tests, which significantly delays the start of the treatment process. Pronounced symptoms may not manifest themselves in a feeling of heaviness in the area of the right hypochondrium, attacks mild nausea, stomach fullness, belching mixed with bitterness (bile).
The histomorphological manifestation of persistent hepatitis is fibrous formations on the liver tissue, balloon cell degeneration affected by Mallory bodies. In the absence of symptoms of fibrosis, with a mild course of the disease, the clinical picture of the “sleepy state” of alcoholic hepatitis can last for 5 or 10 years, even with minimal alcohol consumption.
Progressive form, characteristic symptoms:
- Weakness;
- Nausea;
- Vomit;
Moderate, severe form manifests itself:
- Fever;
- Disease Jaundice;
- Nosebleeds;
- Pain in the right hypochondrium;
Clinical picture of the body’s chemical reactions:
- Increased bilirubin;
- Increased immunoglobulin;
- Increased gammaglutamyl transpeptidase;
In persistent hepatitis, there are high levels of transaminase activity and moderate thymol tests.
The process of the active chronic stage of hepatitis is characterized by:
- Development of liver cirrhosis;
- Under the influence of ethanol, an increase in alcoholic hyaline (Mallory bodies);
Changes in ultrastructural stellate reticuloepitheliocytes, hepatocytes.
Ultrastructural changes in the above processes show the level of damage by ethanol to the digestive, circulatory, gastrointestinal and liver organs.
For any form of hepatitis in the chronic stage, diagnosis is carried out using ultrasound abdominal cavity. It is necessary to study and observe organs such as the liver and spleen. When examining with ultrasound diagnostics, it is possible to track changes in the structure of the liver (organ degeneration), a significant enlargement of the spleen, the diameter of the portal vein and other changes in the liver and spleen are determined.
The method of Doppler ultrasound (USDG) is used to establish the cause or exclude the degree of pressure increase in portal vein liver (portal hypertension). Radionuclide hepatosplenoscintigraphy can confirm or refute this diagnosis. Such research is carried out using radioactive isotopes.
The development of alcoholic hepatitis has a chronic and acute period
Acute alcoholic hepatitis (AAH) - Rapidly progressive, inflammatory destruction, active processes of liver damage.
IN clinical form Acute alcoholic hepatitis has 4 variants of the course of the disease:
- Icteric;
- Latent;
- Fulminant;
- Cholestatic.
Long-term alcoholism, its manifestation in the OAS according to statistics in 60-80% of cases, 5% of which leads to cirrhosis of the liver. The more severe the disorders associated with liver function, the more acute the question of the course of acute alcoholic hepatitis becomes. The excesses of the formation of liver cirrhosis have the most severe consequences in the acute form of alcoholic hepatitis.
Long-term drinking bouts, the cause and onset of manifestations of alcoholic hepatitis and already acquired cirrhosis of the liver. Symptoms worsen every day, the prognosis for recovery of such a patient is reduced to the minimum indicators for recovery.
The icteric form is one of the most common in all types of hepatitis, and especially in alcoholic hepatitis.
Symptoms of jaundice:
- Staining of the sclera, mucous membrane of the eyes, skin yellow (without skin rashes);
- Weakness;
- Pain in the right hypochondrium;
- Heaviness in the area of the right hypochondrium;
- Sudden weight loss (anorexia state);
- Attacks of nausea;
- Attacks of vomiting;
- Diarrhea;
- Enlarged liver;
- Hand trembling.
With liver enlargement, a progressive process that is accompanied by thickening of the liver tissue, in a state of cirrhosis, the parenchyma becomes lumpy, and the organ is very painful on palpation. Background manifestations include ascites, splenomegaly, telangiectasia and palmar erythema.
As the disease progresses, side infections such as bacterial peritonitis, urinary infection, septicemia, pneumonia. If the diagnosis of liver failure (hepatoreanal syndrome) is added to the listed infections, the patient’s condition worsens significantly, in some cases, it can lead to death.
To confirm the latent type of alcoholic hepatitis, the so-called state of the “sleepy form” of the course, an analysis is carried out using a biopsy of liver tissue. In the study of parenchymal biopsy, increased transminase plays a role. Transminase, its level increases with the abuse of alcohol-containing drinks.
In 10-13% of cases, the course of alcoholic hepatitis is expressed as a cholestatic variant, in which symptoms manifest themselves according to the icteric form (dark urine, colorless feces, the skin, sclera, and mucous membranes of the eyes turn yellow). For pain in the hypochondrium and fever, clinical symptoms may be similar to the disease - cholangitis. In order not to confuse one disease with another, they carry out lab tests for blood counts, tissue biopsy. Acute alcoholic hepatitis is severe in its course with a protracted form.
