Long-term alcohol abuse leads to the development of cirrhosis. This pathology is based on the defeat of liver cells with alcoholic toxins, which subsequently leads to the death of hepatocytes.
Alcoholic cirrhosis of the liver
Alcoholic or toxic cirrhosis refers to the extensive lesions of liver tissue that develop with prolonged uncontrolled consumption of alcohol. Normal cell structures of the organ die, and in their place, scars and fibrous tissues are formed. To begin to develop severe cirrhosis-forming fibrosis of the liver tissues, a negative impact of several factors is necessary. Such factors can be long and regular alcoholic libations, hereditary predisposition to disease, female sex, vitamin and protein deficiency, abuse of fatty and spicy dishes, etc.
First with frequent intake of alcohol, the liver manages to develop specific enzymes that process ethanol and itsproducts of decay, but over time the organ is depleted, and its walls are overgrown with fat. Develops fatty hepatosis. Then hepatocytes begin to die and are replaced not by new liver cells, but by connective tissue structures. As a result, the liver undergoes significant changes in its structure, gradually leading to organ dysfunction.
Mechanism of development of hepatic cirrhosis of alcoholic origin is simple.
When alcohol is processed, radicals are formed that negatively affect the hepatic tissues and cause:
- Damage to cell membranes;
- Cell destruction;
- Violation of the vascular structure;
- Vascular spasms develop;
- Hepatic hypoxia occurs;
- Death of hepatocyte structures is aggravated;
- As a result, the liver gradually loses its functionality.
The above described changes are irreversible, leading to the disability of patients with subsequent fatalities.
Effect of alcohol on the liver:
Forms and stages of
Hepatic cirrhosis is divided into mixed, coarse nodular and shallow-knot forms. In the case of small-node or micronodular cirrhosis, practical identical small nodules with a diameter less than 3 mm are formed in tissues, and with large-node or macronodular cirrhosis, the size of the nodules can reach up to 5 cm, the nodes being very different in size.
Classify cirrhosis and in accordance with functional disorders:
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- Compensated - the disease at this stage is not clinically apparent, because the liver is fully capable of coping with its tasks. Only a biopsy can tell about the presence of a pathological process;
- Subcompensated - cirrhosis at this stage begins to manifest itself in liver failure and is easily confirmed in diagnostic studies;
- Decompensated cirrhosis is characterized by organ dysfunction, the liver simply refuses, alcohol damage affects the entire body. To save a patient at this stage can only be a liver transplant.
On photo healthy liver and liver with cirrhosis
Signs and symptoms
Initially, the disease from the constant intake of alcohol develops imperceptibly. Until the time of the first signs of cirrhosis can go 5 years and even more, although throughout this period the normal parenchyma will be replaced by fibrotic structures.
The first manifestations of the cirrhosis process are usually:
- Symptoms of asthenic nature such as reduced performance, lack of mood and appetite, drowsiness and poor health, etc.;
- Weight Loss;
- Lowered upper pressure, not exceeding 100 mm.gt;p.
- Erythematous reddening of the skin on the palms and feet;
- Appearance on the surface of the body of stars from small vessels.
First the face becomes red due to the extensive expansion of the capillary mesh, but over time the skin acquires an icteric tinge over the entire body, even in the mouth and on the sclera of the eyes appears yellow. Outward appearance can also be called the appearance on the nails of a lot of leukonichias( whitish strips), and the ends of the fingers become like drumsticks.
Patients with cirrhosis often worry about digestive disorders such as bloating and flatulence, nausea or vomiting, rumbling sounds in the abdomen. In the portal vein, pressure often rises, causing accumulation of fluid in the peritoneum or the development of splenomegaly( enlargement of the size of the spleen).Often such patients have an increase in veins on the limbs.
Patients report such manifestations as:
- Muscular atrophy;
- Dyspnea and cough;
- Cardiovascular lesions and tachycardia, low-grade fever( 37-38 ° C).
Otherwise, the pathology reaches the stage of hepatic encephalopathy, which causes toxic damage to brain cells, disrupts the work of internal structures, damages nervous tissues. Sometimes liver can form hepatocellular carcinoma, which is a malignant tumor.
A gastroenterologist or surgeon is involved in the diagnosis and subsequent treatment of cirrhosis. Usually diagnostic processes do not take much time and do not cause complexity. The patient is taken for general and biochemical laboratory testing, and feces and urine samples are also taken.
As for instrumental diagnostics, the most highly informative methods are:
- Ultrasound examination of the abdominal cavity, which allows to determine the structure of the hepatic parenchyma, the size of the organ, the presence of fibrotic processes and the size of the spleen;
- Computer and magnetic resonance imaging provides a complete picture of the hepatic structure and organs surrounding it;
- ERCP or endoscopic retrograde cholangiopancreatography. The procedure shows the state of the strokes within the liver, determines the presence of constrictions or stricture formations;
- Elastography study - the technique refers to the category of ultrasound and helps to determine the degree of fibrotic processes;
- Hepatic biopsy - involves a percutaneous take of a biomaterial and its subsequent investigation.
How to treat
The main condition for the treatment of chronic liver cirrhosis is the complete elimination of alcoholic beverages, replenishment of mineral, vitamin and protein deficiency. If there are narcological indications, then the patient must undergo social rehabilitation for alcohol-dependent patients. In addition, dietary food is recommended according to the recommendations of table number 5.
In general, treatment of hepatic cirrhosis is based on conservative methods that prescribe medication. Necessarily appointed hepatoprotective drugs that support the remaining healthy cells in the liver. Among the most common are Essentiale, Allochol, Phosphogliv, LIV-52, etc.
In addition, the reception of vitamin products that promote the maintenance of normal organic activity is shown. Also, experts recommend taking drugs based on ursodeoxycholic acid such as Ursodez, Ursosan, Ursohol, etc. These drugs prevent the death of liver cells.
Assign and funds to prevent fibrosis, as well as glucocorticoid drugs that eliminate inflammation, protecting against the formation of scars.
Importance is also given to the patient's diet, involving the rejection of food prepared by smoking or frying, pickling or drying. Also, sharp and fatty foods are forbidden. Drink a day should be about one and a half liters of water, and the daily calorific value should not exceed 2,800 kcal. The daily ration is divided into five receptions, coarse fiber and meat can be eaten in a grated form. Broths based on fish, mushrooms or meat, sausages and canned food, beans, etc. are also forbidden.
Forecasts and complications of
It is impossible to cure finally cure completely, although with a liver transplant the patient will be able to get rid of the pathology forever. But this treatment costs beyond the limits, it is more complicated from the technical point of view, so this option is available only for units.
If the cirrhosis was detected at the initial stage of development, and the treatment process for combating it was put competently and professionally, the patient has every chance of stopping the devastating changes in the hepatic parenchyma and delaying the probable complications. Existing hepatoprotective agents, which perform only protective functions, are unable to restore already lost cellular structures.
How many live with the last stage? With decompensatory cirrhosis - about three years, and the prescribed therapy performs the function of alleviating the patient's condition, and does not treat it.
On the video about the treatment and prognosis of alcoholic cirrhosis: