Alcoholic liver disease is a social and medical problem in all countries of the world. When drinking 40–80 grams of alcohol per day, the risk of developing cirrhosis of the organ increases significantly, especially women suffer from this. In addition to alcoholic damage to the liver, other systems and organs are also damaged, primarily: the digestive and nervous systems, the heart, and the pancreas. And the manifestations of alcoholic disease are very diverse. Prolonged drinking contributes to the progression of liver disease from fatty degeneration to alcoholic hepatitis and cirrhosis.
Causes of the disease and risk factors
The development of the disease provokes uncontrolled drinking. Alcohol has a toxic effect on the liver, in which:
- oxygen starvation of liver cells occurs, disruptedtheir structure and functions;
- connective tissue grows;
- necrosis of liver cells appears under the influence of ethanol decomposition products, and the breakdown of the organ occurs faster than natural recovery;
- suppresses protein synthesis, which increases the water content in the cells and leads to an increase in their size.
Risk factors that provoke alcoholic liver damage include:
- Hereditary predisposition. Some people are genetically less active in enzymes that break down alcohol.
- Female. It is noted that when taking the same doses, the content of ethanol in the blood of women is higher than that of men. This phenomenon is explained by the different activity of the enzymes that ensure the metabolism of alcohol.
- Psychic addiction. Bad social conditions, emotional instability, constant stressful situations contribute to the development of alcohol dependence. Long-term use of alcohol-containing beverages in large doses leads to alcoholic damage to the liver and other organs.
- Metabolic disorders. Improper nutrition, bad eating habits, obesity disrupt metabolic processes, create an additional burden on the liver and increase the risk of its disease.
- Associated pathologies. Congenital or acquired liver diseases that appeared before alcohol abuse lead to disruption of its functioning. Chronic use of ethanol, even in small doses, in such people causesliver failure.
Higher likelihood of disease occurs when several risk factors coincide.
The mechanism of development of alcoholic lesions of the gastrointestinal tract and liver
The digestive organs are the first to experience the influence of alcohol and play a protective role when it enters the body. Through the mucous membranes of the stomach and duodenum, ethanol enters the bloodstream and is delivered to other organs, already having a lower concentration. The mucous membrane of the digestive organs has a good regenerative capacity. But with constant exposure to ethanol, it does not have time to recover. As a result, alcoholic esophagitis (inflammation of the esophageal mucosa) develops. There is a change in the motor function of the esophagus, which disrupts the function of swallowing. Food from the stomach returns to the esophagus. This is due to the effect of ethanol on the esophageal sphinkers. The patient develops heartburn and vomiting.
Chronic alcohol poisoning provokes esophageal varicose veins. Their walls become thin and burst during gag reflexes, severe bleeding occurs, the patient most often dies. In addition, there is a decrease in the production of gastric juice, the protective gel of the walls of the stomach changes, and gastritis develops. The cells of the stomach atrophy, food absorption and digestion are disturbed, stomach ulcers and bleeding occur. Following problems with the gastrointestinal tract, other organs begin to suffer.
The process of alcoholic liver damage has several stages: fatty degeneration, hepatitis and cirrhosis. Its structureunder the influence of alcohol changes all the time. Violated fat metabolism, it provokes the deposition of fat in the cells. Enzymes begin to be produced more slowly, the breakdown of ethanol slows down. There is a violation of protein metabolism as a result of fluid retention, the size of the liver increases.
Immune pathologies come into play - the body's reactions to changes in the functioning of the liver. When exposed to them, the destruction of liver cells is accelerated. Even after stopping the intake of alcoholic beverages, the immune system provokes the continuation of the development of the disease. The higher the ethanol content in drinks, the faster the pathology appears.
Cirrhosis of the liver with alcoholic heart disease
With prolonged and systematic use of alcohol, a violation of the structure of the myocardium occurs, the disease is called cardiomyopathy. Diffuse damage to the heart muscle occurs, the structure of muscle fibers is disturbed, and heart failure progresses. The disease has other names:
- beer heart;
- alcoholic heart disease;
- myocardial dystrophy.
When the disease is an increase in the size of the heart, it stretches and ceases to perform its functions. As a result, heart failure occurs, swelling, pain in the chest, shortness of breath appear. Symptoms worsen after drinking. With untimely treatment, serious complications occur, often ending in death.