Progressive symptoms of Fulminant acute alcoholic hepatitis, manifested in aggravated icteric conditions, hemorrhagic syndrome (bleeding), renal and liver failure. Death occurs due to hepatorenal syndrome, hepatic coma.
Chronic alcoholic hepatitis, symptoms and treatment
As we wrote above, this disease has “sleepy” states, a latent form of the disease, in which symptoms may be absent or minimally manifested.
Increased transmyase activity, increase and dominance of AST and ALT cells. Increased indicators of cholestasis. There are no portal hypertensive signs. Analyzes for histological changes corresponding to processes of inflammation of a morphological nature without the development of cirrhotic changes are also manifestations of alcoholic chronic hepatitis.
It is quite difficult to make an accurate and timely diagnosis for a patient due to the reasons for the course of alcoholic syndrome (binge). The doctor makes conclusions taking into account the signs of alcoholism (alcohol dependence).
Alcohol addiction, criteria for making a diagnosis:
- Constant desire to drink alcohol;
- Violation of alcohol dosage standards, drinking large quantities every day;
- Purchasing alcoholic beverages becomes a priority for the patient;
- Avoiding work for a reason constant state alcohol intoxication;
- Drinking alcohol in dangerous doses, registering with a neuropsychiatric department;
- Increased binge drinking, violations of rules of conduct in in public places under the influence of alcohol;
- Psychological states with a pronounced aggressive mood towards other people;
- Signs of withdrawal syndrome (intoxication syndrome, headaches, hand tremors);
- Repeated intake of alcohol in order to relieve withdrawal symptoms the next day (popularly the process is called “hangover”).
Based on the two or three manifestations of alcoholism listed above, the doctor can make a diagnosis of alcohol dependence.
Treatment of alcoholic hepatitis
Treatment for alcoholic hepatitis includes many etiological factors, according to which the scheme is constructed. This is an energy diet With mandatory increased protein consumption, as we have already mentioned, with alcoholism, protein consumption is reduced due to the consumption of a large number of calories through alcohol consumption.
For acute, severe forms it is prescribed drug treatment with the introduction of liver hepatoprotectors to maintain the organ. Removing toxins using intoxication procedures, such as blood hemolysis, drinking large amounts of water, at least 2-2.5 liters per day. Fortifying the body with vitamins B and C.
The first and most important thing in the treatment of alcoholic hepatitis, of all forms, is a complete abstinence from ethanol-containing (alcohol) drinks in any form.
Statistics on complete abstinence from alcohol among patients are very low, no more than 1/3 of all alcohol addicts. With the help of conversations with the doctor, the same number of patients quit this addiction themselves, using medication, and the prognosis for recovery in this group is quite good. A group of patients who categorically do not listen to the doctor and continue to drink alcohol are registered in psychological dispensaries with a narcologist and hepatologist for further management of such a patient.
The risk group of such patients may face the impossibility of prescribing antipsychotics for treatment, since such drugs cannot be prescribed for liver failure, which may already be developing in the body at the time of the chronic form of alcoholic hepatitis.
Jaundice manifestations go away the moment the patient gives up alcohol completely. Diseases such as ascites and encephalopathy go away. In the case of further malignant or minimal alcohol intake in the chronic stage of the disease, it leads to the fatal outcome of the patient (death).
Studies conducted in the USA have shown that a characteristic nutritional deficiency, disturbances in the consumption of protein foods, and water are inherent in every person suffering from alcoholic hepatitis; accordingly, the level of liver damage is directly related to the indicators of gross violations of food intake standards.
The norm for the proper functioning of the body, stable operation of all systems and organs, is the consumption of at least 2000 calories per day. high rate protein, one kilogram of human weight is 1 gram of protein food. A complete supply of B vitamins, folic acid. In case of sudden weight loss of the patient (anorexia), tube feeding or parenteral nutrition is used. In the case of anorexia, the usual way of consuming food, essential microelements and calories is hampered, the body does not accept food due to the development of the disease and causes vomiting.
Due to the correlation of calorie intake, it was noticed that the group of patients who take over 2,500-3,000 calories have a higher percentage of recovery. The other side of the coin is increased mortality when consuming 1000 calories per day.
Diet No. 5, principles, food exclusions
Diet No. 5 was developed in 1920 by the physician Pevzner. He has 15 in his arsenal therapeutic diets(tables) by different groups diseases. To date, Pevzner diets are effective in the treatment of various diseases.
Diet principles No. 5.
