What happens if you drink with cirrhosis of the liver. What is alcoholic cirrhosis of the liver, and how quickly can it kill

It would seem - to whom, to whom, but thin people definitely should not worry about the health of the liver. After all, NAFLD (non-alcoholic fatty liver disease) is the lot of fat people. But, as it turned out, everything is not so simple. It turns out that people who go on a variety of diets undermine the health of the liver 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 purifies our blood. Improper diet and overweight 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 the liver cells. In this century, this disease is spreading at the speed of not even an epidemic, but a pandemic. According to studies, about 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 has no pronounced symptoms. It can be accompanied by symptoms that are characteristic of many other conditions, such as fatigue or discomfort in the abdomen, however, if not diagnosed in time, the situation can worsen over time and lead to severe liver damage.

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So, excess fat in the cells undergoes 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 can manifest itself as pain in the right hypochondrium, 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 of the liver within 8 years.

The good news is that if you identify the disease at an early stage and take up the mind (more precisely, go on a diet) and lead a healthy lifestyle, you can prevent the further development of the disease.

Although non-alcoholic fatty liver disease is most commonly diagnosed in people who are overweight or obese, there are exceptions in people with high levels of cholesterol or triglycerides in the blood, as well as people with diabetes. Rapid weight loss (more than 1.5 kg/week), an overly restrictive 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 adversely affect the condition of the liver. Malnutrition, protein malnutrition, and a calorie deficit disrupt metabolism, leading to the accumulation of fat in the liver cells: the body tries to replenish energy by storing fat in the face 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 their regular and long-term use,” said PhD, senior researcher at the Department of Gastroenterology and Hepatology of the Research Institute nutrition and biotechnology” Sergey Morozov. - In some cases, an insufficient amount of calories from food can lead to the accumulation of fat in the liver tissue - the development of fatty liver. Most trendy diets do not take into account the individual characteristics of a person, so their use may be associated with the risks of insufficient intake of a number of nutrients. Maintaining a healthy lifestyle, following the principles of rational nutrition and monitoring the state of health in general should be for all people, and not just thin or fat people. Early detection of the disease can allow adequate treatment before serious complications develop. With regard to liver diseases, the problem is that many of them are asymptomatic for a long time and can be diagnosed already at a late stage, when changes in the organ are irreversible. Regular scheduled examinations with tests for viral hepatitis B and C, HIV, biochemical and general blood tests, ultrasound examination of the abdominal organs can allow timely detection of existing violations and take effective measures.

reference

The liver is the largest organ in the human body. Its mass reaches 1500 g - approximately 1/50 of the mass of the whole body. Anatomically, the liver is divided into two lobes - right and left. The right lobe is almost 6 times larger than the left.

The liver acts as a filter in the human body.

Aversion to work as a symptom of illness

THE HERO OF Jerome K. Jerome's book "Three Men in a Boat, Not Counting the Dog" once went to the London Public Library, took a medical reference book, read it, found all sorts of ailments in himself and came out a deeply ill man. Among all other diseases, he identified the presence of problems with the liver by the main symptom - "aversion to work." On the one hand, this may seem ridiculous, on the other hand, the compiler of the reference book, apparently, knew a lot about diagnostics, because, oddly enough, often the only complaint in liver diseases is asthenic syndrome, that is, decreased performance, weakness, excessive sleepiness.

Unwillingness to do something may be the only, but characteristic sign. Another thing is that it is nonspecific and occurs in a host of other diseases. If we talk seriously about the symptoms that clearly indicate liver disease, these are jaundice, itching, baldness, reddening of the palms, in women - a menstrual disorder; heaviness in the abdomen, nausea, belching, unstable stool.

In the later stages, there may be an increase in the abdomen due to the accumulation of fluid in it (ascites), darkening of urine (it becomes the color of beer), discoloration of feces, subcutaneous bleeding. In order not to bring to such a state, it is necessary to take care of yourself at the first adverse symptoms. In this sense, the liver is a grateful organ - with proper care, it recovers well, and healthy cells can work for themselves and their injured comrades.

What happens in cirrhosis? A healthy liver is made up of liver lobules. With cirrhosis, a change in the structure of the liver occurs, the liver contains a large amount of connective tissue, and nodules of different sizes appear instead of lobules, the overgrown scar tissue compresses the blood vessels, as a result, blood circulation is disturbed. The loss of normal liver cells leads to the fact that the liver is not able to synthesize proteins and other substances necessary for the body, as well as to neutralize toxins, that is, to perform its functions.

