Treatment of alcoholic cirrhosis of the liver and symptoms of the disease. How much do you need to drink to develop cirrhosis of the liver, how does anesthesia work and why does ammonia smell so strong Alcoholic cirrhosis of the liver takes how long to form

Alcoholic cirrhosis of the liver is the most severe form of alcoholic disease. Its essence boils down to the fact that normal functioning cells (hepatocytes) die off under the toxic effects of alcohol, and in their place inelastic fibrous tissue, similar to a scar, is formed. Toxic cirrhosis of the liver will not develop due to a one-time use of a small dose of alcohol - it is necessary to take it systematically in large quantities. The disease develops in approximately 10% of people who take uncontrolled alcoholic drinks, but changes at the stage of cirrhosis are already irreversible.

Causes of the disease

Alcoholic cirrhosis of the liver does not develop in a day or even a year. It is diagnosed in individuals who systematically abuse alcoholic beverages for 8-12 years. This figure depends on many factors - the frequency of heavy drinking, gender, genetic characteristics, as well as the type, strength and quality of alcohol. In particularly advanced cases, cirrhosis can develop over several years.

Alcohol and heredity

Identical doses of alcohol can cause different effects, even if other conditions are the same. Doctors attribute this fact to the innate activity of enzymes that are responsible for the utilization of ethyl alcohol. There are 5 such enzymes in total, and it depends on them what proportion of alcohol consumed will be excreted from the body, and what will turn into toxic acetaldehyde, which will destroy the liver.

In addition to genetic material, the likelihood of developing alcoholic cirrhosis of the liver is influenced by the standard of living, the patient’s environment and the culture of drinking alcohol in the family. In addition, statistics indicate that most often monozygotic twins suffer from alcoholism together. This rate is lower among dizygotic twins.

The effects of alcohol on men and women

The increase in alcoholism among women is associated with the progression of their role in society. Female representatives can drink alcohol on an equal basis with men, which does not cause condemnation. However, physiologically their body is unable to absorb ethanol in full. The gastric mucosa contains an enzyme that is involved in the metabolism of ethyl alcohol, and in women it is inactive. For this reason, it is not processed and excreted from the body, but forms toxins that destroy liver cells.

In addition, women rarely seek medical help for alcoholism. Their loved ones and relatives also do not sound the alarm, since this disease is more often associated with men. Patients with toxic cirrhosis of the liver are admitted to the hospital in the final stages, when changes in the tissues are already irreversible. Moreover, after a course of therapy, they experience breakdowns more often than after treatment for alcoholic cirrhosis of the liver in men.

Alcoholic cirrhosis and nutrition

Toxic cirrhosis is the last stage of alcoholic liver disease. The rate of its development is influenced not only by the doses of alcohol consumed, but also by other factors. It is noted that the likelihood of this disease is highest with poor nutrition, especially with a deficiency of protein in the diet. The first signs of liver damage appear against the background of a lack of proteins and vitamins, an abundance of fatty, fried foods and fast food. Alcohol intoxication provokes further destruction of hepatocytes.

Other reasons

with non-alcoholic hepatitis of any origin;
with metabolic disorders;
for inflammatory and ulcerative diseases of the gastrointestinal tract.

When taking any medications, you also need to consider their compatibility with alcohol. In addition to a short-term deterioration in health, unacceptable combinations can provoke intoxication of the body and have a detrimental effect on the liver.

How much alcohol do you need to drink to develop cirrhosis of the liver?

The main factor that plays a role in the development of toxic cirrhosis is the duration of alcohol intake, and not its one-time use. The body is able to cope with incoming ethanol, but its processing products tend to accumulate in the liver. Therefore, alcoholic cirrhosis of the liver develops within 10-15 years with daily intake of even large quantity alcohol

Ethanol is present in alcoholic beverages in different concentrations. The table provides data on the permissible number of different types that will not cause signs of alcoholic cirrhosis.

Ethanol in small quantities does not harm the liver if consumed 1 or 2 times a week. However, the problem with most alcoholics is that they cannot control their dosage. Alcoholism is a disease that requires significant self-control. It is best to avoid any amount of alcohol and prefer other drinks. Non-alcoholic beer contains a minimal percentage of alcohol and can serve as an alternative to the classic recipe.

Pathogenesis - how does alcohol affect the body?

Alcoholic cirrhosis is the last stage of liver damage caused by ethanol. First, the liver cells manage to produce specific enzymes in sufficient quantities, and it is completely eliminated from the body. If you take it regularly in abnormal amounts, the enzymes cannot cope with this task, and toxic acetaldehyde is formed during the processing of alcohol. He determines Negative influence alcohol on the human body.

At the cellular level, acetaldehyde produces a number of negative effects:

interferes with the normal course of redox reactions in liver cells;
increases the susceptibility of hepatocytes to the harmful effects of free radicals;
provokes lipid peroxidation reactions, which occur with the destruction of functional cells;
disrupts the structure of important cellular elements: microtubules, mitochondria and nuclei.

First, fatty liver degeneration develops from alcohol. This is a syndrome associated with lipid metabolism disorders in which fat accumulates in normal cells. Then inflammatory reactions are involved in the process, and alcoholic hepatitis develops. If you continue to drink alcohol, the first manifestations of cirrhosis occur: tissues die and are replaced by dense connective tissue.

