Alcoholic hepatitis is pathological changes in the liver, characterized by signs of inflammation, fatty degeneration, fibrosis, the cause of which is the toxic effect of alcohol metabolites on the organ. With the continuation of the etiological factor, liver changes turn into cirrhosis – irreversible damage. The severity of the disease is determined by both the dose and the quality and duration of alcohol intake. Hepatitis can occur in acute or chronic form. Treatment is aimed at giving up alcohol, providing a sufficiently high-calorie and nutritious diet, normalizing the functional state of the liver.
ICD 10
K70.1 Alcoholic hepatitis
Meaning
Alcoholic hepatitis is a disease that is one of the main manifestations of alcoholic liver disease, which in modern gastroenterology, along with alcoholic fibrosis, refers to the precursors or initial manifestations of cirrhosis of the liver. As a rule, this disease develops after five to seven years of regular use of alcohol. The pathology progresses with the continued use of alcoholic beverages.
Causes of alcoholic hepatitis
The cause of alcoholic hepatitis is prolonged alcohol abuse. In men, liver damage can develop when drinking 50-80 grams of alcohol per day, in women – 30-40 grams, in adolescents – 15-20. The rate of development and progression of the disease is determined by the amount, frequency of alcoholism, quality of drinks consumed, individual characteristics of the body, duration of abuse.
The probability of developing alcoholic liver damage is higher in individuals with genetic characteristics of alcohol-metabolizing enzymes, in patients who have had viral hepatitis, as well as with an initial nutritional deficiency.
Pathogenesis
Alcohol intake is accompanied by its metabolism in the liver to acetaldehyde, which has the property of damaging hepatocytes (liver cells). The cascade of chemical reactions triggered in the body by this substance causes hypoxia of hepatocytes, and eventually their death. As a result of toxic alcohol damage to the liver, a diffuse inflammatory process develops in its tissue.
Classification
Alcoholic hepatitis can have a persistent or progressive course. The persistent course is a relatively stable form of the disease, while in the conditions of cessation of alcohol consumption, damage to liver cells is reversible. The continuation of alcoholism leads to a transition to a progressive form.
The progressive form (divided into mild, moderate and severe degrees of activity) is characterized by a small-focal necrotic lesion of the liver, which often turns into cirrhosis. Timely treatment of this form leads to stabilization of the process, residual phenomena persist.
Depending on the course, acute and chronic alcoholic hepatitis are isolated. The acute course is characterized by acute progressive liver damage. About 70% of cases of long-term abuse are caused by acute hepatitis, which in 4% of cases very quickly turns into cirrhosis. This form can occur in the following variants: latent, jaundice, cholestatic and fulminant. Severe variants of acute alcoholic hepatitis often develop against the background of existing cirrhosis after a heavy binge.
Symptoms of alcoholic hepatitis
The latent variant of the course has no characteristic symptoms. Patients feel some heaviness in the hypochondrium on the right, slight nausea. This variant is usually detected by the results of laboratory studies (increased transaminases). Making a definitive diagnosis requires a biopsy.
The jaundice variant of the course is the most frequent. Characteristic signs are complaints of pronounced weakness, anorexia, pain in the right hypochondrium, diarrhea, nausea, vomiting, weight loss, yellowing of the skin, sclera. Possible increase in body temperature. The liver is enlarged, smooth (with cirrhosis – bumpy), painful on palpation. The detection of symptoms such as splenomegaly, ascites, erythema palmar (redness of the palms), telangiectasia, indicates the presence of background cirrhosis.
The cholestatic variant of alcoholic hepatitis is less common, its characteristic signs are intense skin itching, fecal discoloration, jaundice, darkening of urine. This option has a protracted course. The fulminant variant is characterized by rapid progression of hepatorenal, hemorrhagic syndrome, pronounced changes in laboratory markers. Against the background of hepatic coma, hepatorenal syndrome, the outcome can be fatal.
The chronic course of alcoholic hepatitis is characterized by moderate severity of clinical signs and laboratory markers. The diagnosis is based on the characteristic signs detected by liver biopsy, which indicate the presence of inflammation in the absence of cirrhosis.