What will help to make a correct diagnosis? First of all, a visit to a gastroenterologist, who, in addition to a visual examination, can use the following diagnostic methods:

• a biochemical blood test that will show an increase in liver enzymes, an increase in the amount of bilirubin;
• Ultrasound of the liver and other abdominal organs will reveal a change in the size and structure of the liver, the presence of fluid in the abdominal cavity;
• gastroscopy is useful for assessing the condition of the veins of the esophagus and determining the risk of bleeding;
• blood test for markers of viral hepatitis;
• in some cases, a liver biopsy is performed (for this, under local anesthesia, the skin directly above the liver is pierced with a special thin needle, a piece of tissue is taken);
• study of the liver vessels (angiography, splenoportocavagraphy) using a special contrast agent under X-ray control is necessary when planning surgical treatment.

It's never too late to stop drinking

The MOST common causes of liver cirrhosis are alcohol abuse and viral hepatitis (primarily hepatitis B and C). Less commonly, they are poisoning with toxic substances (for example, the poison of the pale toadstool, some drugs), diseases of the gallbladder and bile ducts, accompanied by prolonged jaundice.

The growth of environmental pollution, the increase in the use of various preservatives, alcohol, the uncontrolled use of drugs increase the load on the liver.

According to experts, the next 10 years will be marked by an increase in chronic liver pathology associated with the hepatitis C virus.

As for the effect of alcohol on the liver, in terms of "normal" drinkers and quality alcoholic beverages, the time that must elapse from the start of drinking until the development of liver disease depends on many factors. Firstly, on how much a person drinks, and secondly, who drinks - a man or a woman. In a woman, ceteris paribus, the disease will develop faster and at lower doses. It is believed that for men the maximum allowable dose is 60 g of pure alcohol per day: this is 3 bottles of beer, or 3 glasses of dry wine, or 3 glasses of vodka. Anything more than this, the liver cannot process without harming itself. In women, liver damage can develop even with a constant intake of 20 g of alcohol per day.

On average, from the beginning of systematic drunkenness to the appearance of classic alcoholic cirrhosis, at least 8-10 years pass. In women and adolescents, this period may be shorter - about 5 years. Alcoholic liver damage can be asymptomatic for a long time. A person drinks and drinks until the liver is no longer able to drive blood through itself, stagnation occurs in the portal vein system, increased pressure in it, and as a result - ascites - accumulation of fluid in the abdomen. Often patients come to the doctor for the first time only at this stage - the stomach began to increase due to the fact that liquid appeared there. This is a very important symptom and a serious prognostic sign. Often, if ascites appears, the patient's life expectancy is estimated at several years. If a person does not stop drinking at the same time, this gap will rapidly decrease. However, if the patient can be persuaded to give up alcohol, then despite the fact that he came to the doctors already at the stage of ascites, they can observe him for 10 years or more without further deterioration. Why? Because he stops drinking, there is no progression of the cirrhotic process, and the restoration of liver functions under these conditions may well occur. Therefore, it is never too late to stop drinking alcohol.

How to protect the liver?

There are a lot of drugs on the market. Some of them stimulate the production of essential phospholipids - substances necessary to restore the integrity of the liver tissue. Others already contain essential phospholipids in finished form, moreover, of natural origin, easily absorbed by the body.

Even if the process in the liver ends with recovery, the damage still does not go unnoticed and can make itself felt with a certain functional inferiority, one degree or another of hepatic dystrophy. To avoid this, the doctor may recommend hepatoprotectors - drugs that help the liver restore its structure and protect it from adverse influences. Now in our pharmaceutical market there are about 30 types of hepatoprotectors: herbal, homeopathic, synthetic. Most of all herbal preparations, including homeopathic ones. Doctors prefer to prescribe them because these drugs have a wide spectrum of action, a minimum number of side effects and an acceptable price.

As far as liver cirrhosis is concerned, the results of its treatment are both disappointing and encouraging. The disturbed architectonics of the liver in cirrhosis of the liver is never restored, but the ability to recover in liver cells is so good that even with cirrhosis, improvement in liver function can be achieved.