There is an alternative option for the development of cirrhosis - fibrosis. In this case, it appears bypassing the first stages of fatty degeneration and cirrhosis. Doctors believe that lactic acid plays a leading role in this mechanism, which affects specific fat-storing Ito cells. They turn into fibroblasts, which resemble a scar in structure. In addition, increased collagen synthesis is observed in liver tissue instead of normal hepatocytes.

If the disease is detected at the first stage, it can be completely eliminated with medications and diet. An alcoholic is rarely able to recognize his problem on his own, so providing him with medical care and monitoring the treatment process is the task of his loved ones and relatives. Over time, the task only becomes more complicated, and rarely do any patients manage to live with liver cirrhosis for more than 5 years.

Forms of alcoholic cirrhosis

There is a Child-Pugh classification of toxic cirrhosis, which determines the severity of the disease. Based on the results of ultrasound and blood tests, as well as clinical manifestations, you can select from 1 to 3 points on a special scale. Next, the points are summed up, and based on the resulting value, the class of the disease can be determined. These data make it possible to predict how long different patients with liver cirrhosis will live.

Options	Points
Options	1	2	3
Ascites (presence of fluid in the abdominal cavity)	No	Slightly	A large number of
Brain damage	No	Easy stage	Severe stage
Bilirubin in blood, µmol/l	Less than 34 (2.0)	34-51 (2,0-3,0)	More than 51 (3.0)
Albumin, g	More than 35	28-35	Less than 28
PTI (prothrombin index)	More than 60	40-60	Less than 40

Interpretation of results:

5-6 points - class A, or compensation stage. This is the first stage, in which life expectancy can be up to 15-20 years.
7-9 points - class B, or subcompensation stage. In this case, the clinical manifestations of cirrhosis are pronounced, frequent exacerbations and severe pain are observed. The patient's life expectancy is 5-7 years. Liver transplantation has a mortality rate of up to 30%.
10-15 points - class C, or stage of decompensation. Symptoms of alcoholic cirrhosis of the liver are pronounced, complications develop. With this diagnosis, a patient can live from 1 to 3 years, the probability of death after a liver transplant is up to 82%.

The disease is also usually classified according to the extent of damage to liver tissue. He can be:

small nodular - small areas of cirrhosis are formed in the parenchyma;
large nodular - large cirrhotic lesions;
mixed, if scar lesions of different sizes are formed.

Cirrhosis is distinguished from fibrosis by the severity of liver damage. If during fibrosis its structure is preserved, then cirrhosis destroys the normal structure in the form of lobes and lobules.

Symptoms of the disease

Signs of liver cirrhosis in alcoholics do not appear immediately. Over the course of several years, the replacement of normal tissue with scar tissue can occur unnoticed. Then the organ cannot cope with the toxins that enter the body, and the first symptoms appear.

General symptoms

Intoxication affects all organ systems and causes a general deterioration in the patient’s well-being. The first signs will not be specific, but will only indicate the presence of a pathological process in the body:

permanent increase in body temperature by 0.5-1 ᴼС;
insomnia and other sleep disorders;
fatigue, decreased performance;
weight loss;
frequent mood changes.

The patient may experience pain in the right hypochondrium, but the liver is not visually enlarged in size. An accurate diagnosis at this stage can only be made based on the results of an ultrasound and blood test.

Liver failure syndrome

Over time, symptoms appear that indicate liver cirrhosis:

pain in the right hypochondrium;
an increase, and over time, a decrease in the volume of the organ;
nausea, flatulence, vomiting of intestinal contents;
jaundice - yellowing of the skin and mucous membranes;
the appearance of spider veins on the skin;
“drumsticks” - thickening of the joints of the terminal phalanges of the fingers;
Dupuytren's contracture is an anomaly of the tendons of the hands, which leads to impaired mobility;
enlargement of salivary glands.

Portal hypertension

This term means high blood pressure in the portal vein system. The walls of the blood vessels weaken, and internal bleeding may occur. Clinically, this phenomenon is manifested by characteristic symptoms:

vomiting with blood from gastric and intestinal bleeding;
black stool with bleeding from the intestinal veins;
stool mixed with bright blood (bleeding from hemorrhoidal veins);
ascites - dropsy of the abdominal cavity;
“jellyfish head” syndrome - the abdomen is swollen due to the presence of fluid, veins are clearly visible on it;
enlarged spleen.

Treatment at this stage will no longer be effective. The disease is accompanied by constant pain in the liver and interferes with the patient’s normal life.

Cardiovascular failure

Liver cirrhosis affects all organ systems, including the cardiovascular system. The walls of blood vessels become brittle and the heart cannot cope with the stress. The patient is diagnosed with:

decreased blood pressure;
tachycardia;
shortness of breath when moving;
heart rhythm abnormalities;
pain in the heart area.

Increased vascular permeability is manifested by swelling. The symptom intensifies when it is impossible to carry out normal physical activity.

Diagnostics

In many cases, the diagnosis can be made by characteristic clinical signs, as well as by interviewing the patient. First of all, you need to determine whether you have been drinking alcohol for a long time. The doctor also studies the medical history to identify possible concomitant pathologies. Past liver diseases of various origins are important.