The main cause of the disease is prolonged drunkenness, cirrhosis of the liver, geneticpredisposition, weak immunity, poor nutrition, frequent stress. The symptoms of a beer heart are:
- Pain syndrome - severe pain, shortness of breath, cyanotic skin color, cold extremities, rapid heartbeat.
- Alcohol intoxication - decreased intelligence, insanity, impaired coordination of movements, aggressiveness, absent-mindedness.
- Heart failure - characterized by swelling of the face and legs, blue nasolabial triangle and fingers, cough, shortness of breath, feeling short of breath.
- Asthenic syndrome - general weakness, fatigue occurs, bouts of fussiness and inappropriate behavior are possible.
- Arrhythmia - atrial fibrillation or extrasystolic, there are interruptions in the work of the heart.
Alcoholic heart disease is an incurable disease. Morphological changes in the myocardium cannot be eliminated. The prognosis is often poor.
Symptoms of disease
Several stages of the disease include alcoholic liver damage, and the signs of this disease also depend on them:
- The first is fatty liver disease. It can last more than ten years with regular alcohol consumption. Mostly asymptomatic. In some cases, there is a decrease in appetite, the occurrence of dull pain in the right hypochondrium, the appearance of nausea. Jaundice may occur in 15% of patients.
- The second is acute alcoholic hepatitis. There is a rapid severe course of pathology with a fatal outcome or,on the contrary, it proceeds with minor signs. The most common symptoms of alcoholic liver damage in the second stage of the disease are: pain in the right side, nausea, diarrhea, vomiting, loss of appetite, weakness, jaundice, hyperthermia.
- Third - chronic alcoholic hepatitis. The disease proceeds for a long time, and exacerbations are replaced by remissions. Characteristic signs: moderate pain, belching, nausea, heartburn, constipation may be replaced by diarrhea, jaundice may appear.
- Fourth - cirrhosis of the liver. The patient has the appearance of spider veins on the face and body, reddening of the palms, thickening of the phalanx of the fingers, a change in the shape and composition of the nail plates, expansion of the veins around the navel, in men the testicles decrease and the mammary glands increase. With the continuation of the development of cirrhosis, the following symptoms of alcoholic liver damage appear: enlargement of the auricles, proliferation of dense knots of connective tissue near the little finger and ring finger on the palms, which interfere with their flexion and extension, and eventually lead to immobilization.
Diagnosis of disease
To diagnose an alcoholic disease, you need to contact a gastroenterologist who will carry out the following activities:
- Survey of the patient - the doctor will find out the amount and frequency of alcohol-containing drinks consumed daily, the duration of alcohol dependence, its symptoms, listen to the patient's complaints.
- External examination - palpation of the liver and spleen is performed to determine their size, drawnattention to the enlargement of the parotid glands, dilatation of the saphenous veins of the abdominal wall, swelling of the legs, thickening of the phalanx of the fingers.
When signs of alcoholic liver damage appear, the following tests are prescribed:
- Biochemical and immunological blood test, which make it possible to more accurately assess the patient's condition: the level of liver enzymes AST and ALT, the concentration of bilirubin, the level of immunoglobulins are checked.
- Complete blood count - determines the number of platelets, leukocytes, monocytes and the erythrocyte sedimentation rate (ESR), as well as the level of hemoglobin
- Ultrasound of the liver - allows you to determine its size, fat deposits in the parenchyma are visible.
- Doppler study with ultrasound - examines the state of blood vessels.
- CT or MRI - shows changes in the tissues and vessels of the liver.
- For the final diagnosis of alcoholic liver damage, an instrumental study is being carried out. A piece of the organ is taken from the patient for a biopsy. It is she who allows you to give an accurate answer about the state of the liver and prescribe the appropriate treatment.
In the presence of other diseases, the patient is consulted by other specialists who conduct an examination and prescribe additional treatment.
Treatment methods
Not at any stage of liver damage, the treatment of the disease will be effective. With fatty degeneration, a reversible process is possible, but successful therapy depends on the desire of the patient. The diagnosis of "cirrhosis of the liver" indicates the impossibility of a complete cureand all actions during healing are aimed at alleviating the patient's condition.
- The main condition for the treatment of alcoholic liver damage is the complete rejection of alcoholic beverages, otherwise drug treatment will not give positive results. However, patients most often have been drinking alcohol for many years, and it is difficult for them to give up addiction, so they need the help of loved ones, and often a psychologist.
