Alcoholic liver disease is a social and medical problem in all countries of the world. With the use of 40–80 grams of alcohol per day, the risk of developing cirrhosis increases significantly, especially women suffer from it. In addition to alcoholic liver damage, other systems and organs are also damaged, primarily: the digestive and nervous systems, heart, pancreas. And the manifestations of alcoholic illness themselves are very diverse. Prolonged use of alcoholic beverages 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 the uncontrolled use of alcohol. Alcohol has a toxic effect on the liver, in which:
- there is oxygen starvation of liver cells, their structure and functions are violated;
- connective tissue grows;
- there is necrosis of liver cells under the influence of ethanol decomposition products, and the organ decays faster than natural recovery;
- protein synthesis is suppressed, which increases the water content in the cells and leads to an increase in their size.
The risk factors that provoke alcoholic liver damage include:
- Hereditary predisposition. Some people have the genetic characteristics of reduced activity of enzymes that destroy alcohol.
- Female. It is noted that when taking the same doses, women have more ethanol in their blood than men. This phenomenon is explained by the different activity of enzymes that provide the metabolism of alcohol.
- Mental addiction. Poor social conditions, emotional instability, constant stressful situations contribute to the development of alcohol dependence. Long-term use of alcohol-containing drinks 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.
- Concomitant pathology. Congenital or acquired liver diseases that appeared before the abuse of alcohol, lead to disruption of its functioning. The constant intake of ethanol even in small doses in such people causes liver failure.
A high probability of the disease occurs when several risk factors coincide.
The mechanism of development of alcoholic damage to 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 system has good regenerative ability. But with constant exposure to ethanol, it does not have time to recover. As a result, alcoholic esophagitis (inflammation of the mucous membrane of the esophagus) develops. There is a change in the motor function of the esophagus, which disrupts the function of swallowing. Food from the stomach goes back into the esophagus. This is due to the effect of ethanol on the esophagus sphincters. The patient develops heartburn and vomiting.
Chronic alcohol poisoning provokes varicose veins of the esophagus. 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, gastritis develops. Gastric cells atrophy, digestion and digestion are disrupted, 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 structure under the influence of alcohol is constantly changing. Fat metabolism is disturbed, it provokes the deposition of fat in the cells. Enzymes begin to be produced more slowly, the decomposition 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 effect - the body's reactions to changes in the functioning of the liver. Under their influence, the destruction of liver cells is accelerated. Even after stopping the use of alcohol-containing drinks, immunity 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 damage to the heart
With prolonged and systematic use of alcohol, a violation of the myocardial structure occurs, the disease is called cardiomyopathy. Diffuse damage to the heart muscle occurs, the structure of muscle fibers is disrupted, heart failure progresses. The disease has other names:
- beer heart;
- alcoholic damage to the heart;
- myocardial dystrophy.
With the disease, an increase in the size of the heart occurs, it stretches and stops performing its functions. As a result, heart failure occurs, swelling, pain in the chest, shortness of breath appear. Symptoms worse after binge. With untimely treatment, serious complications arise, often ending in death.
The main cause of the disease is prolonged drunkenness, cirrhosis, genetic predisposition, poor immunity, poor nutrition, frequent stresses. The following symptoms are characteristic of a beer heart:
- Pain syndrome - severe pain, lack of air, bluish skin color, cold extremities, heart palpitations.
- Alcohol intoxication - decreased intelligence, insanity, impaired coordination of movements, aggressiveness, distraction.
- Heart failure - characterized by swelling of the face and legs, blueness of the nasolabial triangle and fingers, coughing, shortness of breath, feeling of lack of air.
- Asthenic syndrome - general weakness, fatigue occurs, bouts of fussiness and inappropriate behavior are possible.
- Arrhythmia - atrial or extrasystolic, interruptions in the work of the heart occur.
Alcoholic damage to the heart is an incurable disease. Morphological changes in the myocardium cannot be eliminated. The prognosis is most often unfavorable.
Symptoms of the disease
Several stages of the disease include alcoholic liver damage, and the signs of this ailment depend on them:
- The first is fatty degeneration of the liver. It can last more than ten years with regular use of alcohol. Mostly asymptomatic. In some cases, there is a decrease in appetite, the occurrence of dull pain in the right hypochondrium, the appearance of nausea. 15% of patients may cause jaundice.
- The second is acute alcoholic hepatitis. There is a rapid, severe course of pathology with a fatal outcome or, conversely, 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.
- The third is chronic alcoholic hepatitis. The disease proceeds for a long time, and exacerbations are replaced by remissions. Characteristic signs: moderate pain, belching, nausea, heartburn, constipation can be replaced by diarrhea, jaundice may occur.
- The fourth is cirrhosis of the liver. The patient has the appearance of vascular asterisks on the face and body, redness of the palms, a 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 are reduced and the mammary glands are enlarged. With the continued development of cirrhosis, the following symptoms of alcoholic liver damage appear: enlargement of the auricles, growth of dense bundles of connective tissue on the palms of the little finger and ring finger, which interfere with their flexion and extension, and eventually lead to immobilization.
