Alcoholic liver disease is a structural degeneration and impaired liver function caused by systematic prolonged alcohol consumption. Patients with alcoholic liver disease have decreased appetite, dull pains in the right hypochondrium, nausea, diarrhea, jaundice; cirrhosis and hepatic encephalopathy develop in the late stage. The diagnosis is facilitated by ultrasound, Dopplerography, scintigraphy, liver biopsy, and the study of biochemical blood samples. Treatment involves abstaining from alcohol, taking medications (hepatoprotectors, antioxidants, sedatives), and, if necessary, liver transplantation.
K70 Alcoholic liver disease
Alcoholic liver disease develops in people who have been abusing alcoholic beverages for a long time (more than 10-12 years) in average daily doses (in terms of pure ethanol) of 40-80 grams for men and more than 20 grams for women. Manifestations of alcoholic liver disease are fatty degeneration (steatosis, fatty degeneration of tissue), cirrhosis (replacement of liver tissue with connective – fibrous), alcoholic hepatitis.
The risk of alcohol-related illness in men is almost three times higher, since alcohol abuse among women and men occurs in the proportion of 4 to 11. However, the development of alcoholic illness in women occurs faster and with the use of less alcohol. This is due to the gender characteristics of absorption, catabolism and alcohol excretion. Due to the increase in the consumption of strong alcoholic beverages in the world, alcoholic liver disease is a serious social and medical problem, which is being addressed by specialists in the field of modern gastroenterology and narcology.
Causes of alcoholic liver disease
Among the main reasons provoking alcoholic liver disease, researchers indicate:
- high doses of alcohol consumed, the frequency and duration of its use;
- female (alcohol dehydrogenase activity in women is usually lower);
- genetic predisposition to decreased activity of alcohol-destroying enzymes;
- concomitant or transferred liver diseases;
- metabolic disorders (metabolic syndrome, obesity, bad eating habits), endocrine disorders.
The bulk of ethyl alcohol entering the body (85%) is exposed to the enzyme alcohol dehydrogenase and acetate dehydrogenase. These enzymes are produced in the liver and stomach. The rate of alcohol breakdown depends on genetic characteristics. With regular prolonged alcohol consumption, its catabolism accelerates, there is an accumulation of toxic products formed during the splitting of ethanol. These products have a toxic effect on liver tissue, causing inflammation, fatty or fibrous degeneration of liver parenchyma cells.
Alcoholic liver disease symptoms
The first stage of alcoholic liver disease, which occurs in almost 90 percent of cases of regular alcohol abuse for more than 10 years, is fatty liver dystrophy. Most often it is asymptomatic, sometimes patients note a decreased appetite and periodic dull pains in the right hypochondrium, possibly nausea. Approximately 15% of patients have jaundice.
Acute alcoholic hepatitis can also occur without pronounced clinical symptoms, or have a lightning-fast severe course, leading to a fatal outcome. However, the most common signs of alcoholic hepatitis are pain syndrome (dull pain in the right hypochondrium), dyspeptic disorder (nausea, vomiting, diarrhea), weakness, appetite disorder and weight loss. Also a common symptom is hepatic jaundice (the skin has an ochre tinge). In half of cases, acute alcoholic hepatitis is accompanied by hyperthermia.
Chronic alcoholic hepatitis proceeds for a long time with periods of exacerbations and remissions. Moderate pains occur periodically, nausea, belching, heartburn, diarrhea, alternating with constipation, may appear. Sometimes jaundice is noted.
With the progression of alcoholic illness, the symptoms of hepatitis are joined by signs characteristic of developing cirrhosis of the liver: erythema palmar (redness of the palms), telangiectasia (vascular asterisks) on the face and body, “drum sticks” syndrome (characteristic thickening of the distal phalanges of the fingers), “watch glasses” (pathological change in the shape and consistency of nails); “medusa heads” (dilated veins of the anterior abdominal wall around the navel). Men sometimes have gynecomastia and hypogonadism (breast enlargement and testicular reduction).
With the further development of alcoholic cirrhosis, patients have a characteristic increase in the parotid glands. Another characteristic manifestation of alcoholic liver disease in the terminal stage are Dupuytren contractures: initially, a dense connective tissue nodule (sometimes painful) is found on the palm above the tendons of the IV-V fingers. In the future, its growth occurs with the involvement of the joints of the hand in the process. Patients complain of difficulty in bending the ring finger and little finger. In the future, their complete immobilization may occur.
