Alcoholic hepatitis Hepatitis - the scourge of our time   It develops in virtually all patients with chronic alcoholism. The extent of its activity depends on the individual, the frequency and amount of alcohol. But reserves of the body such that when the termination alcohol lesions in the liver in most cases, undergo reverse changes.

Why and how to develop alcoholic hepatitis

Alcoholic hepatitis - this is inflammatory and metabolic and degenerative changes in the liver that occur under the influence of the regular use of alcohol. Alcohol is considered a specific poison for the liver cells (hepatocytes), since its expansion in the liver formed a very toxic substance - acetaldehyde.

Under the influence of acetaldehyde in liver cells disturbed metabolism, and they are partly or completely lose their function. Drink and its metabolism products trigger a cascade of chemical reactions in the body, leading to disruption of receipt in liver cells of oxygen and ultimately to their destruction (necrosis). Sometimes, if the amount received spirits were very high, hepatocytes immediately destroyed (undergo necrosis). Gradually dead hepatocytes are replaced by connective tissue cells, and the liver loses its function - the so-formed cirrhosis.

It was found that changes in the liver develop within 1-2 years of regular use of alcohol. However, the first clinical signs of the disease appear only after 3-5 years. If the patient is alcoholic hepatitis continued to drink alcohol, then after 5-10 years, he developed irreversible changes in the liver to decrease its function - alcoholic cirrhosis.

Persistent alcoholic hepatitis - a relatively benign form of the disease, in which perhaps a full recovery of the liver with the full elimination of alcohol intake.

Progressive alcoholic hepatitis can be mild, moderate or severe activity. The disease is damage to the liver tissue in the form of small foci of necrotic hepatocytes from connective tissue replacement, and therefore proceeds quickly enough hepatitis cirrhosis. Complete cure in this case is problematic, but the complete elimination of alcohol and timely treatment can stop the progression of hepatitis preserving residual effects.

Symptoms of alcoholic hepatitis

Signs of acute alcoholic hepatitis (OAS) usually develop after a long period of use of alcoholic beverages in patients with existing liver cirrhosis, which significantly worsens the prognosis. Current OAS can be latent, jaundice, cholestatic or fulminant.

Latent within the OAS is shown only in the form of changes in laboratory parameters of hepatic function: elevated blood level of liver enzymes (transaminases - ALT, AST) released from hepatocyte death.

Yellowness within the OAS - the most common option, the signs of which - lethargy, weakness, decreased performance, loss of appetite, dull pain in the right upper quadrant, nausea, vomiting, diarrhea or constipation Constipation - Watch out for food , Weight loss, jaundice staining of the skin without itching, sudden changes in body temperature or a high temperature stable, painful enlarged liver. Sometimes the spleen is also increasing, it appears ascites (accumulation of fluid in the abdominal cavity). Reddened palms patients, appear on the skin spider veins Spider veins - a sign of several diseases   (telangiectasia), pinpoint hemorrhages (petechiae). To join the OAS often infection (pyelonephritis, pneumonia, peritonitis, and so on).

Cholestatic jaundice within the OAS and accompanied by intense itching, dark (in the form of beer) urine, discolored feces, sometimes - pain in the right upper quadrant and protracted.

Fulminant (lightning) OAS differs rapidly progressing with development of jaundice, hemorrhages and bleeding, hepatic encephalopathy (toxic brain damage), renal failure Kidney failure - when treatment is vital   and hepatic coma.

How to treat alcoholic hepatitis

First of all, it requires a complete rejection of alcohol, heavy physical exertion, stress and diet (table number 5). Drug treatment of alcoholic hepatitis include prescription drugs with hepatoprotective (maintain and restore the work of hepatocytes) action. These drugs are essentiale, Essliver fort CARS ademetionine (Heptral, Geptor) and others. In the absence of effect of conservative treatment and progression of the disease recommended a liver transplant.

For the treatment of alcoholic hepatitis today there are effective medicines that allow patients or completely cure or stop the progression of the disease. But this is possible only if complete abstinence from alcohol.

Galina Romanenko

The analysis on a dysbacteriosis is very important, as goiter is not the primary diagnosis, this is a symptom of some other disorder. If you can not figure out why the developed goiter, and some microorganisms are prevalent in the intestines, eliminate dysbacteriosis will not be possible.

