Alcohol-Related 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 disease. Most often it is asymptomatic, sometimes patients report decreased appetite and periodic dull pain 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 severe fulminant course, leading to death. However, the most common signs of alcoholic hepatitis are pain (dull pain in the right hypochondrium), dyspeptic disorder (nausea, vomiting, diarrhea), weakness, loss of appetite and weight loss. Also a frequent symptom is hepatic jaundice (the skin has an ocher tint). In half of the cases, acute alcoholic hepatitis is accompanied by hyperthermia.

Chronic alcoholic hepatitis proceeds for a long time with periods of exacerbations and remissions. Periodically, moderate pain occurs, nausea , belching, heartburn, diarrhea, alternating with constipation, may appear . Jaundice is sometimes noted.
With the progression of alcoholic disease, the symptoms of hepatitis are joined by signs characteristic of developing liver cirrhosis : palmar erythema (reddening of the palms), telangiectasias (spider veins) on the face and body, "drumsticks " syndrome (characteristic thickening of the distal phalanges of the fingers), "watch glasses" (pathological change in the shape and consistency of nails (dilated veins in the front abdominal wall around the navel) "heads of a jellyfish" in men, gynecomastia and hypogonadism (enlargement of the mammary glands and reduction of the testicles) are sometimes noted .

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 is dupuytren's 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, it grows with involvement in the process of the joints of the hand. Patients complain of difficulty in bending the ring finger and little finger. In the future, their complete immobilization may occur.

Complications:

Hepatic encephalopathy, in which toxic compounds build up in the body as a result of a decline in functional activity and are deposited in the brain tissues, and reduced kidney function are all common complications of alcoholic liver disease. Alcoholics are susceptible to liver cancer.
 

Causes

Among the main causes of 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 reduced activity of alcohol-destroying enzymes;
•    Concomitant or past liver disease;
•    Metabolic disorders ( metabolic syndrome , obesity , bad eating habits), endocrine disorders .

Pathogenesis:

The bulk of ethyl alcohol entering the body (85%) is exposed to the action of 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 use of alcohol, its catabolism accelerates, and there is an accumulation of toxic products formed during the breakdown of ethanol. These products have a toxic effect on the liver tissue, causing inflammation, fatty or fibrous degeneration of the liver parenchyma cells.

Treatment

A prerequisite is the complete and final renunciation of 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, a balanced content of proteins, vitamins and minerals, since 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 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 a severe form of acute alcoholic hepatitis that 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's contractures, initially they are treated with physiotherapeutic methods ( electrophoresis , reflexology , exercise therapy , massage , etc.), and in advanced cases they resort to surgical correction.

Liver cirrhosis requires symptomatic treatment and treatment of emerging complications (venous bleeding, ascites , hepatic encephalopathy). In the terminal stage of the disease, donor liver transplantation may be recommended for patients. This operation requires strict abstinence from alcohol for at least six months.

Tests Required for Diagnosis

In the diagnosis of alcoholic liver disease, a significant role is played by the collection of anamnesis and the identification of a patient's prolonged alcohol abuse. During the consultation, a hepatologist or gastroenterologist carefully finds out how long, with what regularity and in what quantities the patient drinks alcohol.

In laboratory studies, a general blood test shows macrocytosis (the toxic effect of alcohol on the bone marrow), leukocytosis, and accelerated esr. Megablastic and iron deficiency anemia may be present . A reduced platelet count is associated with inhibition of bone marrow function, and is also detected as a symptom of hypersplenism with increased pressure in the vena cava system in cirrhosis.

In a biochemical blood test, an increase in the activity of ast and alt (hepatic 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.

A thorough history taking is essential for the diagnosis of alcoholic liver disease. It is important to consider the frequency, quantity and type of alcoholic beverages consumed. Due to the increased risk of developing liver cancer in patients with suspected alcoholic disease, the content of alpha-fetoprotein in the blood is determined. At its concentration of more than 400 ng / ml, the presence of cancer is suggested. Also, patients have a violation of fat metabolism - the content of triglycerides in the blood increases.

Instrumental methods that help diagnose alcohol disease include ultrasound of the abdominal cavity and liver, dopplerography, ct, liver mri , radionuclear testing and liver tissue biopsy.

When performing ultrasound of the liver, signs of changes in size and shape, fatty degeneration of the liver (characteristic hyperechogenicity of liver tissues) are clearly visible. Doppler ultrasound reveals portal hypertension and increased pressure in the hepatic vein system. Computed and magnetic resonance imaging well visualizes the liver tissue and its vascular system. Radionuclide scanning reveals diffuse changes in the hepatic lobules, and the rate of hepatic secretion and bile production can also be determined. For the final confirmation of alcoholic disease, a liver biopsy is performed for histological analysis.