Products allowed for consumption:
- Rye bread (yesterday's baked goods);
- Products made from soft dough (filling – boiled meat, fish, apples, cottage cheese);
- Milk soup with pasta;
- Soups with vegetable infusions (cereals, cabbage soup, beetroot soup, fruit soup);
- Low-fat fish (fillet, baked, boiled, dumplings, meatballs);
- Poultry meat (low-fat, skinless, boiled poultry, beef, rabbit, turkey, chopped or whole);
- Milk sausages, children's sausage;
- Pilaf with a high content of carrots and boiled meat;
- Stuffed cabbage rolls;
- Dairy products (yogurt, kefir, low-fat yogurt, cottage cheese, low-fat, non-spicy cheese);
- Vegetable oil;
- Butter (in small doses);
- Cereals (oatmeal, buckwheat);
- Dried fruits;
- Krupeniki;
- Egg white omelette without yolk;
- One yolk per day;
- Boiled, stewed or raw vegetables ( green pea, broccoli, boiled onions, carrots, beet);
- Boiled zucchini salads (squash caviar);
- Seafood (boiled);
- Fruits and berries (not sour, in the form of compotes, jelly, mousses, jellies);
- Vegetable juices;
- Green tea;
- Rose hip decoction;
- Coffee with cream, milk;
- Spices, parsley, dill, and sour cream sauce are allowed in moderate doses.
Product exclusions:
- Butter dough (products);
- Fresh bread;
- Puff pastry;
- Fried pies;
- Soup (mushroom, fish broth, sorrel cabbage soup, okroshka);
- Fish (canned, fatty, smoked, salted);
- Meat (smoked meats, brains, kidneys, liver, fatty streaky pork, lamb, poultry skin, goose, duck, fatty and smoked sausages);
- Fat sour cream, fermented baked milk, cream, feta cheese, fat homemade cottage cheese;
- Pig lard, lamb, chicken and mutton fat;
- Legumes;
- Fried eggs;
- Radish, spinach, sorrel, garlic, green onions;
- Pickled vegetables;
- Salted and marinated mushrooms;
- Chocolate, cakes, pastries with cream;
- Horseradish, mustard, hot pepper;
- Strong coffee, strong tea;
- Complete exclusion of alcoholic beverages of any kind.
Why is it worth adhering to diet No. 5 in treatment combined with medication?
The diet is designed in such a way that it provides adequate nutrition and helps normalize the functioning of the gastrointestinal tract and liver. Following a diet guarantees the accumulation of glycogen in the liver, which leads to the normalization of fat and cholesterol metabolism. Bile secretions are well stimulated, and all activity of the gastrointestinal tract is normalized.
As a rule, the diet is prescribed not only during the treatment of acute forms of alcoholic hepatitis, during the treatment of cholecystitis, cholelithiasis, liver cirrhosis in the absence of liver failure, and postoperative periods.
Diet No. 5 for the daily diet is:
- 70 grams of fat;
- 50 grams of carbohydrates;
- 100 grams of protein.
- The energy amount is 2600-3000 kcal.
- Meals are divided into 4-5 meals a day, not in large portions.
The basis of nutrition is boiled food, in rare cases stewed. Products must be coarsely chopped, without chopping. Meat and fish in large boiled pieces, one per serving. The process of sautéing vegetables (sautéing) when preparing gravy and frying is excluded. Frying is completely eliminated. Cold dishes and cold water should not be in the diet due to excessive irritation of the gastrointestinal tract, leading to a slower process of food digestion.
Examples of diet recipes No. 5 for every day
Monday
- First breakfast - one egg white omelette, rice porrige with milk, tea.
- Second breakfast – lazy cottage cheese dumplings with low-fat sour cream.
- Lunch – cabbage soup without sorrel, stewed carrots, a piece of boiled meat, dried fruit soup.
- Afternoon snack – biscuits, tea.
- Dinner - boiled pasta, low-fat cheese, mineral water no gases.
Tuesday
- First breakfast - salad of raw carrots and apples, steamed cutlets (meat, fish), coffee with milk;
- Second breakfast – one apple.
- Lunch – potato or vegetable soup(mashed potatoes), stewed cabbage, meat or boiled fish, jelly.
- Afternoon snack – rosehip decoction, one biscuit.
- Dinner – buckwheat cereal, still mineral water.
- Before bed - a glass of low-fat kefir.
Wednesday
- The first breakfast is a mixture of low-fat cottage cheese with low-fat sour cream, oatmeal.
- Lunch - boiled chicken, vegetable soup, boiled rice, fresh fruit compote.
- Afternoon snack – mashed potatoes, boiled meat, rosehip decoction.
- Before bed - a glass of low-fat kefir.
Thursday
- First breakfast – buckwheat porridge, a little butter, coffee with milk, low-fat cottage cheese with low-fat sour cream.