Alcoholic liver disease often leads to the development of gastrointestinal bleeding, hepatic encephalopathy (toxic substances that accumulate in the body as a result of a decrease in functional activity are deposited in brain tissues), impaired kidney function. People suffering from alcohol-related illness are at risk of developing liver cancer.
In the diagnosis of alcoholic liver disease, a significant role is played by the collection of anamnesis and the detection of prolonged alcohol abuse by the patient. During the consultation, the hepatologist or gastroenterologist carefully finds out how long, with what regularity and in what quantities the patient consumes alcoholic beverages.
In laboratory studies, macrocytosis is noted in the general blood test (the toxic effect of alcohol on the bone marrow affects), leukocytosis, acceleration of ESR. Megablastic and iron deficiency anemia may occur. A reduced platelet count is associated with inhibition of bone marrow functions, and is also detected as a symptom of hypersplenism with increased pressure in the vena cava system in cirrhosis.
In the biochemical study of blood, an increase in the activity of AST and ALT (liver transferases) is noted. Also note the high content of bilirubin. Immunological analysis reveals an increase in the level of immunoglobulin A. When alcohol is consumed in an average daily dose of more than 60 g of pure ethanol in the blood serum, an increase in carbohydrate-depleted transferrin is noted. Sometimes there may be an increase in the amount of serum iron.
For the diagnosis of alcoholic liver disease, a thorough collection of anamnesis is necessary. It is important to take into account the frequency, quantity and type of alcoholic beverages consumed. Due to the increased risk of liver cancer in patients with suspected alcoholic illness, the content of alpha-fetoprotein in the blood is determined. At its concentration of more than 400 ng /ml, the presence of cancer is assumed. Also, patients have a violation of fat metabolism – the content of triglycerides in the blood increases.
Instrumental methods that help diagnose alcoholic illness include ultrasound of the abdominal cavity and liver, Dopplerography, CT, MRI of the liver, radionuclein examination and liver tissue biopsy.
During ultrasound of the liver, signs of changes in size and shape, fatty degeneration of the liver (characteristic hyperechogenicity of liver tissues) are clearly visible. Ultrasound Dopplerography reveals portal hypertension and increased pressure in the hepatic vein system. Computer and magnetic resonance imaging visualizes liver tissue and its vascular system well. Radionucleid scanning reveals diffuse changes in the hepatic lobules, and it is also possible to determine the rate of hepatic secretion and bile production. For final confirmation of alcoholic illness, a liver biopsy is performed for histological analysis.
Alcoholic liver disease treatment
A prerequisite is a complete and final refusal to drink alcohol. This measure causes an improvement in the condition, and in the early stages of steatosis can lead to a cure. Also, patients with alcoholic liver disease are prescribed a diet. Be sure to eat with sufficient calories, balanced protein, vitamin and trace elements, because people who abuse alcohol often suffer from hypovitaminosis and protein deficiency. Patients are recommended to take multivitamin complexes. With severe anorexia, parenteral nutrition or with the help of a probe.
Drug therapy includes detoxification measures (infusion therapy with glucose solutions, pyridoxine, cocarboxylase). Essential phospholipids are used to regenerate liver tissue. They restore the structure and functionality of cell membranes and stimulate the activity of enzymes and the protective properties of cells. In severe acute alcoholic hepatitis, which threatens the patient’s life, corticosteroid drugs are used. A contraindication to their appointment is the presence of infection and gastrointestinal bleeding.
Ursodeoxycholic acid is prescribed as a hepatoprotector. It also has choleretic properties and regulates lipid metabolism. The drug S-adenosylmethionine is used to correct the psychological state. With the development of Dupuytren contractures, physiotherapy methods (electrophoresis, reflexology, physical therapy, massage, etc.) are initially treated, and in advanced cases, surgical correction is resorted to.
Cirrhosis of the liver requires symptomatic treatment and therapy of emerging complications (venous bleeding, ascites, hepatic encephalopathy). In the terminal stage of the disease, patients may be recommended to have a donor liver transplant. This operation requires strict abstinence from alcohol for at least six months.
Prognosis and prevention
The prognosis directly depends on the stage of alcoholic liver disease, strict adherence to medical recommendations and complete abstinence from alcohol consumption. The stage of steatosis is reversible and with proper therapeutic measures, the work of the liver is normalized within a month. The development of cirrhosis itself has an unfavorable outcome (survival for 5 years in half of patients) and threatens the occurrence of liver cancer. Prevention of alcoholic liver disease involves abstinence from alcohol abuse.