What tests will pass on a dysbacteriosis

General analysis on dysbiosis are coprogram (general analysis of feces) and sowing fecal bacteria overgrowth. These analyzes prescribed by a doctor (pediatrician, internist or gastroenterologist) on the basis of complaints and examination of the patient. The doctor also explained to the patient, where to be tested for bacteria overgrowth. Full screening for bacteria overgrowth can be passed in the laboratories at the multidisciplinary (including regional) hospitals or specialized gastroenterology clinics.

Coprogram and its interpretation

Coprogram or general analysis of feces How to pass a stool, so as not to spoil it   - A description of the combined physical, chemical and microscopic examination of feces. Determines the degree of digestibility of food, enzyme activity, the presence of inflammatory processes. Dysbacteriosis does not develop in a vacuum. It is a symptom of some other disease. With coprogram can reveal not only the overgrowth, and dysfunction of the stomach, pancreas Diabetes and pancreas - the things you need to know , The liver, the presence of fecal accelerated evacuation from the stomach and intestines, impaired digestion and absorption of food in the duodenum and small intestine inflammation in the gastrointestinal tract. That is, it is possible to identify (or suspect) the main cause of dysbiosis.

Deciphering the analysis on a dysbacteriosis (in this case coprogram) may reveal a number of characteristic features. If goiter accompanied by the fermentation reaction, the amount of feces increased significantly. Stool pasty, frothy, with a strong acid reaction. Under the microscope, can be seen in the feces undigested muscle fibers and fatty acids. Very positive response to starch and fiber.

If goiter accompanied by rotting food, feces increased volume, liquid stool, with putrid odor of feces alkaline reaction. Under the microscope you can see undigested muscle fibers and connective tissue, increased ammonia content.

If goiter accompanied by constipation, fecal amount reduced calories has the form of solid beads (sheep feces) reaction - alkaline. In the presence of intestinal wall inflammation can be detected in stool mucus, a large number of leukocytes White blood cells as the basis of immunity   and cells of the intestinal epithelium.

Fecal bacteria overgrowth - inoculation of bacteria overgrowth

Fence stool for microbiological examination (inoculation of nutrient medium) is carried out in a sterile bowl with a sterile instrument. Feces on dysbacteriosis should be delivered to the laboratory no later than two hours after collection or after six hours (if calories stored in the refrigerator).

Dysbacteriosis seen as an imbalance of microorganisms in the gut, which manifests itself in the change of their qualitative and quantitative composition ratio. Disrupts the normal ratio between the anaerobic (without air-paced) and aerobic (for its vital functions need access to air) microflora. How to decipher the analysis on a dysbacteriosis, tell doctor. For example, it may reduce the content of bifidobacteria and lactobacilli and simultaneously increases the amount of E. coli with altered properties. Another embodiment - reducing the amount of normal colon bacilli at least 1 million. Colony forming units - CFU / g or increase them to 1 billion or more cfu / g. The results of the analysis on a dysbacteriosis can properly assess a doctor.

Norm analysis on dysbacteriosis:

• reduction of bifidobacteria in faeces at least 10 8 CFU in 1 ml of (d); in children under 3 years - less than 10 9 CFU / g;
• reduction of lactobacillus less than 10 6 KOE / g; in children under 3 years - less than 10 7 CFU / g;
• increase in E. coli than 10 8 CFU / g; children of the first six months - more than 10 9 CFU / g;
• reduction of E. coli at least 10 6 cfu / g;
• emergence coliform with altered properties, for example, lactose or weakly cleaving amino acid producing hydrogen sulfide, and so on) in an amount of more than 10% of the total number;
• Enterococci content of more than 10 6 cfu / g;
• appearance in the golden stool or hemolytic streptococci;
• appearance in the feces of pathogenic organisms - some types of E. coli, Salmonella, Shigella, and others, which cause intestinal infections;
• appearance in the feces of conditional - pathogenic Gram-negative rods - Proteus, Klebsiella and others;
• the appearance of yeast fungi of the genus Candida;
• emergence Clostridia more than 10 3 CFU / g.

Tests of dysbacteriosis in children Dysbacteriosis children - Digestive Disorders   evaluated on the same criteria. The volume of the normal microflora in children than in adults. Analysis for neonatal goiter detects primarily reducing the number of bifidobacteria.

Galina Romanenko