- Diet is important for recovery. People with alcoholism have a lack of proteins and vitamins. It is necessary to introduce as many products containing these elements into the diet as possible, and at the same time consume vitamin complexes.
- Before treatment, it is necessary to remove signs of intoxication of the body. For this, the patient is prescribed droppers with glucose, "Cocarboxylase" and "Pyridoxine".
- Hepatoprotectors in alcoholic liver damage accelerate tissue repair, increase its resistance to abnormal influences. Ursodeoxycholic acid will help normalize lipid metabolism and enhance the choleretic effect.
- In severe liver damage, hormonal anti-inflammatory drugs are used. They help eliminate lethality.
Drug therapy for cirrhosis of the liver is powerless. Only an organ transplant can save a patient's life. The operation is possible with a complete rejection of alcohol.
Consequences
Patients who have the initial stage of the disease and symptoms of alcoholic liver damage, treatment can only be started if they refuse to drink alcohol. ATOtherwise, they have no chance of recovery. The disease begins to progress every day and leads to the following complications:
- colopathy - intestinal damage;
- gastropathy - a disease of the stomach caused by impaired liver function;
- GI bleeding;
- hepatorenal syndrome – severe impact on kidney function;
- liver cancer;
- hepatopulmonary syndrome – characterized by low blood oxygen levels;
- peritonitis - inflammation of the peritoneum;
- infertility;
- fatal.
To eliminate the negative consequences, it is necessary to start treatment on time.
Medicated treatments
First of all, a therapy is carried out that provides detoxification of the body. It is necessary for any degree of alcoholic liver damage. Medicines used for this purpose:
- "Pyridoxine";
- Glucose;
- "Thiamin";
- Piracetam;
- Hemodez.
All solutions are administered intravenously for five days. After that, a rehabilitation course of therapy begins, which includes drugs:
- Essential phospholipids - serve to restore the structure of liver cells.
- Ursodeoxycholic acid - stabilizes the action of hepatocyte membranes.
- "Ademetionine" - has an anti-cholestatic and anti-depressant effect.
- "Essentiale" - helps restore liver cells.
- "Furosemide" - removespuffiness.
- "Prednisolone" - the appointment of corticosteroid drugs for alcoholic liver damage is allowed only if the patient is in a serious condition and there is no bleeding in the abdominal cavity.
The outcome of the disease depends on abstinence from alcohol.
Pathological Anatomy
When affected by alcohol, in the anatomical structure of the liver, at different stages of the development of the disease, the following changes are observed:
- Acute hepatitis - fatty degeneration is detected in hepatocytes of the liver, small foci of tissue necrosis appear, around which there is a small amount of segmented leukocytes. The liver increases in size up to 46 kg. Its tissue acquires a yellow color, soft, greasy texture. The cessation of alcohol intake leads to the restoration of the structure of the liver. Otherwise, stromal fibrosis appears in the centers of the lobules, which increases with the use of ethanol.
- Path anatomy of chronic alcoholic liver damage is marked by the penetration of the inflammatory infiltrate into the parenchyma of the lobules to a significant depth to the central veins. Lymphocytes begin to show aggression towards hepatocytes, causing ladder areas of necrosis. The synthesis of immunoglobulins occurs in the liver. Small bile ducts often become inflamed.
- Cirrhosis of the liver is an irreversible form of organ damage. The enlarged liver initially retains a flat surface. Its color becomes reddish-brown, the surface is greasy. There is a diffuse proliferation of connective tissue, falsedystrophic lobules, necrosis of hepatocytes occurs, regeneration is disturbed. Due to the decrease in fat, the liver changes color to brown. Nodules form on its surface, which increase with the progression of the disease. The organ is deformed, its surface becomes bumpy.
Conclusion
Alcoholic liver disease is a social problem. It can be solved only with the help of thorough medical and social programs. With the entry of ethanol into the body, the mechanism for the development of alcoholic damage to the gastrointestinal tract and liver immediately begins.
These organs are the first to fight, producing special enzymes to break it down. Subsequently, there is a gradual defeat of all body systems. And with cirrhosis of the liver, the disease begins to progress even with abstinence from alcohol. The key to success is treating the disease at an early stage.