The diagnosis can be confirmed by ultrasound and blood tests. These diagnostic methods will reveal;

enlargement of the liver, changes in its structure;
enlarged spleen;
in the blood - increased activity of liver enzymes (ALT, ALT), bilirubin levels, erythrocyte sedimentation rate; decrease in the number of red blood cells.

Treatment methods

At the stage of cirrhosis, there are few ways to cure the disease. In some cases, transplantation is performed from a healthy donor, but this method also has contraindications. During surgery, mortality can reach 80%. Before surgery, you must completely avoid alcohol for a period of 6 months or more.

In other cases, it makes no sense to treat the disease. All manipulations are aimed at prolonging life and relieving symptoms, but not at complete recovery. The patient is prescribed:

detoxification infusions;
hormonal anti-inflammatory drugs;
hepatoprotectors;
diuretics to relieve swelling.

Diet is important. Alcohol in any doses is contraindicated for the patient throughout his life. You should also exclude fatty and fried foods, salty and smoked foods, carbonated water and drinks. The diet should contain large quantities of protein, vitamins and minerals.

Prevention and prognosis

The only measure to prevent the disease is proper consumption of alcohol. In this case, it is worth paying attention not only to the amount of alcohol, but also to the quality of the drinks. Liver disease can also be prevented if you watch your diet. The diet should contain a sufficient amount of protein, vitamins and microelements. You should reduce your consumption of fatty, fried foods, and carbonated non-alcoholic drinks. If cirrhosis develops, treatment will not imply complete recovery. Therapy is aimed at maintaining the patient's life and delaying death. In different cases, the patient can live from 1 to 15 years with this diagnosis.

Toxic cirrhosis of the liver develops at the last stage of alcoholic disease. This is a dangerous pathology, which is characterized by complete destruction of the organ, intoxication of the body, and disruption of the functioning of all systems. It is completely impossible to cure, but some patients undergo a liver transplant. This operation allows him to prolong his life and get rid of the symptoms of cirrhosis, but it is not available to all patients. Treatment of alcoholic cirrhosis of the liver in any case implies a complete abstinence from alcoholic beverages, otherwise the prognosis will be disappointing.

The relevance of such a problem as alcoholic illness the liver is very large. In terms of prevalence and social significance, this pathology ranks second after viral hepatitis.

There are no safe doses of alcohol. According to WHO recommendations, up to 20–40 ml of ethanol for men and up to 20 ml of ethanol for women can be considered relatively safe doses of alcohol. A dose of 10 ml of ethanol is contained in 25 ml of vodka, 100 ml of wine or 200 ml of beer.
Signs indicating the harmful effects of alcohol on the liver appear when drinking more than 80 ml of ethanol per day for five or more years.

For an adult man to develop alcoholic liver disease with a possible transition to cirrhosis, it is enough to drink alcohol in a dose of 50–80 ml of ethanol per day; for a woman this dose is already 30–40 ml, and for adolescents it is even lower: 15–20 ml per day. And this is only 0.5 liters of 5% beer every day!

According to WHO, more than 90% of the population drink alcohol, of which almost half do so monthly and for several days. 10% of men and 3–5% of women drink daily.

The myth about the harmlessness of “weak” alcohol

There is a common misconception that if you drink weak alcohol (beer, low-alcohol cocktails, etc.), then it will benefit the body as a whole. But is it?

The effect and harm of low-alcohol drinks is equivalent to the effects of strong ones. And the main reason for this equivalence is quantity. Few people think about how much ethanol enters the body if you drink “just” a few bottles of beer a day.

You only need to drink three bottles of beer or two cans of low-alcohol cocktail to get the same amount of ethanol as is contained in a glass of vodka.

According to statistics, beer is consumed by more than half of the population of our country. And the popularity of beer does not lose ground due to its apparent “harmlessness”. The number of beer consumers is growing every year. Experts consider beer a legalized drug, to which physical and psychological dependence. Teenagers and women can become addicted to beer especially quickly.

Beer contains toxic compounds and heavy metals that can change the hormonal status of the body and cause poisoning.

“Beer makes you lazy, stupid and powerless,” said Bismarck, the first Reich Chancellor of Germany. And he knew a lot about beer firsthand.

Low-alcohol canned cocktails are also gaining popularity, especially among young people. Due to their sweetish taste, they are perceived as strong lemonade. But one can contains an amount of ethanol equal to 100 ml of vodka. And this is not counting various chemical additives (flavors, dyes) and sugar, which also harm the liver and cause poisoning of the body as a whole.

Therefore, we can confidently conclude that beer and other low-alcohol drinks are no less harmful than strong alcohol.

Liver and alcohol

The effect of alcohol on the liver is direct. After entering the body, part of the alcohol is eliminated through the skin, lungs and kidneys. The main “blow” and harm (and this is about 90% of consumed alcohol) is taken by the liver, where further processing of the alcohol consumed occurs.

First, under the influence of a special enzyme - alcohol dehydrogenase - ethyl alcohol is oxidized and converted into acetaldehyde. Next, acetaldehyde is oxidized through complex chemical reactions and decomposes to the final substances - carbon dioxide and water. But this only happens when the amount of alcohol is small and sufficient to completely complete the cycles of converting ethanol into breakdown products that are not harmful to the body and do not cause poisoning.