Of course, the choice of the optimal treatment regimen for a particular patient can only be made by a doctor, but a lot also depends on the patient himself. It is important how he will behave during treatment, whether he will be able to follow all the recommendations both in terms of drug treatment and diet, etc. If you have been diagnosed with liver cirrhosis, carefully follow the doctor's advice. In addition, take care of yourself: rest as soon as you feel tired. Do not lift weights: a sharp increase in pressure in the abdominal cavity can provoke gastrointestinal bleeding. Watch the frequency of your stool (the optimal frequency of stool is 2 times a day).

It is necessary to be treated, because the complications of cirrhosis of the liver are very serious. Hepatic encephalopathy - damage to the brain by toxic products that are not neutralized by the liver as a result of its damage. It can manifest itself in various disorders of consciousness, intellect, behavior, neuromuscular disorders. Another possible complication is ascites, the accumulation of fluid in the abdominal cavity. In addition, patients with cirrhosis of the liver are more susceptible to bacterial and viral infections than healthy people. The most common infections in these patients are those of the respiratory tract and urinary tract.

What can a patient with cirrhosis of the liver complain about?

• Increased fatigue.
• Weight loss.
• Various disorders of consciousness and behavior (decreased concentration of attention, drowsiness during the day, disturbed night sleep, etc.).
• Decreased appetite and abdominal discomfort (bloating, feeling full quickly when eating).
• Jaundice (staining of the skin, sclera in yellow).
• Lightening or discoloration of feces, darkening of urine.
• Stomach ache.
• Swelling of the legs and (or) an increase in the size of the abdomen due to free fluid in the abdominal cavity (ascites).
• Bleeding: nasal, gastrointestinal, from the gums, hemorrhoidal, and subcutaneous hemorrhages.
• Frequent bacterial infections (respiratory tract, etc.).
• Decreased sex drive.
• In men - often gynecomastia (enlargement of the mammary glands).

It is advisable to exclude the use of mineral waters containing sodium.

Since alcohol contributes to the development of cirrhosis of the liver, its use in any form and quantity is prohibited.

With fluid retention in the body (edema, ascites), it is necessary to limit the intake of table salt to 0.5 g per day, liquids - up to 1000 - 1500 ml per day. Ideally, food should be cooked without adding salt. Salt-free bread, crackers, biscuits and crispbreads are used, as well as salt-free butter.

Seasonings such as lemon juice, orange peel, onion, garlic, salt-free ketchup and mayonnaise, pepper, mustard, sage, cumin, parsley, marjoram, bay leaf, cloves, and yeast extract (low salt) help make meals more palatable. to taste.

Any products containing baking powder and baking soda are excluded (cakes, biscuits, cakes, pastries and regular bread).

Pickles, olives, ham, bacon, corned beef, tongues, oysters, mussels, smoked herring, canned fish and meat, fish and meat pate, sausage, mayonnaise, various canned sauces and all types of cheeses, as well as ice cream are excluded.

Salty canned foods are excluded.

Allowed 100 g of beef or poultry, rabbit or fish and one egg per day. One egg can replace 50 g of meat.

Milk is limited to 1 glass per day. You can eat low-fat sour cream.

You can eat boiled rice (without salt).

Any vegetables and fruits are allowed fresh or in the form of home-cooked dishes.

The urgency of such a problem as alcoholic liver disease is very high. In terms of prevalence and social significance, this pathology is in second place 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 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 more than 80 ml of ethanol is consumed per day for five or more years.

In order to develop alcoholic liver disease with a possible transition to cirrhosis for an adult male, it is enough to take alcohol at a dose of 50–80 ml of ethanol per day, for a woman this dose is already 30–40 ml, and for adolescents even lower: 15–20 ml per day. And that's just 0.5 liters of 5% beer every day!

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

The myth of the harmlessness of "weak" alcohol

There is a common misconception that if you drink weak alcohol (beer, low-alcohol cocktails, etc.), then it brings less to 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 "only" a few bottles of beer a day.

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

According to statistics, more than half of the population of our country drink beer. And the popularity of beer does not give up its positions because of the seeming "harmlessness". The number of beer consumers is growing every year. Experts consider beer a legalized drug, which quickly develops 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 people lazy, stupid and powerless," said Bismarck, Germany's first chancellor. And he knew firsthand a lot about beer.

Also gaining popularity, especially among young people, low-alcohol canned cocktails. Due to their sweetish taste, they are perceived as strong lemonade. But one jar contains the 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 immediate. 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 the alcohol consumed) is taken by the liver, where the alcohol is further processed.

