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Aug 22, 2022
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Alcoholic hepatitis: treatment

Alcoholic hepatitis: treatment

Among the forms of chronic liver diseases, alcoholic liver disease occupies 24%. Alcoholic liver disease is a group of diseases that are the result of long-term alcohol abuse. These are sequentially developing conditions – from hepatic steatosis to cirrhosis, which are stages of one process.

Alcohol has a toxic effect on liver cells and alcoholic toxic hepatitis develops. Long-term and daily drinking is more dangerous than occasional drinking because it can repair and regenerate the liver. The toxic effect depends on the dose of ethanol and does not depend on the type of drink: 10 g of ethanol is contained in 25 ml of vodka, 200 ml of beer and 100 ml of wine.

Patients do not attribute beer to those, but meanwhile, the daily intake of this drink is enough for the development of hepatitis. It has been established that a risky dose of ethanol for the development of liver damage is a daily intake of 30-60 g of ethanol, a dangerous dose is 60-80 g, and a cirrhogenic dose is 80-160 g. Women are more sensitive to alcohol, and they often develop severe forms of the disease with short-term use of small doses of alcohol.

The diagnosis is established on the basis of regular alcohol consumption, the presence of clinical changes and laboratory and instrumental abnormalities. The relevance of the problem lies in the fact that this pathology is associated with a high risk of developing cirrhosis of the liver, which leads to disability and death. Cirrhosis of the liver is the culmination of the disease. The ICD-10 code for alcoholic cirrhosis of the liver is K70.3.

The reasons

Alcohol abuse, which to some extent is associated with a genetic predisposition. In half of the cases, the predisposition to addiction is inherited and is associated with changes in the GABRA2, PNPLA3 and PARy2 genes. It has been established that carriers of the PNPLA3 gene mutation have a 2.8-fold increased risk of liver cirrhosis.

Association with chronic viral hepatitis. The combination of viral hepatitis C and alcoholism causes more significant organ damage.

It is also worth noting the factors affecting the development of alcoholic disease in severe form:

  • dose and duration of use;
  • type of alcohol;
  • gender (in this case female);
  • obesity;
  • nutritional imbalance (consumption of excess fat, lack of vitamins and proteins);
  • trophological deficiency.

Symptoms of alcoholic hepatitis
Manifestations of alcoholic liver damage depend on the type of damage and its severity.
So, alcoholic hepatosis is asymptomatic or with minimal symptoms. Patients are concerned about the periodic heaviness of the hypochondrium on the right, which appears after drinking alcohol, nausea and poor tolerance to fatty foods. On examination, an enlarged liver is found, liver samples are normal or elevated. An increase in the level of alkaline phosphatase is characteristic.

Symptoms of alcoholic hepatitis are variable, depending on the activity of the process. Most often, hepatitis occurs with increasing jaundice, which is the main symptom, weight loss, fever, nausea, and decreased appetite.

The development of jaundice is associated with temperature, weight loss, and nutritional deficiencies. In severe cases, jaundice is observed in 100%, in such patients the temperature rises to 38-40 C. Ascites in hepatitis is rare, but patients have an increased risk of infections.

The severity of hepatitis is determined by the degree of liver dysfunction.

  • With a mild degree, the activity of enzymes is three times higher than normal.
  • With an average degree – five times.
  • In severe cases – more than five times.

Most people experience improvement in liver function after months of abstaining from alcohol.

Symptoms of alcoholic cirrhosis of the liver depend on the stage of cirrhotic changes. For many years, cirrhosis is compensated. In the initial stage, patients complain of flatulence, heaviness in the right side of the abdomen, weight loss, and general weakness. In more advanced stages, there is an increase in the abdomen, the appearance of dilated veins on the abdominal wall (venous collaterals develop), diuresis decreases, there may be fever, jaundice, bleeding (nasal and esophageal), reddening of the palms (“liver palms”). Expansion of the saphenous veins on the abdominal wall (“jellyfish head”) indicates an increase in pressure in the portal vein system. With obstacles to the passage of blood through the liver against the background of cirrhosis, venous blood is redistributed along the bypass outflow tracts.