If a lot of alcohol is consumed, enzyme deficiency occurs and the process of ethanol processing at different stages is disrupted. There is an accumulation of intermediate products of its oxidation and breakdown in the liver. Acetaldehyde is tens of times more toxic than ethanol; its excess causes, in addition to its direct damaging effect, disruption of the normal outflow of bile, accumulation of fats in the liver, and general poisoning of the body. And ethyl alcohol, which does not oxidize due to excess, causes the development of connective tissue in the liver, which leads to fibrosis.

The liver has amazing regenerative functions and the ability to heal itself. But these liver abilities are not endless, and, in the end, this potential is exhausted. Liver cells begin to be replaced by fibrous tissue with a restructuring of their functions and transition to cirrhosis.

What mechanisms and risk factors cause alcoholic liver damage?

First of all, this is chronic alcohol abuse. Sometimes the quantity and quality of liver enzymes that metabolize alcohol can be genetically impaired.

It has been noted that women are more susceptible to alcohol and their addiction develops faster.

When combining alcohol intake with drugs metabolized in the liver, the harmful effect on hepatocytes increases several times.

The lifestyle that a person drinks alcohol leads also matters. It is known that nutritional deficiencies (malnutrition, diets) and alcohol are incompatible.

If there is viral hepatitis, then the negative effect of alcohol on the liver increases with its consumption. Vaccination against hepatitis helps prevent the disease. A quarter of patients diagnosed with alcoholic liver disease have antibodies to chronic hepatitis C, indicating an increased risk of infection with this type of virus.

Vaccination against hepatitis - for or against?

IN last years Distorted opinions are formed in society related to the supposed harm of vaccinations against dangerous diseases on the body. Therefore, I would like to separately touch on the topic of vaccination against hepatitis.

Currently, there are vaccinations against two types of viral hepatitis: A and B.

Hepatitis A is considered a “disease of unwashed hands”, the main route of transmission is household.
Hepatitis B is transmitted primarily through blood. To transmit the virus, a drop of blood that remains, for example, in a syringe needle is enough. But one should not think that this is a disease only of drug addicts or socially disadvantaged elements. The spread of hepatitis B has become an epidemic in recent years.

Hepatitis B in most cases becomes chronic, which can lead to the development of cirrhosis and even liver cancer.

Vaccination against hepatitis B is included in the vaccination schedule for children. Adults are given this vaccination if they wish and consent. Typically, the vaccination schedule looks like this: 0 – 1 – 6. That is, the vaccination should be repeated after 1 and 6 months.

Many people have questions about the effect of alcohol on the effectiveness of hepatitis vaccination. Drinking alcoholic beverages in acceptable doses has no effect on vaccination. But you will still need to stop drinking alcohol for three days after vaccination due to the fact that each vaccination has its own side effects, which alcohol intake can aggravate.

This is also true for vaccination against other pathogens. The exception is the rabies vaccination, after which it is recommended not to drink alcohol for 12 months.

Alcoholic liver disease

It develops as a result of long-term poisoning of the entire human body with alcohol (ethyl alcohol).

During its course, three successive stages of development are distinguished:

Liver steatosis (fatty degeneration; fatty hepatosis);
Alcoholic hepatitis;
Cirrhosis of the liver.

Hepatosis (steatosis)

The initial stage, or fatty hepatosis, is characterized by the deposition and accumulation of fat cells in the liver parenchyma. Occurs in people who abuse alcohol in more than 90% of cases. It is usually asymptomatic, there may be symptoms of dyspeptic disorders, a feeling of heaviness in the right hypochondrium, weakness, yellowness of the skin and mucous membranes. Liver steatosis is a reversible process, and with abstinence from alcohol and treatment, complete recovery is possible. If further exposure to ethanol occurs on hepatocytes, alcoholic liver damage progresses to the second stage - alcoholic hepatitis. In this case, deeper damage to hepatocytes occurs with disruption of their functionality.

Alcoholic hepatitis

The course of alcoholic hepatitis can be in the form of a persistent (stable course, usually without or little symptoms, relatively reversible changes in the liver) or a progressive form (transition from the previous phase in case of further alcohol abuse; an unfavorable course, as a rule, turns into cirrhosis).

Hepatitis can occur with an acute onset or have a latent and then chronic course. The acute form of hepatitis is usually observed after a long, often repeated binge in an alcohol abuser, when the body is poisoned with large doses of alcohol.

There are several varieties of the course, but the most common is the icteric variant. In this case, in addition to jaundice, pain in the right hypochondrium, severe weakness, loss of appetite, nausea, vomiting, prolonged loose stools, and noticeable weight loss are observed. The liver is enlarged, has a dense structure, and is painful.
Chronic hepatitis is often relatively asymptomatic. Only laboratory and additional research methods can indicate severe damage to the organ. The liver also enlarges significantly, reaching enormous sizes.

The third stage is cirrhosis of the liver. This is a completely irreversible stage, when normal liver tissue is replaced by fibrous cords and connective tissue fibers and, as a result, a profound disruption of all its functions develops. Cirrhosis occurs, according to statistics, in 15–20% of patients with chronic alcoholism. Worsening of the symptoms and course of cirrhosis is observed when combined with chronic viral hepatitis B or C, obesity, and being female.