- Second breakfast – one baked apple.
- Lunch – beetroot soup, boiled meat with pasta (naval pasta).
- Afternoon snack – one biscuit cookie.
- Dinner - mashed potatoes, stewed meat, vegetable salad, still water.
- Before bed - a glass of low-fat kefir.
Friday
- First breakfast - oatmeal, butter, coffee with milk.
- Second breakfast – baked apple.
- Lunch – borscht without frying, noodles with boiled meat, low-fat sour cream, berry jelly.
- Afternoon snack – biscuits, not strong tea.
- Dinner – mashed potatoes, boiled raba, vegetable salad, still mineral water.
- Before bed - a glass of low-fat kefir.
Saturday
- First breakfast – steamed chicken cutlet, buckwheat, tea.
- Second breakfast – carrot puree, apple jam.
- Lunch – milk soup with pasta, curd babka, low-fat sour cream, uzvar.
- Afternoon snack – fruit jelly.
- Dinner - semolina with prunes and low-fat milk, still mineral water.
- Before bed - a glass of low-fat kefir.
Sunday
- First breakfast - boiled potatoes, pieces, unsalted herring, tea with a slice of lemon.
- Second breakfast – baked apple.
- Lunch – cabbage soup without frying or meat, vermicelli, steamed poultry cutlets, compote.
- Afternoon snack – biscuits, rosehip infusion.
- Dinner – curd pudding, egg white omelette, still mineral water.
- Before bed - a glass of low-fat kefir.
When treating alcoholic hepatitis, it is extremely important to completely abstain from alcohol, adhere to diet No. 5 with its exceptions and the introduction of foods and elements into the diet. Drink as much liquid as possible without gas (mineral water), include vitamins B and C in your daily diet.
Remember that your timely arrival at the doctor for a consultation with possible complaints or a desire to get rid of alcohol addiction(alcoholic hepatitis), this is your road to recovery and prolongation of life.
Alcoholic hepatitis is called degenerative changes, inflammatory processes that begin in the liver due to long-term alcohol consumption. This disease is the most common on the list of alcoholic liver diseases, despite the fact that WHO recognized it as recently as 1995. You should be aware of the symptoms and treatment of alcoholic hepatitis, which can lead to serious consequences without timely help.
Alcoholic liver hepatitis is a disease that takes a long time to develop. The main factor in the occurrence of this form of hepatitis is alcohol abuse, and its type does not matter; negative changes in the liver are affected solely by dosage and frequency. Toxic substances produced during the body's processing of alcohol literally poison and destroy the human liver.
This disease is becoming one of the main causes of liver cirrhosis, which can be fatal. Developed alcoholic hepatitis always leads to severe consequences, even after the end of treatment, the patient has to change his lifestyle forever.
There are two main forms of alcoholic hepatitis according to the nature of the disease:
- Persistent form. At this stage, there are no symptoms of the disease; it is quite mild and not dangerous. However, if alcohol intake is not stopped in the persistent form, it will quickly become progressive. If alcohol intake is completely stopped on time, treatment begins, then there is a chance to fully recover from the disease.
- Progressive form. The disease progresses into it if timely assistance is not provided in case of persistence. Characterized by focal lesion liver, which often progresses to cirrhosis. This form of the disease is diagnosed less frequently than the persistent form.
With a progressive form, the symptoms of the disease become much more noticeable. However, both forms can be quite dangerous if measures are not taken in time.
Based on the speed of development, two forms of the disease are also distinguished, both of which can be extremely dangerous for humans:
- Acute alcoholic hepatitis. It is much more common; most cases of long-term alcohol abuse lead to this form of the disease. Symptoms appear quickly, and the disease itself develops rapidly. In some cases, the manifestation of acute hepatitis occurs against the background of already developed cirrhosis, which worsens the course of the disease. In the acute form, it is important to provide assistance to the patient as quickly as possible.
- Chronic hepatitis. It does not manifest itself so actively; it is often difficult to identify it if the hepatologist is not aware of the patient’s lifestyle. To make a diagnosis, it is important to know about the patient’s alcohol dependence.
In any case, when identifying signs of alcoholic hepatitis, it is important to use the criteria for alcohol dependence; this is important in further treatment; in order to get rid of alcoholic hepatitis, the patient will have to change their lifestyle.
Important! Often, for the treatment of alcoholic hepatitis to be most effective, the support and assistance of the sick person’s loved ones is required.
It is also worth saying a few words about the effect of alcohol on the liver with developed hepatitis C. Hepatitis C is viral disease transmitted mainly through blood. The virus causes changes in the liver that are dangerous for the body. It has been proven that when drinking alcohol against the background of hepatitis C, the likelihood of developing dangerous complications increases many times.