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

If a lot of alcohol is consumed, a deficiency of enzymes occurs and the process of processing ethanol at different stages is disrupted. There is an accumulation of intermediate products of its oxidation and decay in the liver. Acetaldehyde is ten times more toxic than ethanol, its excess causes, in addition to its direct damaging effect, a violation of the normal outflow of bile, the accumulation of fats in the liver, and general poisoning of the body. And ethyl alcohol, which is not oxidized 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 abilities of the liver are not endless, and, in the end, this potential is depleted. Liver cells begin to be replaced by fibrous tissue with the restructuring of their functions and the transition to cirrhosis.

What mechanisms and risk factors cause alcoholic liver damage?

The first is chronic alcohol abuse. Sometimes the quantity and quality of liver enzymes that metabolize alcohol can be genetically impaired.

It is noted that women are more susceptible to alcohol and the development of dependence in them occurs faster.

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

The lifestyle that a person who consumes alcohol 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 is enhanced by its use. Vaccination against hepatitis can 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 recent years, distorted opinions have been formed in society related to the alleged 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 way of its transmission is household.
Hepatitis B is transmitted mainly through the blood. To transmit the virus, a drop of blood is enough, which remains, for example, in the needle of a syringe. 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 epidemic in recent years.

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

Hepatitis B vaccination is included in the vaccination calendar for children. Adults are vaccinated with their desire and consent. Usually the vaccination schedule looks like this: 0 - 1 - 6. That is, the vaccination should be repeated after 1 and 6 months.

Many people have a question about the effect of alcohol on the effectiveness of the hepatitis vaccine. The use of alcoholic beverages in acceptable doses does not affect the vaccination. But you will still need to stop drinking alcohol for three days after the vaccination, due to the fact that each vaccine has its own side effects, which drinking alcohol can exacerbate.

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 prolonged poisoning of the entire human body with alcohol (ethyl alcohol).

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

1. Liver steatosis (fatty degeneration; fatty hepatosis);
2. alcoholic hepatitis;
3. 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. It occurs in people who abuse alcohol in more than 90% of cases. Usually asymptomatic, there may be symptoms of dyspeptic disorders, a feeling of heaviness in the right hypochondrium, weakness, icterus of the skin and mucous membranes. Liver steatosis is a reversible process, and if alcohol is given up and treatment is carried out, a complete cure is possible. If there is a further effect of ethanol on hepatocytes, alcoholic liver damage passes into the second stage - alcoholic hepatitis. In this case, a deeper lesion of hepatocytes occurs with a violation of their functionality.

Alcoholic hepatitis

The course of alcoholic hepatitis can be in the form of persistent (stable course, usually asymptomatic or asymptomatic, relatively reversible changes in the liver) or progressive form (transition from the previous phase in case of further alcohol abuse; 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 drinking in a person who abuses alcohol, when the body is poisoned by large doses of alcohol.

There are several varieties of flow, but the icteric variant is the most common. At the same time, 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 increases, has a dense structure, is painful.
Chronic hepatitis is often relatively asymptomatic. Severe organ damage can only be indicated by laboratory and additional research methods. The liver also increases significantly, up to a huge size.

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

Symptoms of cirrhosis can be quite scarce, especially against the background of a long course of the disease. The patient is concerned about fatigue, weakness, pain in the liver, asthenia (weakness, fatigue). A characteristic “hepatic” erythema (redness) appears on the palms, small capillaries expand on the entire surface of the body. The liver is enlarged or, conversely, reduced, may already be painless, its surface is bumpy. Signs of ascites are revealed, an enlargement of the spleen, as a result of which the abdomen increases with an expanded venous network on its surface. Symptoms of portal hypertension appear. There is a violation of the functions of other organs and systems as a result of poisoning with 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, perform diagnostic laparoscopy and liver biopsy.

How is alcoholic liver disease treated?

The most important condition is the complete refusal of the patient from alcohol. At some stages of alcoholic liver damage, complete regeneration of the liver tissue can occur. But it should be noted that, unfortunately, this recommendation is fulfilled by no more than a third of patients. Just as many simply reduce the amount of alcohol consumed, and the rest completely ignore it and continue 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. The protein content is about 1 g per 1 kg of the patient's weight. It is necessary to saturate with vitamins, especially group B. Table number 5 can be an example of such a diet.

Medical 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 violations.

With the ineffectiveness of conservative treatment, the question of liver transplantation is decided.