Symptoms of cirrhosis can be quite sparse, especially against the backdrop of a long course of the disease. The patient is worried fast fatiguability, weakness, pain in the liver area, asthenia (weakness, fatigue). A characteristic “hepatic” erythema (redness) appears on the palms, and small capillaries expand over the entire surface of the body. The liver is enlarged or, conversely, reduced, may already be painless, its surface is bumpy. Signs of ascites and an enlarged spleen are revealed, as a result of which the abdomen becomes enlarged with an expanded venous network on its surface. Symptoms of portal hypertension appear. The functions of other organs and systems are disrupted as a result of poisoning by toxic products that are not neutralized by the liver.

The course of cirrhosis is unfavorable. The disease is combined with progressive liver failure, up to hepatic coma, which leads to death. There is also a high probability of malignancy - the occurrence of hepatocellular carcinoma.

The diagnosis is confirmed by laboratory, ultrasound or radioisotope studies, computed tomography. If necessary, diagnostic laparoscopy and liver biopsy are performed.

How is alcoholic liver disease treated?

The most important condition is the patient’s complete abstinence from alcohol. At some stages of alcoholic liver damage, complete regeneration of liver tissue can occur. But it should be noted that, unfortunately, no more than a third of patients follow this recommendation. Another percentage simply reduces the amount of alcohol they consume, while the rest completely ignores it and continues to lead their normal lifestyle.

The second condition is a complete energy diet with a high protein content. The calorie content of such a diet should be at least 2000–3000 kcal per day. Protein content is about 1 g per 1 kg of patient weight. It is necessary to be saturated with vitamins, especially group B. An example of such a diet would be table No. 5.

Drug treatment

Hepatoprotectors, glucocorticoids, agents that improve microcirculation and similar drugs are used. Of course, the necessary treatment in each case is prescribed by the doctor individually after a full examination and taking into account the identified disorders.

If conservative treatment is ineffective, the issue of liver transplantation is decided.

Our interlocutor: Pavel Petrovich Ogurtsov, Doctor of Medical Sciences, Professor, Head of the Center for Liver Studies, Faculty of Medicine Russian University Friendship of Peoples, Head of the Department of Hospital Therapy.

1. The liver is the main filter of our body. Maybe that’s why today we are called on from the pages of advertising newspapers, and sometimes from the TV screen, to clean it using “folk” methods. What is your attitude to this kind of “cleansing”?

Behind the methods of cleaning the liver are exclusively methods of cleaning the brain and wallet. The most “popular” method today is when someone who wants to cleanse is offered to drink vegetable oil with lemon juice, and the next day the surprised person sees multi-colored “stones” coming out with waste products. And few people understand that if you add lemon juice to a jar of vegetable oil and place it in a warm, dark place (similar to the intestines), in the morning the same crystals will settle at the bottom of the jar. That is, the usual thing will happen chemical reaction oils with citric acid. The level of other liver cleansing methods is similar.

2. That is, there is not a single proven effective method for cleaning the liver?

It's not so bad, at least one exists. But not cleansing, but stimulating the secretion and excretion of bile. It is carried out in specialized gastrointestinal sanatoriums; this physiotherapeutic technique is called tubage. This technique includes taking choleretic drugs, mineral water with simultaneous heating of the liver area, the use of other physiotherapeutic effects on the right half of the chest and right hypochondrium.

3. How else can you protect? The same advertisement offers a variety of remedies - from dietary supplements to hepatoprotectors.

Unfortunately, the liver is affected daily by so many various factors, which is impossible to protect from everyone at once. Therefore, the same dietary supplements often become an extra burden for the liver, from which it is time to protect the liver itself. As for hepatoprotectors, the consumer should know that such drugs are not available as a class in the rest of the world. Well, there are no such things in national pharmacopoeias, that’s all. Why? Because they have not proven any effectiveness in studies. With the exception of two active ingredients: ademetionine (several drugs have been developed on its basis), which is effective for protecting and restoring the liver from chronic drug and other intoxications, and ursodeoxycholic acid (several drugs have also been developed on its basis), effective in primary biliary cirrhosis and less effective for other cirrhosis.

4. That is, if you overdid it with alcohol during the holidays, you should take ademetionine?

This may improve liver health, but it is best not to expose it to toxic doses of alcohol.

5. We come to a question that worries many: liver and alcohol. How much and how to drink so as not to develop cirrhosis?

There is no common denominator in this matter, especially since the liver is a very “patient” organ. Some people “drink” all their lives and have a relatively healthy liver, others “drink like everyone else,” and by the age of 40 they develop cirrhosis. Therefore, in recent years we have come to some interesting conclusions. Firstly, alcohol in almost any dose is poison. Moreover, the poison is both ethanol itself and the formaldehyde formed during its breakdown. We believe that anything more than 20 ml of pure alcohol per day (45 grams of vodka) is already a poison that is harmful. And now everything depends on what kind of genetics a person is given, what kind of enzymatic system of the liver, what kind of metabolism, and how long the liver can withstand the blow depends on these factors. And here we come to the second interesting conclusion: a healthy liver can withstand the blow for a very long time. If alcoholic hepatitis and then cirrhosis develop, it means that besides alcohol there is someone else who enhances its effect.