Diagnosis of the disease
To diagnose an alcoholic disease, you need to contact a gastroenterologist who will conduct the following activities:
- Survey of the patient - the doctor will find out the number and frequency of alcohol-containing drinks consumed daily, the duration of alcohol dependence, its symptoms, and will listen to the patient's complaints.
- External examination - palpation of the liver and spleen is performed to determine their size, attention is drawn to an increase in the parotid glands, expansion of the saphenous veins of the abdominal wall, swelling of the legs, and thickening of the phalanx of the fingers.
When signs of alcoholic liver damage appear, the following studies are prescribed:
- Biochemical and immunological blood tests, which make it possible to more accurately assess the patient's condition: the level of hepatic enzymes AST and ALT, the concentration of bilirubin, the level of immunoglobulins are checked.
- General blood test - the number of platelets, white blood cells, monocytes and the erythrocyte sedimentation rate (ESR), as well as the level of hemoglobin, are determined
- Ultrasound of the liver - allows you to determine its size, visible fat deposits in the parenchyma.
- 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 performed. The patient takes a piece of the organ for biopsy. It is she who allows you to give an accurate answer about the state of the liver and prescribe appropriate treatment.
In the presence of other diseases of the patient, other specialists consult who conduct the examination and prescribe additional treatment.
Treatment methods
Not at any stage of liver damage, treatment of the disease will be effective. With fatty degeneration, a reversible process is possible, but successful therapy depends on the patient's desire. The diagnosis of cirrhosis indicates the impossibility of a complete cure, and all actions during treatment are aimed at alleviating the patient's condition.
- The main condition for the treatment of alcoholic liver damage is a complete rejection of alcohol-containing drinks, otherwise drug treatment will not give positive results. However, patients have most often consumed alcohol for many years, and it is difficult to give up addiction, so they need the help of loved ones, and often a psychologist.
- Of no small importance for recovery is the diet. People with alcoholism have a lack of proteins and vitamins. It is necessary to introduce as much as possible products containing these elements into the diet, and at the same time use vitamin complexes.
- Before treatment, it is necessary to remove the signs of intoxication of the body. For this, the patient is prescribed droppers with glucose, Cocarboxylase and Pyridoxine.
- Hepatoprotectors for alcoholic liver damage accelerate tissue repair, increase its resistance to abnormal effects. “Ursodeoxycholic acid” will help normalize lipid metabolism and enhance the choleretic effect.
- With severe liver damage, hormonal anti-inflammatory drugs are used. They help to eliminate lethality.
Drug therapy for cirrhosis is powerless. Only organ transplantation can save a patient’s life. The operation is possible with a complete rejection of alcohol.
Effects
Patients with an initial stage of the disease and symptoms of alcoholic liver damage can begin treatment only if they refuse to drink alcohol. Otherwise, they have no chance of recovery. The disease begins to progress every day and leads to the following complications:
- colopathy - damage to the intestines;
- gastropathy - a disease of the stomach that arose due to impaired liver function;
- gastrointestinal bleeding;
- hepatorenal syndrome - severe effects on renal function;
- liver cancer;
- liver-pulmonary syndrome - characterized by a low oxygen content in the blood;
- peritonitis - inflammation of the peritoneum;
- infertility;
- fatal outcome.
To eliminate the negative consequences, it is necessary to start treatment on time.
Medical treatments
First of all, 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";
- Thiamine;
- Piracetam
- "Hemodez."
All solutions are administered intravenously over five days. After this, 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.
- "Ademethionine" - has an anticholestatic and antidepressant effect.
- "Essential" - helps restore liver cells.
- "Furosemide" - relieves puffiness.
- "Prednisolone" - the appointment of alcoholic liver damage drugs corticosteroids is allowed only with a serious condition of the patient and the absence of bleeding in the abdominal cavity.
The outcome of the disease depends on abstinence from alcohol.
Pathological anatomy
With 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 the liver cells of hepatocytes, small foci of tissue necrosis appear, around which there is a small amount of segmented white blood cells. The liver increases in size up to 46 kg. Her fabric acquires a yellow color, soft, greasy consistency. Stopping alcohol leads to restoration of the liver structure. Otherwise, stromal fibrosis appears in the centers of the lobules , which increases with the use of ethanol.
- Pathanatomy of alcoholic liver damage of a chronic nature is noted by the penetration of inflammatory infiltrate into the parenchyma of the lobules to a significant depth to the central veins. Lymphocytes begin to show aggression to hepatocytes, causing staircases of necrosis. In the liver, the synthesis of immunoglobulins occurs. Small bile ducts are often inflamed.
- Cirrhosis is an irreversible form of organ damage. Enlarged liver initially maintains a flat surface. Its color becomes reddish-brown, the surface is greasy. Diffuse proliferation of connective tissue occurs, false dystrophic lobules appear, hepatocyte necrosis occurs, and regeneration is impaired. 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 tuberous.
Conclusion
Alcoholic liver disease is a problem of the whole society. It can be solved only with the help of thorough medical and social programs. With the intake of ethanol in the body, the mechanism of the development of alcoholic damage to the gastrointestinal tract and liver begins immediately.
These organs are the first to enter the struggle, producing special enzymes for its cleavage. Subsequently, there is a gradual defeat of all body systems. And with cirrhosis, the disease begins to progress even with abstinence from alcohol. The key to success is the treatment of the disease at an early stage.