What are the symptoms of alcoholic hepatitis

Update: November 2018

Only one in three people who abuse alcohol
changes in liver can lead to hepatitis,
циррозу или раку. Most people who suffer from chronic
alcoholism, there are irreversible damage to the central nervous

Many experts associate alcoholic hepatitis with development
alcoholic cirrhosis of the liver, other experts do not find explicit
confirmation of this fact. However, if cirrhosis occurs only
у людей, принимающих чрезмерно высокие дозы алкоголя,  то
the development of alcoholic hepatitis contributes to even the reception of 50 g of alcohol
(1 l of beer, 100 ml of vodka or 400 ml of wine). And “need” to
This amount was taken daily for a long time.
time (at least 5 years).

According to statistics, mortality during an acute alcohol attack
hepatitis is 20-60 percent, which depends on the option
the course of the disease.

Alcohol and Liver

Large amounts of alcohol are poisonous to the body. Why
big ones? Because in a small volume ethanol (or ethyl alcohol)
produced by the body itself, is present in some
biochemical reactions and is a source of energy.

What is considered a large number? That’s all the most
safe daily dose, that is:

  • more than 30 ml of 40% alcoholic beverage (vodka, brandy, rum,
    whiskey or konyaka);
  • more than 75 ml of 17% alcohol (port wine, fortified wine or
    port wine);
  • more than 100 ml of 11-13% alcohol (white wine,
    champagne, red dry wine);
  • more than 250-330 ml of beer (depending on its strength).

And abuse will be called, even if
the above dose was not exceeded, but used more than 5 times
in Week.

The human body is trying to get rid of alcohol: its
splitting starts in the mouth (using saliva), following 20%
neutralized in the stomach. The intensity of such reactions depends on
addition, high acidity or low, is there currently in
stomach food or not. As a result of gastric reactions is formed
acetaldehyde is a very toxic substance.

All other alcohol, except a small amount, which
excreted through the lungs, with exhaled air, enters for
decontamination to the liver. There, ethanol first turns first into
acetaldehyde is the poison that makes a person feel bad, and
that then turns into acetic acid. Last harmless
after several reactions it decomposes into carbon dioxide and water. Than
more often a person takes alcohol, the more affected these enzyme
system. As a result, a person needs all the smaller doses to get drunk.
In this case, ethanol is already included in the metabolism.

How does alcoholic hepatitis develop?

The activity of enzymes decreases for a reason. This is due to the fact
that ethanol (more precisely, acetaldehyde) directly damages cells
the liver. It happens through the fatty degeneration of its tissue.
It happens like this:

  • Fatty acid formation occurs in the liver cells. Getting into
    in these cells, ethanol disrupts this process;
  • the liver perceives it as inflammation, therefore in its tissues
    a large amount of a substance called “factor
    tumor necrosis ”(TNF);
  • when TNF becomes greater than adiponectin substances,
    Liver cells accumulate fat drops (triglycerides).
    Promotes fat accumulation and intestinal substances

In addition, ethanol causes stagnation in the liver cells of bile (it
it is there that is produced).

All these changes lead to liver cell replacement.
connective tissue (fibrosis). This is the initial, and yet
обратимая, стадия cirrhosis. If here eliminate the effect of alcohol and
conduct anti-inflammatory therapy to achieve a reduction
TNF can prevent its development.

Types and forms of alcoholic hepatitis

Alcoholic hepatitis can occur in several

  • acute liver inflammation (acute hepatitis). It develops into
    70% of cases;
  • chronic hepatitis.

Each of these species has its own forms, which are characterized by
your symptoms.

Acute alcoholic hepatitis

People who regularly consume large amounts of alcohol
risk “earn” acute or chronic alcoholic hepatitis.
Symptoms of this type of toxic hepatitis develop
predominantly in men who abuse alcohol in
for at least 3-5 years. However, there are rare cases where
the acute course of hepatitis develops rapidly over
буквально нескольких days запоя. When this happens strong
интоксикация всего организма, воспаление и разрушение the liver.

Most often, acute hepatitis develops when a person already has
cirrhosis of the liver, not necessarily developed as a result of taking
of alcohol.

Read also on the topic:

  • Hepatitis C incubation period
  • How is hepatitis C transmitted
  • The cost of treating hepatitis C is equal to the price of a foreign car in Russia
  • How much live with hepatitis C
  • Chronic hepatitis: symptoms, causes

Additional factors provoking the transient flow of this
diseases are:

  • smoking
  • inferior nutrition
  • genetically determined alcoholism
  • viral hepatitis
  • medication with toxic effects
    on the liver

Alcoholic hepatitis usually occurs for the first time with significant
dose of alcohol, consumed in a short time, it flows into
acute form with the following symptoms:

  • nausea
  • bitterness in the mouth
  • vomiting
  • lack of appetite Печень, пораженная гепатитом
  • temperature increase 38-38,5С
  • pain in the liver in the right hypochondrium
  • upset stool
  • abdominal distention
  • two days after the initial symptoms, the jaundice occurs
    staining of the skin
  • violation of the sensitivity of the tongue, legs
  • growing weakness in the whole body
  • various mental disorders
  • ascites – accumulation of fluid in the peritoneum may develop.