6. Who is this stranger?

First of all...iron. Previously, we underestimated how common one genetic disease in the population is hereditary hemochromatosis. This is a disorder of iron metabolism, in which it is intensively deposited in the liver. Not only does iron lead to the development of liver fibrosis when it becomes dense, but it and ethanol also enhance the destructive effect of each other. The worst thing is that most often a person has only one gene for this disease in a pair, and it is erased, without symptoms. As a result, a person “drinks like everyone else,” and by the age of 40 he comes to us with cirrhosis of the liver. This disease can be indicated by a constant blush of the cheeks, a high level of hemoglobin (for example, 170-180 g/l), and an increased level of the iron storage protein - ferritin. The second likely stranger is unrecognized chronic viral hepatitis. The patient suffers from a chronic form of hepatitis B or C, does not know about it and drinks alcohol, meanwhile, the liver is already seriously affected by the virus. The third enhancer of the effects of alcohol is medications. This is especially true in our country, where most of them are sold without a prescription. Many people, and women more often than men, swallow painkillers and non-steroidal anti-inflammatory drugs by the handful, and in the evening they calmly drink a couple of glasses of wine or champagne. For the liver, this is not a double, but a quadruple blow, and cirrhosis can occur very quickly. Therefore, I would suggest to everyone young man, entering adult life, take several tests that will help him integrate right relationship with alcohol. This is an analysis for viral hepatitis, a genetic test for hereditary hemochromatosis, “liver” enzymes ALT and AST. If everything is normal, you can be friends with alcohol, of course, within reason. If not, go to an appointment with a hepatologist, who will give further recommendations.

7. Some people don’t drink at all, but still experience liver problems. First of all, with fatty hepatosis. What is this disease and how to avoid it?

Our ancestors' liver was like a camel's hump. The hunter ate “to his fill” and moved on; perhaps in the coming days there would be no prey, and there would be no food. But he walks a lot and gradually burns all the liver fat. Nowadays, the situation has changed: we have not forgotten how to eat to our heart's content, but we are too lazy to walk, and a hearty lunch will be followed by an equally hearty dinner. As a result, fat in the liver is retained and liver cells are gradually replaced by it almost completely. At first, liver function does not suffer, this is the stage of fatty hepatosis, but then excess fat disrupts its function and causes inflammation, and fatty hepatitis develops.

8. Is it possible to remove fat from the liver?

It is possible, and most naturally- reduce fat and calorie content of food and increase physical activity. The main thing is to start a war with fat at the stage of fatty hepatosis, before fatty hepatitis has yet begun, in which case some liver cells will already die. Fortunately, there are additional ways to combat fatty liver disease.

Certainly. Personally, I prevent fatty hepatitis with several cups of coffee a day. It has been proven that the substances contained in coffee have a strong anti-inflammatory effect, especially in relation to cytokines - inflammatory factors that play an important role in the development of hepatitis.

10.You have already mentioned viral hepatitis. Which of them are the most dangerous for humans today? Are new viruses emerging like the mutation of the influenza virus?

Hepatitis A virus is considered the mildest because it is acute and never becomes chronic. I got sick with jaundice and didn’t remember about it anymore. Although this opinion is quite misleading, any inflammation of the liver can become life-threatening. Do not forget about hepatitis E - a brother of hepatitis A in terms of transmission mechanism and symptoms. But the peculiarity of this infection is that it can become very dangerous for mother and child in the 3rd trimester of pregnancy. Fortunately, a vaccine has recently been developed for it and will soon be introduced into healthcare. Hepatitis B can go into a chronic stage, this figure reaches 15%, and in the acute form it is much more severe and dangerous than hepatitis A. It is also very contagious, a literally invisible drop of blood is enough for the virus to enter our body. Hepatitis C has received the nickname “gentle killer”, and all for its ability to settle in the liver for a long time and become chronic. According to statistics, up to 85% of all cases of hepatitis C become chronic. It is this virus that has many genotypes and is prone to constant changes in the genome, like a “Rubik’s cube”, which, each time passing through the liver, comes out a little different, so a vaccine against it has not yet been developed It turns out that immunity is poorly developed; if you become infected with one genotype of the virus, you can easily pick up another. Over time, in almost ¼ of cases, chronic hepatitis C develops into cirrhosis of the liver, so I consider it the most dangerous for humans. Hepatitis D is a superinfection¸ it affects those who are already sick with hepatitis B. In general, more than 70 viral hepatitis are known today, so the letters of the alphabet were no longer enough, viruses began to be called like ttv car numbers, etc. Fortunately, they are mild and the immune system copes with them. Almost every one of us has suffered from one of the viral hepatitis at least once in our lives, sincerely believing that it was the flu or ARVI.

Scientists have proven that coffee has a beneficial effect on the liver and protects it from inflammation.

11. How effective is the hepatitis B vaccine, when to vaccinate against hepatitis A, and can we expect the development of a hepatitis C vaccine in the coming years?