With this type of viral infection, you should go on a diet and avoid alcohol. Depending on the extent of the damage caused by the virus, you may have to diet and abstain from alcoholic beverages for life. Drinking alcohol during hepatitis C increases the risk of cirrhosis, which can be fatal.
Causes
Alcoholic toxic hepatitis has one cause - alcohol abuse. For the disease to develop, a person must spend 5–10 years permanent basis drink alcohol, the rate of occurrence of the disease depends on the quantity and quality of alcohol. Typically, people with alcoholic hepatitis already have a diagnosis of alcohol dependence.
Alcohol has such a negative effect on the liver because most of it is broken down in this organ. Large doses alcohol puts too much stress on the liver, which leads to its disruption normal functioning. It is also worth noting that in women, the body’s ability to produce the necessary enzymes to break down the products that make up alcohol is lower.
Important! Even in people without severe alcohol dependence, long-term constant consumption of alcohol can provoke degenerative changes in the liver.
Symptoms
Symptoms of alcoholic hepatitis depend on the stage and form of the disease. In almost all cases it begins with a persistent form, which is not as noticeable as subsequent ones. At the very beginning of the disease, the patient may notice a slight malaise, heaviness in the right hypochondrium, belching, mild nausea and a feeling of discomfort in the stomach.
That is why the very beginning of alcoholic hepatitis is often missed. The patient often does not pay attention to initial symptoms, the persistent form can only be detected during examination.
When transitioning to a progressive form, the patient's condition sharply worsens. All symptoms of eating disorders appear, and jaundice may occur. If the patient is not helped at this stage, cirrhosis can lead to death.
Acute alcoholic hepatitis is the most pronounced. If the following symptoms appear, you should consult a doctor as soon as possible; if your condition rapidly worsens, you should call an ambulance:
- the occurrence of jaundice - yellowing of the skin and whites of the eyes;
- severe weakness, chills, pain in the right hypochondrium;
- nausea, vomiting, stool disorders;
- in some cases itchy skin occurs.
Against the background of acute alcoholic hepatitis, various bacterial infections also often occur, for example, pneumonia or various types of peritonitis. It is worth noting that the occurrence of bacterial infection and other complications against the background acute illness may be fatal.
Chronic alcoholic hepatitis
This form rarely manifests itself noticeably; making a correct diagnosis can be extremely difficult. Usually they look at changes in the condition of the liver and the level of transmiases in the blood; with hepatitis it is increased.
In general, with the chronic form of the disease, digestive problems and sleep disturbances constantly arise; men may develop gynecomastia or hypogonadism. With any of similar violations you should consult a doctor.
Complications
The main complication of alcoholic hepatitis is cirrhosis of the liver, which can ultimately lead to death if the disease is advanced. Generally possible various disorders liver functions, which are severe cases do not always fully recover after treatment.
Complications also include bacterial infections, which very often occur against the background of hepatitis. They can significantly worsen the course of the disease.
Forecast
With timely treatment, the prognosis is favorable; in some particularly successful cases, it was possible to completely restore liver function. However, even after treatment ends, you will no longer be able to drink alcohol.
Also, the success of therapy depends on the patient himself and the desire to recover. Any treatment will be in vain if the patient does not follow a strict diet and listen to all the doctor’s recommendations.
Often treatment of this disease begins with admission to intensive care, the patient’s condition can be so severe and deadly. In general, the treatment plan depends on the stage of the disease, concomitant diagnoses and characteristics of the course of the disease.
Treatment in a hospital is more often recommended, then after the main symptoms and the inflammatory process have resolved, a transfer to home treatment. At home, it is important to ensure that the patient does not return to alcoholic beverages, otherwise the disease will return.
In general, the treatment regimen consists of several mandatory points, only complex therapy you can achieve the most noticeable positive result. First of all, the patient begins taking special medications - hepatoprotectors, which allow you to restore liver function and neutralize toxins. They are divided into several groups:
- drugs based on medicinal plant milk thistle;
- based on the substance – ademetionine;
- from bear bile;
- preparations based on animal products;
- products based on essential phospholipids.
All groups of drugs are similar in action, the most suitable medicine selected by the attending physician. In addition to hepatoprotectors, anti-inflammatory drugs can be used bacterial infections, with strong alcohol poisoning IVs are placed with drugs that help neutralize intoxication and avoid dehydration and starvation of the body.
Important! In the most dangerous advanced cases, surgery may be indicated.
Diet
Diet is one of the most important aspects of hepatitis treatment. To ensure that your medication is most effective, you should adhere to certain rules nutrition, simply eliminating alcohol is not enough.