Diagnostics
Diagnosis of alcoholic hepatitis may be associated with certain difficulties. The mild course of the disease may not be accompanied by any specific symptoms, and it can only be suspected if changes in laboratory parameters are detected.
Laboratory signs of acute form are leukocytosis, less often – leukopenia (with toxic effects of alcohol on the bone marrow), B12-deficiency anemia, accelerated ESR, as well as increased markers of liver damage. Ultrasound examination of the liver reveals an increase in its size, heterogeneity of the structure, smooth contours. Magnetic resonance imaging (MRI of the liver) determines collateral hepatic blood flow, concomitant damage to the pancreas.
In the chronic form, ultrasound examination of the liver reveals a slight or moderate increase in the liver, an increase in its echogenicity, and uniformity of structure. Laboratory parameters were changed moderately. A liver biopsy with alcohol damage can reveal specific signs of inflammation, fibrosis, necrosis. The severity of the damage depends on the form of the disease and its duration.
The detection of signs of liver damage during the examination should be combined with anamnestic data indicating long-term alcohol consumption, as well as the presence of addiction, abuse. This is difficult because the doctor does not always have complete information about the patient. That is why relatives should be involved to collect a complete anamnesis, since patients often significantly reduce the amount of alcoholic beverages consumed.
Characteristic external signs of alcoholic illness (alcoholism) are also revealed: puffiness of the face, tremor of the hands, tongue, eyelids, atrophy of the shoulder girdle muscles, Dupuytren contracture (fibrous change of the palmar tendons, leading to their shortening and flexion deformation of the hand), damage to the peripheral nervous system, other target organs (kidneys, heart, pancreas, central nervous system).
Alcoholic hepatitis treatment
Therapy of this disease should be comprehensive. The main directions of treatment are the elimination of the damaging factor, the appointment of an appropriate diet, and drug therapy. Any form of alcoholic hepatitis first of all requires the termination of the etiological factor – alcohol. Without giving up alcohol, the progression of damage is inevitable. In mild forms, this is already enough for the reverse development of changes in the liver.
Alcoholic hepatitis is accompanied by nutritional deficiency in most patients. The more severe the damage to the liver, the more pronounced trophic insufficiency. The recommended energy value of the daily diet is about 2000 calories. The protein content should be 1 g per kilogram of weight. There must be a sufficient supply of vitamins, unsaturated fatty acids. In the case of anorexia, a probe enteral or parenteral nutrition is prescribed. Infusions of amino acids reduce protein catabolism (consumption of intracranial protein reserves), improves the metabolism of brain tissues.
Drug therapy includes the appointment of essential phospholipids, which reduce fatty liver changes, have an antioxidant effect, slow down liver fibrosis, accelerate the regeneration of its cells. Also, with alcohol damage, especially cholestatic form, ursodeoxycholic acid preparations with cytoprotective effect are prescribed. In order to achieve an antioxidant effect, blocking the production of acetaldehyde, damage to cell membranes, silymarin-containing hepatoprotectors are prescribed.
Treatment of the acute form includes detoxification therapy, administration of plasma-substituting solutions, correction of electrolyte disorders. In severe cases with hepatic cell insufficiency syndrome, glucocorticosteroids are used. Treatment of the chronic form is carried out taking into account the degree of liver damage. The presence of fibrosis requires complete abstinence from alcohol. Drug therapy includes the appointment of drugs that affect the process of fibrosis, γ-interferon, glycine.
Prognosis and prevention
The basis for the prevention of alcoholic hepatitis is the restriction of alcohol consumption, in order to prevent the progression of existing liver damage – a complete refusal. In patients with mild to moderate alcoholic hepatitis with complete cessation of the action of acetaldehyde, the prognosis is good – complete restoration of liver function is possible. Currently, in order to treat this pathology, highly effective drugs are used that can cure the disease or stabilize the patient’s condition for a long time, preventing the transition to cirrhosis of the liver.
Treatment should be carried out by a hepatologist or gastroenterologist together with a psychotherapist and a narcologist, since the decisive factor is the refusal of alcohol. With the continuation of the etiological factor, the disease is complicated by cirrhosis of the liver. This is an irreversible condition, which is the final stage of alcohol damage. In this case, the prognosis is unfavorable. Such patients have a high risk of developing hepatocellular carcinoma.