Alcoholic liver disease called alcoholic liver disease. It is a violation of the structure and function of normal liver structure under the influence of systematic excessive use of alcohol. In accordance with the recommendations of the World Health Organization safe dose of alcohol is converted to alcohol for men no more than 20-40 g of alcohol per day, and 20 g of alcohol per day for women.
In terms of 10g of alcohol is vodka 25 ml, 100 ml of wine or 200 ml of beer. When the body alcohol is absorbed from the gastrointestinal tract. A small part of it is derived through the lungs and kidneys, the remainder (90%) goes to the liver, where it is processing. First, in liver cells by the enzyme alcohol dehydrogenase oxidizes ethanol to acetaldehyde and vrevraschaetsya. If the amount is large, organelles, cells, which synthesize alcohol dehydrogenase (microsomes) increase in size.
The product of this reaction - acetaldehyde - is a fairly toxic substance. Further, in liver cells is transformed into acetaldehyde, acetic acid and acetic acid in the form of atsetilkoenzima-A is involved in the Krebs cycle. The final products of processing of ethanol in the body are water and carbon dioxide. With an excess of the entire aklkogolya atsetilkoenzim And no time to be disposed of in the Krebs cycle to and from the other synthesized products, which contribute to the development of atherosclerosis.
Under the influence of systematic abuse of alcohol liver cell organelles that are involved in the inactivation of alcohol increased in size, increasing the size and the cells themselves. Increases fatty acid synthesis, which leads to their accumulation in the liver and fatty liver. Gradually, the possibility of the liver for processing ethanol reduced. Acetaldehyde does not have time to turn into acetic acid and stored in the liver.
Acetaldehyde is 30 times more toxic than ethanol. It stimulates the peroxidation of fats and the formation of free radicals, which damage liver cells. Acetaldehyde nerushaet work of enzymes, glutathione system, violates the intracellular flow of bile. Under the influence of ethyl alcohol, fatty acids are converted into fat, slow removal of fat from the liver. All this reinforces the fatty liver.
Alcohol reduces the formation of proteins in the cell membranes of liver cells. Under the influence of ethanol produced in the liver of a particular protein - the alcoholic hyaline. The immune system reacts to the protein, as an alien product, and develop autoimmune processes. Ethyl alcohol in the liver contributes to the development of connective tissue, which subsequently leads to cirrhosis.
It is believed that alcoholic liver disease goes through several stages.
1. Alcohol adaptive hepatomegaly. This increase in size of liver cells and the size of the liver under the influence of ethanol. It is believed that this condition occurs in one fifth of patients with chronic alcoholism. Increase the size of liver cells by increasing the cellular organelles involved in the processing of ethanol. Alcohol increases the liver so it is a compensatory response of the liver in excessive amounts of alcohol. These patients usually do not make complaints. Sometimes there is pain in the liver. The examination revealed multiple enlarged liver. In the blood, using special techniques can detect an increase in the number of the enzyme gamma-glyutamintranspeptidazy.
2. Alcoholic steatosis. This condition is found in 75% of patients with chronic alcoholism. Alcohol impairs oxidation of fatty acids and they are converted into ordinary fats (triglycerides), which accumulate in the liver. Ethyl alcohol is also contributes to the removal of fat from adipose tissue, increasing the amount of fat in the blood while decreasing consumption of fat in the muscles. The main site of fat accumulation is the liver. Patients complain of heaviness, pain in the liver, a feeling of fullness in the right upper quadrant. Such patients can not tolerate fatty foods. Often there is general weakness, fatigue, irritability, and bloating. In some patients there is a pronounced degeneration of the liver: there is jaundice, fever, destroyed red blood cells in the blood. This condition is called a syndrome of central and eastern European. Half of the patients continued to feel good. The examination detected an enlarged liver and a few compacted. The blood can be increased by the number of hepatic enzymes and bilirubin. Ultrasonography of the liver ascertain enlarged liver, an increase in the density of liver tissue. Clarify the diagnosis by biopsy of the liver. We study the pieces of liver tissue under a microscope. The diagnosis of fatty liver set, when fat droplets are found in half of the liver cells. If at this point the patient ceases to abuse alcohol, changes in the liver regress.
3. Alcoholic liver fibrosis. Alcoholic fibrosis develops in 8-10% of patients with chronic alcoholism. The cause of alcoholic liver fibrosis is the ability of ethanol to stimulate increased growth of connective tissue. The growth of the connective tissue begins around the central veins in the liver lobules. Then it is distributed in the form of mesh in the liver tissue. The patient has there weakness, fatigue, loss of appetite, nausea, belching. Pain in the liver is not strong, but constant. The liver is moderately enlarged. Biochemical analyzes of blood vary slightly. Diagnosis is by biopsy of liver tissue. If a patient at this time continues drinking, he developed cirrhosis of the liver.
4. Alcoholic hepatitis. Alcoholic hepatitis is an acute or chronic. This form of liver disease occurs in one third of all alcoholics who abuse alcohol more than 5 years. Acute alcoholic hepatitis - an acute inflammatory degenerative disease of the liver caused by the systematic abuse of alcohol. In the liver there is an acute inflammatory reaction with necrosis of the central lobes of the liver and deposition in the liver cells of a particular protein - alcoholic hyaline, called Mallory bodies. Most alcoholic hepatitis develops gradually, after five years of systematic upotrbleniya alcohol. But in some patients at very high doses of alcohol in the liver inflammatory process is developing rapidly, especially if the patient is malnourished, and is able to binge. Usually after a period of binge there are complaints of pain in the right epigastric region, nausea and vomiting. Sclera, skin of face and body become yellow in color. Clinical manifestations of alcoholic hepatitis can be elusive. The patient complains of slight pain in the liver, decreased appetite, but the disease is significantly more difficult. The most common version of ostrorogo alcoholic hepatitis - jaundice. The patient appears intense staining of sclera, skin, body and limbs yellow. For patients concerned about this increase in body temperature, severe weakness, loss of appetite, pain in the liver, which are permanent, and sometimes quite strong. Almost always there is a weight loss patients. May develop severe complications of the central nervous system (hepatic encephalopathy), heart (cardiomyopathy). In blood tests show signs of acute inflammation. In the study of biochemical parameters are increased amounts of bilirubin, liver enzymes, a violation of the relationship of protein fractions of blood. Sometimes alcoholic hepatitis occurs in violation of the outflow of bile from the liver - a cholestatic variant. In this case, the patient appears more than jaundice and itchy skin, dark urine, discoloration of feces (acholia). In the blood dramatically increased the amount of bilirubin and liver enzymes. The most severe variant of acute alcoholic hepatitis is called fulminant.
The patient appears severe weakness, high body temperature, severe pain in the liver. Condition is deteriorating rapidly. Jaundice is growing, there is ascites (accumulation of fluid in the abdominal cavity), renal failure, hemorrhage, hepatic encephalopathy. This option is the development of alcoholic hepatitis can be fatal within two weeks. Upon cancellation of drinking in 10-20% of patients can recover. Those who continue to drink alcohol, it passes into the state of cirrhosis. In severe alcoholic hepatitis and 25% of patients die. Chronic alcoholic hepatitis can occur after acute or occurs gradually. There are chronic active hepatitis, persistent chronic hepatitis. The patient is worried about fatigue, recurrent pain in the liver. Yellowness of skin and sclera expressed moderately. Changes in blood are expressed as moderate. Chronic alcoholic hepatitis may be transferred to cirrhosis of the liver, even if the patient is no longer consume alcoholic beverages.