Alcoholic cirrhosis of the liver is a fatal disease. It is caused by regular alcohol consumption and quickly becomes chronic with constant drinking of alcoholic beverages; in the international classification among classifiers, it has the K74 microbial code. Currently, alcoholic drinks are often not something reprehensible and appear at any holiday. Meanwhile, not only those who drink often and a lot are susceptible to the disease. It is enough to drink every day or every other day, albeit not much.

Alcoholic cirrhosis of the liver develops due to alcohol abuse

What is cirrhosis?

Any drunk drink containing ethanol always leads to poisoning and subsequent destruction of a certain number of liver cells. Liver cells that have died from drunkenness provoke alcoholic cirrhosis of the liver. This disease is not tied to gender, age or nationality; anyone who is addicted to ethyl alcohol can earn cirrhosis.

How much pure alcohol should you drink? Cirrhosis is an extensive liver disease that develops as a result of drinking at least 40g of pure alcohol by a man and more than 20g by a woman over a long period of time. You need to drink this amount daily or every other day. No matter what kind of alcohol a person takes, the content of pure alcohol is extracted from any drink. When people drink, part of the liver cells die, and after a while they cause the first symptoms of alcoholic cirrhosis of the liver.

Pathogenesis

Cirrhosis is the last stage of alcoholic liver disease and develops in about 20% of people who regularly take strong drinks. This pathology gives unfavorable prognosis if a person does not completely give up the desire to drink and does not begin rehabilitation therapy and vitamin intake. If the mode of life does not change, the patient drinks, as he drank, then the stages develop ahead of time and the person dies of cirrhosis within 7-10 years.

Symptomatic use of restorative drugs in combination with a complete abstinence from alcohol can prolong the existence of the patient for several years, as well as significantly improve the quality of life.

When a person drinks a lot and often, the liver does not have time to cope

With the development of liver disease, the pathogenesis is closely related to the lifestyle of the patient. At first, the liver quite successfully manages to process each new dose of ethanol. But when a person drinks a lot and often, the liver does not have time to cope and is gradually covered with adipose tissue. The ability to process fluid becomes less and less, and the walls of the organ become more and more thin. Cells die and are replaced not by similar, but by connective tissue. This process is called liver sclerosis and is quite dangerous.

This further affects the performance of the liver and its ability to process alcohol. After a short time, the body does not cope with the duties assigned to it, ethanol, together with its decay products, poisons the body, affects all internal organs and the circulatory system. Then the liver completely fails, the person becomes disabled and dies in a short time.

Symptoms of the disease

How to understand that alcoholic cirrhosis of the liver has begun? Signs of liver cirrhosis in alcoholics vary by stage and resemble those of hepatitis. In the initial stages, there are usually no symptoms, except for a possible enlargement of the liver in volume. In other cases, it is almost impossible to notice the appearance of cirrhosis until the first signs of liver failure and atherosclerosis appear.

The first signs of liver cirrhosis usually appear 5-7 years after the start of replacement of liver cells with adipose and connective tissue.

The stage of subcompensation is usually characterized by attempts by the body to maintain working functions and then the first symptoms of liver cirrhosis appear. Appetite becomes noticeably worse, weight decreases, fatigue appears. Against the background of frequent or constant weakness, symptoms of alcoholic cirrhosis appear, such as nausea, vomiting, and an increase in the size of the organ.

At the next stage, all the working functions of the liver gradually fade away. A whole complex of liver cirrhosis syndromes develops in women and men equally in various areas of life. Asthenic syndrome is manifested in rapid fatigue and indifference to what is happening, the appearance of depressive states and a complete loss of appetite. Quite quickly, complete exhaustion of the body develops, the first manifestations of constantly low blood pressure and tachycardia. The cheeks, nose, palms and feet often turn red with a purplish tint, the mucous membranes and skin become yellow, bruises often appear.

Symptoms of liver cirrhosis in men are manifested in an excess of female hormones- Obesity appears according to the female type, while the arms and legs remain too thin. The male gonads do not work, and infertility develops. The chest increases, the fingers take on the characteristic appearance of drumsticks with white strokes-scratches on the nail plates. At this stage, it is critical to start treatment, otherwise there are changes in the body that can no longer be reversed. Varicose veins appear in the esophagus and rectum, which leads not only to changes in the veins, but also to frequent bleeding from them. Such incidents dramatically worsen the condition of the body.

At the next stage, increased pressure appears in the neck, a protrusion is found on the greatly enlarged abdomen - ascites. The veins are clearly visible, and the shape of a jellyfish on the stomach can be traced. Due to a strong increase in the size of the liver, ascites can become inflamed and cause peritonitis.