Typically, for this disease, diet No. 5 is used, which is extremely effective in various diseases liver and gastrointestinal tract as a whole. In general, when dieting, you should adhere to the following nutritional rules:
- dishes cannot be fried, but can be baked, boiled and steamed;
- consumption of fatty foods and animal products is limited;
- Too spicy and sour foods, foods with a choleretic effect are unacceptable;
- the basis of the diet should be fresh vegetables and fruits;
- You should eat in small portions, preferably up to 5–6 times a day.
The diet may vary depending on the presence of concomitant diseases and their nature. In some cases, such a strict diet has to be followed for life, even after full recovery.
Treatment with folk remedies
At home, after removal acute form, it is permissible to use a number of folk remedies to improve liver function, get well soon. It's worth remembering that traditional medicines will not help get rid of the disease itself, only make the treatment more effective.
- Treatment with honey. Honey is effective for various diseases of the liver and gallbladder; it will help restore the functioning of the gastrointestinal tract. In the morning before meals, you should dilute one spoon of honey in a glass. warm water, have a drink, in half an hour you can have breakfast.
- Vegetable juices. Beetroot is especially recommended. It is advisable to drink a whole glass of fresh beet juice at least several times a week to improve the condition of the gastrointestinal tract.
By combining various conservative and folk remedies, you can achieve the most noticeable positive result. The main thing with alcoholic hepatitis is to follow all the doctor’s recommendations and constantly monitor the condition of the liver.
Acute or chronic potentially progressive degenerative-inflammatory liver damage caused by alcohol and capable of large number cases develop into cirrhosis of the liver. Two types of alcoholic hepatitis have special characteristics - acute and chronic.
Acute alcoholic hepatitis(alcoholic steatonecrosis, sclerosing hyaline necrosis of the liver, toxic hepatitis, acute liver failure chronic alcoholics) often poses a direct threat to the patient’s life. Among the causes of alcoholic hepatitis of this form is alcohol abuse for more than 5 years, that is, chronic alcoholism. There is also some involvement of genetic factors in the formation of pathology. Regardless of previous liver damage, acute alcoholic hepatitis has certain histological manifestations. Structural changes in the liver are divided into mandatory and optional for alcoholic hepatitis:
- mandatory morphological characteristics- perivenular damage to hepatocytes, manifested by balloon degeneration and necrosis, the presence of Mallory bodies, leukocyte infiltration and pericellular fibrosis;
- optional morphological signs - fatty liver, giant mitochondria, acidophilic bodies, oxyphilic hepatocytes, hepatic vein fibrosis, proliferation bile ducts and cholestasis.
Acute alcoholic hepatitis is characterized by perivenular damage to hepatocytes, or damage to the third zone (microcirculatory periphery) of Rappoport's hepatic acinus. Observed in normal conditions decrease in oxygen tension in the direction from the hepatic artery and portal vein to hepatic vein when alcohol is metabolized, it drops even more, so perivenular hypoxia contributes to the development of hepatocellular necrosis. Necrosis of liver cells is detected mainly in the center of the hepatic hexagonal lobules. Balloon degeneration of hepatocytes is characterized by swelling of individual hepatocytes with an increase in their size, clearing of the cytoplasm and karyopyknosis.
Acute alcoholic hepatitis most often develops in people aged 25-35 years after heavy drinking on the background of 10 years or more of prolonged alcohol abuse. However, the age range can vary from 25 to 70 years. The most popular symptoms are:
- acute onset with sudden appearance pain syndrome(prolonged pain in the right hypochondrium or epigastric region, usually only partially relieved by the administration of analgesics),
- rapid development of jaundice (usually not accompanied skin itching, often moderately expressed),
- dyspeptic syndrome,
- severe weakness
- anorexia (often even before the onset of jaundice)
- nausea and vomiting,
- diarrhea,
- weight loss
- sometimes 40% of patients have remitting or persistent fever.
The latent variant of alcoholic hepatitis is asymptomatic or with mild dyspeptic disorders, without jaundice and significant abnormalities in liver function. The disease is manifested by hepatomegaly, anemia or persistent leukocytosis. Most often, the reason for a thorough examination of the liver and functional studies serve as polyneuropathy, cardiomyopathy, pancreatitis.
Chronic alcoholic hepatitis is divided into chronic persistent hepatitis and CAH, which represent separate stages of the progression of acute alcoholic hepatitis.
Irreversible changes in the liver can persist without progressive fibrosis and transition to cirrhosis for 5-10 years, despite the consumption of alcoholic beverages. This form of hepatitis is characterized by variability in clinical symptoms. Noted:
- anorexia,
- abdominal pain,
- belching,
- slight enlargement of the liver,
- liver hardening.