Care

For alcoholic liver damage, the following approaches to treatment are used:

  • Refusal of alcohol. The fulfillment of this condition alone at the stage of fatty hepatosis causes a reverse development of changes in the liver, and in hepatitis and cirrhosis it improves the state of health and biochemical parameters of liver function.
  • High-calorie and protein-rich food, supplementing it with vitamins (folic acid and vitamin B 1).
  • Detoxification therapy in case of acute hepatitis and active chronic.
  • Hepatoprotectors (phospholipids and amino acids that stabilize cell membranes).
  • Ursodeoxycholic acid preparations.
  • Anti-inflammatory (corticosteroids) at the stage of severe hepatitis.
  • With irreversible liver damage – organ transplantation.

Drug treatment of alcoholic hepatitis

The basis of drug treatment of the liver at any stage are hepatoprotectors. This is an extensive group of drugs with different mechanisms of action.

First of all, these are essential phospholipids in the form of preparations Essentiale-forte N, Livenciale, Livolin-forte (contains phospholipids vitamin E, vitamin B1, B2, B6, B 12, Nicotinamide), Livolife Forte. They are taken in long courses of 3-4 months.

Ademetionine preparations (Heptral, Heptor, Geparetta, Heptrazan). The mechanism of action is to activate the synthesis of glutathione in the liver cells. The preparations have a regenerating and antioxidant effect, help to reduce fibrosis. Increases survival even in the terminal stage of liver damage. Ademetionine is prescribed at a dose of 800 mg for a month (first intravenously, then tablets inside).

Preparations of glutathione Gepaval, Glation. Glutathione is a protective factor for the liver. Considering that glutathione content in mitochondria is depleted in alcoholic liver damage, the appointment of this group of drugs is justified. These drugs restore the membrane of hepatocytes, accelerate regeneration, have an antioxidant and detoxifying effect.

Ursodeoxycholic acid preparations (Ursosan, Ursoliv, Ursohol) are indicated for cholestatic hepatitis, as they well eliminate itching, improve liver function indicators (liver enzymes and bilirubin), and have a cytoprotective and immunomodulatory effect. They are prescribed at 12-15 mg per kg of body weight per day for 3-6 months.

Silymarin-containing hepatoprotectors based on the milk thistle plant (Silibor, Gepabene), artichoke (Hofitol) also have an antioxidant and regenerating effect. Course duration up to 3 months, combined with Livolin-forte or Essentiale-forte N.

Sources of the amino acids arginine and betaine necessary for normal liver function, as they improve intracellular metabolism, protein synthesis function and are involved in the synthesis of phospholipids.
Preparations Citrarginine and Betargin.

For the activation of glycolysis in the liver, alpha-lipoic acid is important (preparations Lipoic acid in tablets, Berlition, Neurolipon, Octolipen).
The drug Glutargin (arginine + glutamic acid) restores the integrity of membranes, stimulates protein synthesis, improves the supply of liver cells with energy, restores the detoxification function of the liver, binding the toxic product ammonia. Especially indicated for cirrhosis of the liver; hepatic encephalopathy with symptoms of hyperammonemia, precoma and coma.

Glucocorticoids are used in the treatment of hepatitis with hepatic impairment. But their use should be short (no more than 4 weeks). Prednisolone is used at 30-40 mg per day. After that, the level of bilirubin is monitored. If it decreases by 25%, then the treatment is extended up to a month. The decrease in bilirubin during treatment with prednisolone correlates with the survival of patients.

In the treatment of alcoholic fibrosis, they affect the formation of fibrogen: γ-Interferon, Neo-minofagen C, Iskador.
Detoxification therapy and vitamins – according to indications.

Treatment of alcoholic hepatitis necessarily includes correction of the patient’s nutritional status. Patients expressed endogenous depletion associated with a decrease in glycogen stores in the liver. This condition is exacerbated by exogenous malnutrition – patients are malnourished and their diet has a low calorie content (less than 1000 kcal) and among such patients there is a high mortality rate.

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