At the last stage, hepatic encephalopathy develops as a result of toxins freely moving in the blood. They cause brain damage, disrupt consciousness and cause personality changes. In addition, this stage causes disruption of the heart, lungs, stomach, kidneys, intestines and nerve damage.

The stages of cirrhosis differ in the severity of the course and the consequences

Functional disorders of the organ can be divided into three successive stages of cirrhosis, differing in severity and consequences. The first stage is the appearance of compensated alcoholic cirrhosis of the liver, in which there are no obvious signs of the disease. Within this stage, the liver is able to cope with its duties, and the disease can only be detected by examining the tissue of the organ by biopsy.

The second stage is called subcompensated and is accompanied by the first serious symptoms and consequences. It is at this stage that the first liver failure appears. The last stage is called decompensated cirrhosis and is characterized by a complete failure of the organ. Besides, with alcoholism, poisoning of all internal organs of a person and their toxic damage appear. At this stage, no conservative treatment will help, the only way out is a donor liver transplant.

However, do not forget that before transplantation, patients awaiting surgery undergo a rigorous selection - people who have not stopped alcohol abuse are not included in the list for transplantation. Physicians in the commission closely monitor the fulfillment of the condition. Most often, patients awaiting surgery do not live to see it, since the queue is much longer than the number of donor organs.

What are the possible complications

The main complication is ascites. This is the formation of fluid in the abdominal cavity that does not find an exit from the body. The accumulation of fluid provokes an increase in the volume of the abdomen, stagnation of blood in the body and an increase in pressure. This disease is not independent, it comes only with cirrhosis. It is ascites that worsens the chances of a complete and speedy recovery, and also aggravates the course of the entire disease. This complication of cirrhosis increases the mortality of patients by 50% within two years.

A patient with ascites complains of a sharp increase in body weight, growth of the abdomen and severe pain in the abdominal cavity. Discomfort is accompanied by the appearance of dilated veins and loss of appetite. A person is quickly satiated and tired, complains of nausea and constipation.

Serious and frequent complications of alcoholic cirrhosis of the liver are also peritonitis and the appearance of infection in the body. Often ascites is the cause of peritonitis and inflammation in the abdominal cavity. Symptoms of these complications are:

• severe cutting pain in the abdominal cavity and hepatic colitis;
• the appearance of high temperature;
• constipation, gas retention in the body;
• bad feeling.

Treatment and preventive measures

The first thing that a person who has firmly decided to get rid of alcoholic cirrhosis of the liver will have to do is to give up alcohol forever. This path is the only one that leads to recovery. It is also important to arrange a proper and balanced diet in small portions. Improper nutrition also leads to the development of cirrhosis, if it has already formed. Can I drink alcohol during treatment? Absolutely not, this is the first rule of treatment.

Most of the treatment for cirrhosis of the liver, especially not in the first degree, takes place in a hospital setting. The main task of specialists is to return the liver to its functions.

Impaired protein synthesis is a dangerous consequence of liver dysfunction. Restoration of the required amount of albumin in the blood is performed using droppers.

With alcoholic cirrhosis of the liver at the decompensated stage, only an organ transplant can save a person.

If there is ascites in the body or ordinary edema on the body, diuretic drugs are prescribed, which are prescribed by the doctor individually, taking into account all the characteristics of the patient. During such therapy, it is important to monitor the patient's water balance. If the disease is accompanied by cholestasis, it is usually recommended to treat it with ursodeoxycholic acid. In the event of such a complication, unbearable skin itching and an increase in the level of bilirubin appear.

In any case, a vitamin complex is prescribed, which helps the liver recover from serious violations in its work. It is impossible to cure alcoholic cirrhosis of the liver in the second or third stage, however, it is possible to maintain the functioning of the organ with the help of special preparations. In this case, his life will last for several years. If alcoholic cirrhosis of the liver is found at the decompensated stage, then only a donor liver transplant can save a person. And also this patient will have to take certain drugs all his life in order to live more than a year.

To ensure preventive measures to combat cirrhosis of the liver of alcoholic etiology, you need to take several precautions that will not only save you from the onset of the disease, but also add quality to a person's life. Such methods include:

It is impossible to answer exactly the question of how long alcoholics with varying degrees of cirrhosis of the liver live, especially if they do not stop drinking. People who have been accidentally diagnosed with alcoholic cirrhosis of the liver in the early stages live longer and better with it. Their life is not accompanied by eternal pain, otherwise the forecasts are very different. It all depends on whether the patient refused to drink strong drinks, since the continuation of a normal lifestyle quickly leads to the development of the last stages of cirrhosis. Since if you take any strength therapy and do not give up drinking, the condition will only worsen. Do not earn cirrhosis, do not drink every day or in excess.