Clinical manifestations of CAH are more pronounced and regular than in chronic persistent hepatitis. Jaundice is common; the liver is enlarged or small (with the development of cirrhosis), dense. Functional indicators usually changed, high activity of γ-glutamyl transpeptidase is detected, increased content IgA in blood serum.
In persistent hepatitis, the activity of glutamate dehydrogenase and gamma-glutamyl transpeptidase increases slightly. Chronic alcoholic hepatitis, according to histological examination, has a 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 active alcoholic hepatitis. The process is characterized by progression, which in some cases is observed even when drinking alcoholic beverages is stopped, as the autoimmune destructive reaction continues to develop.
How to treat alcoholic hepatitis?
Treatment of alcoholic hepatitis fundamentally contains the need to eliminate alcoholism and subsequently completely abstain from drinking alcohol. Treatment of acute alcoholic hepatitis is carried out in a hospital with the provision of a complete diet (3000 cal), rich in protein (1-1.5 g/kg), in the absence of encephalopathy.
Detoxification therapy may be needed - this is a 5% glucose solution with vitamins and electrolytes (10% calcium gluconate solution, 3% potassium chloride solution); hemodez (200-300 ml 2-3 times a week).
In case of severe dyspeptic syndrome, but in the absence of hepatic encephalopathy, it is appropriate to prescribe amino acid mixtures (travazol, alvezin, and others with high content amino acids) in combination with multivitamins.
Treatment with essential phospholipids is indicated, the course of which is compiled individually, taking into account the characteristics of hepatitis in a particular case.
In the presence of cholestasis syndrome in patients with alcoholic liver disease, the use of heptral is indicated. In patients with fever, it is necessary to exclude an infectious source. When saving high temperature body for more than 3-4 days, semi-synthetic antibiotics are prescribed wide range actions (ampicillin, ampiox, ceporin, kefzol, cefamezin).
Glucocorticosteroids are used for particularly severe forms of acute alcoholic hepatitis with severe hepatic cellular failure and without signs of advanced liver cirrhosis, as indicated by an increase in bilirubin levels by more than 10 times and a sharp prolongation of prothrombin time. A 3-4 week course is prescribed at an initial dose equivalent to 32 mg of metipred.
The administration of glucocorticosteroids is contraindicated in the presence of infection, diabetes, pancreatitis, and hepatocellular carcinoma.
In the treatment of alcoholic cirrhosis of the liver, repeated courses of Essentiale and antioxidant drugs are used. The most important is the prevention and treatment of complications (portal hypertension, ascites, encephalopathy).
Ursodeoxycholic acid (UDCA) is used for all forms of alcoholic liver disease. Its positive clinical and biochemical effect is associated with its inherent immunomodulatory effect and anticholestatic effect. Some studies have shown the antifibrogenic and anti-inflammatory effects of colchicine. Additional controlled research is needed on the effect of drugs such as Essentiale, propylthiouracil, and Heptral on the survival of patients with severe forms.
The mortality rate for alcoholic hepatitis is estimated at 10-30%. Prognostically unfavorable symptoms associated with high mortality are encephalopathy, renal failure and prolongation of prothrombin time by more than 50% of the control values. Relapses of acute alcoholic hepatitis against the background of established liver cirrhosis have an unfavorable prognosis. Of the complications leading to death, the most common are hepatic coma (55.8%), bleeding from varicose veins and erosions of the gastrointestinal tract (30.8%), hepatorenal syndrome (27.8%), infectious complications (14,9%).
The prognosis is much better with the latent form of acute alcoholic hepatitis.
The poor long-term prognosis of acute alcoholic hepatitis is associated with a high frequency of its transition to liver cirrhosis.
Complete recovery is possible only if you stop drinking alcohol, but abstinence in some cases does not mean completely eliminating the development of cirrhosis.
What diseases can it be associated with?
Alcoholic hepatitis is often combined with alcoholic fibrosis and.
Reason fatal outcome I can be , . Several weeks of any such pathology or their combination can cause death.
Treatment of alcoholic hepatitis at home
Treatment of acute alcoholic hepatitis is carried out in a hospital, chronic forms diseases require the patient to be discharged from medical institution and continuation of treatment at home after a thorough diagnosis and prescription of a treatment regimen.
A complete abstinence from drinking alcoholic beverages and following a nutritious, protein-rich diet are required.
What drugs are used to treat alcoholic hepatitis?