The duration of acute hepatitis from alcohol is from 3 to 5
weeks. With a mild disease liver test
increase slightly, but with severe form, samples reach
high numbers, developing jaundice and acute hepatic
failure. In differential diagnosis, unlike
viral in acute toxic hepatitis an enlarged spleen does not
characteristic, a violation of digestion is slightly pronounced
character Moreover, with professional poisoning toxic
Hepatitis have a number of other symptoms of intoxication and clinical
indications that establishing a correct diagnosis is not particularly

Acute alcoholic hepatitis may have several options.

Желтушный — самый часто встречающийся вариант
diseases of alcohol, affecting the liver. The following symptoms
alcoholic hepatitis is referred to the icteric type:

  • Severe jaundice, without itching of the skin
  • Снижение веса из-за nausea, vomiting, отсутствия аппетита
  • Pain in the liver, fatigue
  • Feverish fever, lasting up to 10-14
  • Rarely, but with severe forms of hepatitis is splenomegaly,
    ascites, erythema toxic on the hands, signs of hepatic
  • This type of hepatitis is in many ways very similar to acute.
    viral hepatitis.

Латентный — бессимптомное течение заболевания,
it is chronic alcoholic hepatitis, which periodically
patients may experience:

  • slight pain in right hypochondrium
  • loss of appetite
  • possible anemia, increased leukocytes
  • slight liver enlargement

Холестатический — при этом типе заболевания
the highest mortality rate among patients. Clinical signs
alcoholic hepatitis cholestatic options are as follows:

  • dark urine, bright feces
  • severe itching
  • jaundice
  • high amount of bilirubin in the blood

Фульминантный —  отличается
progressive transient character.

  • High body temperature
  • The rapid increase in the symptoms of jaundice
  • Total lack of appetite
  • Severe weakness
  • Strong pain in the liver, epigastric region
  • High body temperature
  • Ascites, hepatic encephalopathy
  • Hemorrhagic manifestations
  • Renal failure

This type of alcoholic toxic hepatitis may end.
fatal from renal-hepatic failure literally
через 14-20 days от начала острого периода.

Chronic alcoholic hepatitis

For the chronic course of alcoholic hepatitis is characteristic
scant symptoms:

  • mild pain or discomfort in the right hypochondrium;
  • loss of appetite;
  • periodic nausea, vomiting;
  • sleeplessness at night, daytime sleepiness;
  • decrease in sexual desire;
  • periodically the temperature rises to low numbers;
  • pallor of nail beds;
  • decrease in the size of the testicles;
  • rumbling in the stomach;
  • appearance of spider veins on the skin of different parts
  • redness of the palms (more) and stop (less);
  • an increase in the abdomen due to the accumulation of fluid in it;
  • pain in the area around the navel;
  • reduced mood and performance;
  • spontaneous flexion of the fingers, their full extension
  • decrease in the volume of arms and legs due to muscle wasting;
  • losing weight

When the first damage to the liver cells occurred,
chronic hepatitis is called chronic persistent.
It has symptoms that rarely cause a person to turn to
to the doctor. It:

  • slight nausea;
  • heaviness in the right hypochondrium;
  • frequent belching;
  • stomach discomfort.

If a person stops taking alcohol for 3-6 months,
changes in his liver may begin to fade. If,
on the contrary, ethanol continues to flow, over time, hepatitis
goes into active form. His symptoms are:

  • vomiting;
  • temperature rise;
  • pain in the right hypochondrium;
  • yellowing of the skin and whites of the eyes;
  • diarrhea;
  • drowsiness.

Symptoms of chronic active hepatitis is very similar
acute hepatitis. In some cases, they can only be distinguished by
microscopic examination of the liver site taken
during a biopsy.

Severity of hepatitis

Each type of hepatitis is acute or chronic (in the form of
active option) has three severity. They are differentiated by
the level of ALT in the blood (liver enzyme, which is determined by
analysis “Hepatic samples”):

  1. Easy In this case, ALT rises no higher than 3 U / ml * h
    (at a rate of up to 0.68 U / ml * h).
  2. Average. ALT rises from 3 to 5 U / ml * h
  3. Тяжелая – при АЛТ выше 5 U / ml * h


For the symptoms alone it is not clear – alcoholic hepatitis
human or viral, or is it the debut of cirrhosis or liver cancer.
First aid in the diagnosis can be provided by relatives who
say that a few years on the eve of the patient:

  • abused alcohol;
  • often felt like drinking;
  • the dose of alcohol gradually increased.