More chances for a healthy existence in young people who agree to adhere to a high-protein diet and all the recommendations of the attending physician. In the presence of obesity, the condition is somewhat worse. In some cases, an operation is prescribed and successfully performed - you have to remove the spleen or suture the liver. In all cases, without exception, it is necessary to consult a specialist. If you follow all the recommendations of doctors, then life expectancy increases by at least 10 years.

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Alcoholic cirrhosis of the liver is the most severe form of alcoholic disease. Its essence boils down to the fact that normal functional cells (hepatocytes) die off under the toxic effects of alcohol, and in their place an inelastic fibrous tissue is formed, similar to a scar. Toxic cirrhosis of the liver will not develop due to a single use of a small dose of alcohol - it is necessary to systematically take it in large quantities. The disease develops in about 10% of people who take alcoholic beverages uncontrollably, 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 persons who systematically abuse alcohol for 8-12 years. This figure depends on many factors - the frequency of binges, gender, genetic characteristics, as well as the type, strength and quality of alcohol. In especially 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 associate this fact with the innate activity of enzymes that are responsible for the utilization of ethyl alcohol. In total, there are 5 such enzymes, and it depends on them what proportion of the consumed alcohol 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 affected by the standard of living, the environment of the patient and the culture of drinking alcohol in the family. In addition, statistics indicate that most often monozygotic twins suffer from alcoholism together. This figure is lower among dizygotic twins.

The effect of alcohol on men and women

The growth of alcoholism among women is associated with the progression of their role in society. Female representatives can consume alcoholic beverages on an equal basis with men, which does not cause condemnation. However, physiologically, their body is unable to absorb ethanol in full. In the gastric mucosa there is 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.

Women's alcoholism often leads to more serious consequences than men's.

In addition, women rarely seek medical help for alcoholism. Their relatives and relatives also do not sound the alarm, since this disease is more often associated with men. Patients with toxic liver cirrhosis are admitted to the hospital in the last stages, when changes in the tissues are already irreversible. Moreover, after a course of therapy, they are more likely to experience breakdowns than after treatment for alcoholic cirrhosis 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 consumed doses of alcohol, but also by other factors. It is noted that the likelihood of this disease is highest with malnutrition, especially with a lack 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;
• in inflammatory and ulcerative diseases of the gastrointestinal tract.

While taking any medication, you also need to consider their compatibility with alcohol. In addition to a short-term deterioration in well-being, unacceptable combinations can provoke intoxication of the body and adversely affect the liver.

How much alcohol do you need to drink to get 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 a single use of it. The body is able to cope with incoming ethanol, but the products of its processing tend to accumulate in the liver. Therefore, alcoholic cirrhosis of the liver develops within 10-15 years with daily intake of even a small amount of alcohol.

The allowable amount of alcoholic beverages differs for representatives of different sexes. The critical dose for men is 40-60 g of pure ethanol per day, for women it is 20 g. If the body regularly receives alcohol in larger quantities, it is unable to cope with its processing. Develops fatty degeneration of the liver, hepatitis, and in the end - alcoholic cirrhosis.

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

Ethanol in small amounts 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 a lot of self-control. It is best to forego 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 have time to produce specific enzymes in sufficient quantities, and it is completely eliminated from the body. If you take it regularly in an irregular amount, the enzymes do not cope with this task, and toxic acetaldehyde is formed during the processing of alcohol. It determines the negative impact of alcohol on the human body.

Cirrhosis is the end stage of alcoholic liver disease.

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

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

First, fatty degeneration of the liver develops from alcohol. This is a syndrome associated with a lipid metabolism disorder in which fat accumulates in normal cells. Then inflammatory reactions are included 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 also 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 tissues instead of normal hepatocytes.

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

Forms of alcoholic cirrhosis

There is a classification of toxic cirrhosis according to Child-Pugh, which determines the severity of the disease. According to the results of ultrasound and blood tests, as well as clinical manifestations, you can choose from 1 to 3 points on a special scale. Further, the scores are summed up, and on the basis of the obtained value, it is possible to determine the class of the disease. These data make it possible to predict how long different patients live with liver cirrhosis.