The combination of drugs is determined on an individual basis. These could be, for example, the following medications:
- - 5-10 ml intravenously in a 5% glucose solution or intravenous drip (500-1000 mg) 10-14 infusions in combination with oral administration at a dose of 6 capsules per day in the first 1-2 months and then 3- 4 capsules for 3-6 months;
- - at a dose of 10 ml (800 mg) intravenously, followed by switching to capsules at a dose of 800-1600 mg per day for 2-3 weeks;
- - 2-5 g/day intramuscularly;
- - 3 mg/day (1 tablet in the morning and 2 tablets in the evening) on the first day of treatment, 2 mg/day (1 tablet in the morning and evening) on the 2nd and 3rd days, 1 tablet. on the 4th and subsequent days.
Treatment of alcoholic hepatitis with traditional methods
The use of folk remedies for treatment of alcoholic hepatitis usually does not show a significant positive effect.
Treatment of alcoholic hepatitis during pregnancy
The development of alcoholic hepatitis during pregnancy is extremely undesirable. Being a consequence of chronic alcoholism, this disease is rarely combined with pregnancy, and if this happens, it is not in prosperous sections of the population. As a result of alcoholism, which entails alcoholic hepatitis, processes that are very unfavorable for the development of pregnancy occur in a woman’s body. The question of the possibility of maintaining a pregnancy, curing alcoholism and its consequences is decided on an individual basis.
Which doctors should you contact if you have alcoholic hepatitis?
The diagnosis of acute alcoholic hepatitis can be assumed on the basis of clinical data, but it can be reliably established using biopsy data. Patients often have to establish systematic alcohol consumption by asking their family and friends. The following are taken into account:
- appearance,
- behavioral characteristics of the individual,
- neurological changes,
- visceral changes characteristic of alcoholism.
The most frequently detected tremors of the hands, eyelids, tongue, facies alcoholica, venous congestion eyeball, polyneuropathy, Dupuytren's contracture. The presence of jaundice, fever, painful enlarged liver, and leukocytosis in patients allows one to suspect acute alcoholic hepatitis with a sufficient degree of accuracy.
An objective examination reveals hepatomegaly, jaundice and fever. The liver is enlarged in almost all patients, often compacted, with smooth surface, painful. Unlike acute cholecystitis the pain is diffuse rather than local. Possible splenomegaly, cutaneous telangiectasias, palmar erythema, asterixis (fluttering tremor of the hands).
A sharp increase in the level of bilirubin, cholesterol, gamma-glutamyl transpeptidase is observed along with slight increase serum aminotransferase activity. A number of patients with acute alcoholic hepatitis have a syndrome that is difficult to distinguish from acute cholangitis or obstructive jaundice- a combination of fever, pain in the right hypochondrium, severe leukocytosis, a significant increase in alkaline phosphatase activity.
Patients with acute alcoholic hepatitis are in serious condition, in most cases they have jaundice, the bilirubin content in the blood serum is constantly increasing, the prothrombin time is lengthening, and the level of serum albumin is decreasing. Anorexia, nausea, ascites, renal failure, encephalopathy, hepatic coma complete the course of the disease and lead to death after a few weeks.
Leukocytosis is almost always detected with an increase in the number of neutrophils, a band shift, and an increase in ESR. In some cases, leukocytosis has the character of a leukemoid reaction. Fever, leukocytosis and high ESR are indirect sign liver necrosis. In 50-75% of patients with alcoholic hepatitis, anemia of the macrocytic or hemolytic type is detected. The platelet count in most patients is normal, but in 30-35% it is increased or decreased.
A pronounced decrease in gamma-glutamyl transpeptidase activity during abstinence is of diagnostic significance. A new marker of alcohol intoxication is carbohydrate-free (desialized) transferrin in blood serum, which is a compound of acetaldehyde with transferrin and is detected when consuming 60 grams or more of ethanol per day for 1 week.
In the convalescence stage, an increase in AST activity is possible, probably due to an improvement in the synthetic function of the liver. A significant proportion of patients have hypoalbuminemia, but the thymol test, unlike the OVG, is usually not changed. The severity of liver damage correlates with the degree of decrease in albumin levels and prothrombin index.
Laparoscopy shows changes in the structure of the liver - it is dense, light brown in color with reddish “speckles”, often with scar grooves. The criterion for a reliable diagnosis is the data of a liver biopsy, the results of which will demonstrate:
- alcoholic hyaline in the central zone hepatic lobule,
- coagulation necrosis of hepatocytes with infiltrates of polymorphonuclear leukocytes,
- centrilobular fibrosis, usually (but not always) combined with steatosis.
Chronic persistent hepatitis according to liver biopsy has characteristic manifestations alcoholic hepatitis in combination with moderate pericellular and subsinusoidal fibrosis in the third zone of the acinar hepatic lobule. In some cases, the portal tracts are enlarged and portal fibrosis is observed.