The hepatitis A vaccine should not be neglected; it is usually given to children 3-6 years old or to adults after contact with a sick person. It is imperative to get vaccinated before traveling to an epidemiologically affected region. When planning a pregnancy, it is important to get vaccinated against hepatitis E. The hepatitis B vaccine has already proven its effectiveness. Firstly, you can make sure that the vaccine “works” by taking a blood test for antibodies to hepatitis B before the first vaccination and after completing the entire course. If the concentration is more than 10, this means that the immune system is tense and will immediately destroy the virus upon first contact. The second evidence is the almost zero incidence of hepatitis B among vaccinated health workers, before the introduction of vaccination - the most “sick” contingent. The first vaccination is carried out in infancy, usually it is 3 injections over several months, but when to do revaccination can be decided together with your local doctor - you can do 1 injection every 5 years, or after 5 years you can get tested for the same antibodies and decide The time has come or you can wait a couple more years. As for the hepatitis C vaccine, the many genotypes of the virus and the tendency to mutation complicate the work on creating a vaccine; while there are no concrete results yet, the appearance of a vaccine for hepatitis C is expected at about the same time as the HIV vaccine - in about 10 years.

12.Is it possible to become infected with viral hepatitis B and C through household means? Are they sexually transmitted?

Symptoms of alcoholic cirrhosis

Of course, cirrhosis occurs not only from alcohol abuse. It can be caused by viral hepatitis and other factors. But alcoholic cirrhosis has its own individual signs that indicate this disease.

Symptoms of alcoholic cirrhosis of the liver are as follows:

- The first signs that will immediately indicate the presence of this disease are an increase in body temperature to 38 degrees, pain in the right hypochondrium, nausea and periodic vomiting. When you stop drinking alcohol, they go away and relief comes. This is typical for a patient with alcoholism if he drinks alcoholic beverages for a long time. These signs occur in the early stages of the disease.
- A professional doctor can diagnose this disease by superficially examining a person. In alcoholics, the liver increases in size in the early stages of the disease, but in the later stages it shrinks and cannot be felt. Therefore, an enlarged or reduced liver indicates the presence of cirrhosis.

- The appearance of a jaundiced coloration of the skin and sclera of the eyes. This indicates that the liver is not performing its functions well, and a lot of insoluble bilirubin appears in the body.
- In more severe cases, when the liver is severely affected, the patient may show signs of “jellyfish” when his abdomen sharply increases in volume and venous networks begin to appear on its surface. This also indicates that the patient suffers from ascites. Ascites refers to the accumulation of fluid in the abdominal cavity.
- With advanced cirrhosis, the venous artery, which collects blood from the abdominal organs and passes it through the liver, experiences great pressure, which is transmitted to the blood vessels of the intestines and stomach. As a result, they begin to burst and internal bleeding begins. Evidence of this is coffee-colored vomit or the presence of scarlet spots in the stool.

In most cases, patients experience swelling lower limbs, disproportionate enlargement of the abdomen, thickening of the extreme phalanges of the fingers. In men, testicular dystrophy occurs; in women, the mammary glands may increase in volume. But these signs are typical when cirrhosis has already passed the first stage of development, and a more severe form of this disease occurs. In general, according to appearance An experienced doctor will immediately determine if a person has cirrhosis.
In some cases, other signs may appear. For example, the death of liver cells causes cerebral encephalopathy. Characteristic features This is caused by nervous disorders in the form of sudden aggression, after which sleep suddenly sets in, loss of orientation in space, the patient generally does not pay attention to his appearance.

These signs indicate that a person has alcoholic cirrhosis, and the sooner he begins to treat it, the more he will be able to live a full life.

It is important to know that in patients with ascites, in most cases cirrhosis is detected. Only doctors will be able to determine the cause of cirrhosis: it is caused by alcohol or other diseases.

Diagnostics

Timely treatment of this disease depends on correct diagnosis. Medicine has many ways to diagnose this disease.

These methods are divided into several types:

laboratory research;
technical studies;
superficial inspections.

In the first case, patients undergo special tests that can help identify liver damage and dysfunction.

This may include:

a biopsy, in which a piece of the affected organ is taken and examined for the presence of fatty connective tissue in it, as well as the percentage of liver damage, all this happens during observation using ultrasound;
a blood test from a vein, when doctors can detect the presence of various antibodies that indicate inflammatory processes and other unfavorable changes in the liver.

In the second case, attention is paid to ultrasound and computed tomography. In principle, ultrasound and tomography do not differ in their functions, but if a doctor prescribes both ultrasound and tomography, it means that he wants to earn more bonuses.

An ultrasound is prescribed in any case. Using ultrasound, you can identify the affected areas of the liver, as well as determine at what stage the disease is.

Doctors distinguish the initial stage, when nodules with a diameter not exceeding 3 millimeters form in the liver lobes, and the last stage involves the presence of larger formations. All this can be perfectly examined with the help of ultrasound and tomography, and a maintenance course of treatment can be started immediately.

Superficial inspections also play an important role.

Looking at the patient and his appearance, the doctor can immediately determine the presence of cirrhosis, and without waiting for laboratory and technical studies, prescribe initial therapy that can protect the patient from death.

It is important to know that when diagnosing cirrhosis, ultrasound plays an important role, since only with the help of it or its computer substitute - a tomograph - can one detect damage to the liver by fatty and scar tissue, as well as an increase and decrease in its volume.