To suspect alcoholic origin of hepatitis can
determination of alcohol dehydrogenase in the blood (the norm is less than 2.8 ME / l
or less than 0.05 катkat / l):

  • if only 1 isomer of this enzyme is elevated, you can think about
    viral hepatitis (until viral markers are obtained
  • if alcohol dehydrogenase-2 is increased (that is, the second isomer) –
    it is alcoholic hepatitis;
  • with an increase in alcohol dehydrogenase-3 you can think about

Clinics rarely identify this enzyme. Suspecting hepatitis,
Doctors usually prescribe the definition of ALT and AST only. At defeat
both enzymes are elevated in liver, but AST / ALT becomes less
0.6. Also, a coagulogram is necessarily determined.
(blood coagulation ability) and proteinogram (total protein
blood and its fractions).

Markers of hepatitis viruses are required (or the definition
DNA or RNA of viruses by PCR-method), liver ultrasound is performed, surrenders
fecal occult blood. FEGGS is performed whenever possible: it
allows you to see damage to the lining of the stomach and
varicose veins, characteristic of cirrhosis of the liver.

When the diagnosis of viral hepatitis is excluded, and indicators
coagulation allow, liver biopsy is performed. She is
the most accurate diagnosis, based on which you can put
diagnosis. In the study of the liver under a microscope is estimated
also the degree of fibrosis (replacement of liver cells by the connective
cloth). It is rated with the letter F with a degree, where F0 is the absence
fibrosis, and F4 – cirrhosis.


Alcoholic hepatitis therapy consists of such “three
whales “:

  1. The exclusion of alcohol.
  2. Dieting.
  3. Drug therapy.

If necessary, treatment is complemented by surgery.


Food for alcoholic hepatitis should provide the body
all those substances that were lost due to alcohol intake.

  • protein – 1 g of protein per 1 kg of body weight;
  • folic acid: it is found in fresh herbs, nuts,
    tuna, salmon, cereals;
  • group B vitamins: they are found in meat, liver, yeast,
    eggs, cereal bread, cereals;
  • lipotropic substances in the form of low-fat cottage cheese.

Food should be high-calorie: not less than 2000 kcal / day.

Products can only be baked or boiled. Smoked meat
marinated and fried foods are prohibited. Can not also
drink carbonated drinks, juices, fresh sour fruits,
vegetables that contain a lot of fiber. Broths are prohibited.

Protein in the form of boiled meat is prohibited when the patient is disturbed.
sleep and wakefulness schedule, he begins to speak, becomes
aggressive or starting to carry nonsense. In this case, you can eat
only mixtures composed of special amino acids.

Drug treatment

With alcoholic hepatitis are appointed:

  • drugs that inhibit the acidity of the stomach: “Omeprazole”
    �Rabeprazol, Pantoprazole;
  • sorbents: Polysorb, Enterosgel;
  • milk thistle and preparations based on it;
  • hepatoprotectors: Heptral, Methionine, Glutargin.
    Essential acids such as “Essentiale” – after appointment
    hepatologist, gastroenterologist or general practitioner,
    specializing in liver diseases;
  • short course – antibiotics such as “Norfloxacin” or
  • lactic acid bacteria;
  • lactulose drugs: Normaze, Dufalak and others.

It is necessary to pay attention that to allow the development of constipation here.
you can not: with a delay of the chair you need to do an enema and increase
dosage of lactulose preparations.

Acute alcoholic hepatitis is treated only in the hospital.

Surgical treatment

When alcoholic hepatitis can be performed palliative.
operations. They alleviate the condition of the patient, but do not eliminate
main problem. It:

  • paracentesis – with ascites (accumulation of fluid in the abdomen);
  • clipping (“stitching” with metal clips)
    bleeding varicose veins of the esophagus.

These interventions are applied mainly at the stage of

There is also a radical operation that solves the problem.
liver cell death is donor liver transplantation (more precisely,
plot of the liver). Such intervention can be performed in
foreign clinics – for 150-200 thousand euros. It can be done
cheaper in domestic hospitals, but in this case it is possible
длительное ожидание такой operations.

Prognosis of the disease

The prognosis of any disease depends on the duration of the disease,
the severity of the acute period, the frequency of relapses,
timely delivery of medical care. With this type of hepatitis
further abstinence from alcohol is important, it greatly improves

But, as a rule, patients even after a severe form of toxic
Hepatitis, continue to consume alcoholic beverages, while
30% of cases lead to the death of the patient. When cirrhosis of the liver relapses
acute alcoholic hepatitis lead to serious complications
such as gastrointestinal bleeding, acute renal
liver failure.

If a person after a mild course of acute alcoholic hepatitis
recovers (only 10% of all cases) and completely refuses
drinking alcohol, even in this case, the probability of further
The development of cirrhosis is very high.

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