Parameters	Points
	1	2	3
Ascites (presence of fluid in the abdominal cavity)	Not	Slightly	A large number of
Brain damage	Not	Easy stage	severe stage
Bilirubin in the blood, µmol/l	Less than 34 (2.0)	34-51 (2,0-3,0)	Over 51 (3.0)
Albumin, g	Over 35	28-35	Less than 28
PTI (prothrombin index)	Over 60	40-60	Less than 40

Interpretation of results:

• 5-6 points - class A, or stage of compensation. This is the first stage, in which life expectancy can be up to 15-20 years.
• 7-9 points - class B, or stage of subcompensation. In this case, the clinical manifestations of cirrhosis are pronounced, there are frequent exacerbations and a bright pain syndrome. The patient's life span 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 such a diagnosis, the patient can live from 1 to 3 years, the probability of death during liver transplantation is up to 82%.

It is also customary to classify the disease according to the extent of damage to liver tissues. He might be:

• small-nodular - small areas of cirrhosis form in the parenchyma;
• large-nodular - large cirrhotic foci;
• mixed, if cicatricial foci of different sizes are formed.

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

Symptoms of the disease

Signs of cirrhosis of the liver in alcoholics do not appear immediately. For several years, the replacement of normal tissue with scar tissue may occur imperceptibly. Then the body can not cope with the toxins that enter the body, and the first symptoms appear.

Jaundice is a symptom that occurs when there is a violation of the outflow of bile.

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 swings.

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 ultrasound and blood tests.

liver failure syndrome

Over time, symptoms appear that indicate cirrhosis of the liver:

• pain in the right hypochondrium;
• an increase, and over time, a decrease in the volume of an 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 on the hands;
• Dupuytren's contracture - an anomaly of the tendons of the hands, which lead to a violation of their mobility;
• enlargement of the salivary glands.

Some patients develop encephalopathy associated with the entry of toxins into the brain. It is manifested by a loss of orientation in space and time, a change in mood. If the disease progresses, there is a possibility of hepatic coma.

portal hypertension

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

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

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

A characteristic symptom of cirrhosis of the liver is the accumulation of free fluid in the abdominal cavity.

Cardiovascular insufficiency

Cirrhosis of the liver affects all organ systems, including the cardiovascular system. The walls of blood vessels become brittle, the heart can not cope with the stress. The patient is diagnosed with:

• lowering blood pressure;
• tachycardia;
• shortness of breath when moving;
• heart rhythm abnormalities;
• pain in the region of the heart.

An increase in vascular permeability is manifested by swelling. The symptom intensifies when it is impossible to carry normal physical activity.

Diagnostics

In many cases, the diagnosis can be made on the basis of characteristic clinical features as well as patient interviews. First of all, you need to determine the fact of drinking alcohol for a long time. The doctor also examines the medical history to identify possible comorbidities. Past liver diseases of various origins are important.

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

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

The main thing is to find out the etiology of toxic cirrhosis. The fact of alcohol intake may be silent by patients, but it is especially important in the diagnosis. The accompanying patient can provide this information to the doctor.

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, it is necessary to completely exclude alcohol for a period of 6 months or more.

The only way to prevent the disease is a healthy lifestyle and compliance with the rules of alcohol consumption.

In other cases, it does not make sense to treat the disease. All manipulations are aimed at prolonging life and relieving symptoms, but not at full recovery. The patient is prescribed:

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

Diet is important. Alcohol in any dose is contraindicated for the patient throughout life. Fatty and fried foods, salty and smoked foods, carbonated water and drinks should also be excluded. The diet should contain large amounts of protein, vitamins and minerals.

Prevention and prognosis

The only measure to prevent the disease is the proper use of alcohol. At the same time, it is worth paying attention not only to the amount of alcohol, but also to the quality of drinks. You can also prevent liver disease if you follow your diet. The diet should contain a sufficient amount of protein, vitamins and trace elements. You should reduce the consumption of fatty, fried foods, carbonated non-alcoholic drinks. In the case of the development of cirrhosis, treatment will not imply a complete recovery. Therapy is aimed at maintaining the life of the patient and delaying death. In different cases, the patient can live from 1 to 15 years with such a 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, disruption of all systems. It is completely impossible to cure it, but some patients undergo a liver transplant. This operation allows you 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 rejection of alcoholic beverages, otherwise the prognosis will be disappointing.