How to treat this disease

Unfortunately, modern medicine does not know how to treat this disease, but it has all the means to make the patient’s life easier and prolong it for a long time.

Treatment of alcoholic cirrhosis of the liver occurs as follows:

- First of all, this is maintenance therapy, when the patient takes various medications. This includes corticosteroids, intravenous glucose with saline, and other drugs. Gepabene and similar drugs that support the liver are taken.

The next way is to follow a diet, as well as walks and light exercise. Diet and exercise do not put much strain on the liver, so it does not become stressed. Physical exercise strengthen the body. When dieting, first of all, you should give up spicy, fatty, high-calorie foods. Light soups, cereals, and other foods suggested by a nutritionist are welcome.
Good help folk remedies. These include juices from cabbage, beets, and carrots. Decoctions and infusions of various herbs. The only contraindication is the use of alcohol in tinctures.
The last thing that is very important is to give up alcohol. It should not be taken even in the smallest quantities, including beer.

Many people are interested in the question of how long one can live with this disease. If it is diagnosed in the first stages, and the patient does not have ascites, bleeding or lesions nervous system, which means you can live 10-15 years.

If you have the above symptoms, it means that with complex treatment you can live from one to 5 years, depending on how advanced the disease is.

It is important to know that the only way to get rid of cirrhosis is a liver transplant. But for those who suffer from alcoholism, it is not done.

Liver cirrhosis caused by alcohol abuse has specific symptoms. It can be detected even during an external examination of the patient. It is impossible to cure it, but maintenance therapy is necessary, as it can prolong the patient’s life by more than one year.

It would seem that thin people definitely shouldn’t worry about their liver health. After all, NAFLD (non-alcoholic fatty liver disease) is for fat people. But, as it turned out, everything is not so simple. It turns out that people who go on various diets undermine their liver health no less than alcoholics or gluttons.

Everything we eat or drink passes through our liver. In the body, it plays the role of a filter: it converts food into energy and cleanses our blood. Poor diet and excess weight can lead to one of the most common liver diseases in hepatology - non-alcoholic fatty liver disease - a condition in which excess fat accumulates in liver cells. In this century, this disease is spreading at the speed of not even an epidemic, but a pandemic. According to research, approximately one billion patients worldwide have NAFLD. This disease affects 20-30% of the European population and up to 15% of the Asian population. The prevalence of NAFLD in Russia is 37.3%, while over the past 10 years this figure has increased by 10.3%.

Fatty liver disease does not have pronounced symptoms. It may be accompanied by symptoms common to many other conditions, such as fatigue or abdominal discomfort, but if not diagnosed early, the situation can worsen over time and lead to severe liver damage.

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Thus, excess fat in cells is subjected to the so-called. beta-oxidation, which leads to the formation of a large number of cell-damaging radicals. This causes inflammation (called steatohepatitis) and cell destruction. At this stage, the disease may manifest itself as pain in the right hypochondrium and increased fatigue. Subsequently, the patient develops fibrosis (replacement of liver cells with connective tissue) - which is commonly called cirrhosis. 21-26% of patients diagnosed with NAFLD develop cirrhosis within 8 years.

The good news: if you identify the disease at an early stage and come to your senses (more precisely, go on a diet) and manage healthy image life, further development of the disease can be prevented.

Although non-alcoholic fatty liver disease is most often diagnosed in people who are overweight or obese, people with high levels of cholesterol or triglycerides in the blood, or those suffering from diabetes mellitus, there are exceptions. Rapid weight loss (more than 1.5 kg/week), an overly strict diet or a habit of eating unhealthy and nutrient-poor foods can also lead to NAFLD. While maintaining a normal weight, we must remember the importance of a healthy lifestyle and proper nutrition. A strict restrictive diet, prolonged fasting, leading to a sharp weight loss of more than 1.5 kg per week, can negatively affect the condition of the liver. With poor nutrition, insufficient protein intake and calorie deficit, metabolism is disrupted, leading to the accumulation of fat in liver cells: the body tries to replenish energy by accumulating fat in conditions of reduced calorie intake due to diet.

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“The restrictive principle inherent in a number of modern diets can lead to an imbalance in nutrition, especially with regular and long-term use,” said MK, Ph.D., senior researcher at the Department of Gastroenterology and Hepatology of the Federal State Budgetary Institution Research Institute nutrition and biotechnology" Sergey Morozov. – In some cases, an insufficient amount of calories supplied from food can lead to the accumulation of fat in the liver tissue - the development of fatty hepatosis. Most fad diets do not take into account individual characteristics of a person, so their use may be associated with the risks of insufficient intake of a number of nutrients. Maintain a healthy lifestyle, follow the principles rational nutrition and all people, not just thin or fat people, should monitor their overall health. Early detection of the disease can allow adequate treatment before serious complications develop. The problem with liver diseases is that many of them are asymptomatic for a long time and can be diagnosed at a late stage, when changes in the organ are irreversible. Regular scheduled examination with tests for viral hepatitis B and C, HIV, biochemical and general blood tests, ultrasound examination of the abdominal organs can allow timely identification of existing disorders and take effective measures.