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Among the alcohol-related liver diseases, 3 disease forms are observed.
1. Fatty Liver
2. Alcoholic Hepatitis
3. Cirrhosis
Patients first develop fatty liver, followed by alcoholic hepatitis and eventually cirrhosis. These disease types can be seen individually or in combination in patients.
Complaints and examination findings in patients vary with the stage of the disease. Sometimes, unfortunately, patients may not have any complaints or signs until cirrhosis develops.
For this reason, it is extremely important for people with alcohol habits to undergo periodic examination and examination. For example, liver examinations should be performed every 3 months and ultrasonography should be performed every 6 months or once a year.
The most common liver disease in alcohol users is fatty liver (90%). Fat accumulation in liver cells is alcohol-related the earliest and most common change. Liver enlargement is seen in up to 90% of these patients.
There are no complaints in light and moderate lubrication. In severe cases, loss of appetite, nausea, vomiting, pain in the upper right region of the abdomen, that is, under the ribs or above the navel, around the navel may be seen.
Liver tests are usually normal in these patients. In some serious cases, biochemical tests are impaired, AST, bilirubin, alkaline phosphatase tests may be slightly elevated.
The long-term fate of Alcohol-induced fatty liver is unclear. There is no information on how many of these patients will develop alcoholic hepatitis or cirrhosis and when. However, fatty liver should not be considered as a disease that progresses to cirrhosis. Because, if alcohol intake is stopped, lubrication can return to normal in 4-6 weeks.
In addition, it has been reported that cirrhosis develops in approximately 65% of those with fatty liver if they continue to drink alcohol. Those who have fatty liver and quit alcohol have a healthy life for a long time.
If patients with fatty liver continue to drink alcohol, they progress to cirrhosis in an average of 8-10 years. As a result, alcohol-induced fatty liver should be considered as a “silent danger”.
It is the disease picture before cirrhosis. It is an important disease. There is a risk of death. It is seen in approximately 40% of patients who consume alcohol for a long time. The patient may not have any complaints. This situation is more dangerous for the patient as it can be misleading.
Because the patient; He does not realize that he is sick. In some patients, yellowing of the eyes, loss of appetite, nausea, vomiting, abdominal pain, weight loss are observed. In this case, the patient is now aware of the health problem and applies to the doctor.
In the examination of the patient, enlargement of the liver is detected (80-100%). Fluid accumulation in the abdominal cavity (ascites), yellowing of the eyes, fever, enlarged spleen, and liver coma may occur.
In mild forms, liver enzymes may be normal or slightly increased. ALT may be slightly elevated or normal. The AST is often elevated. The AST/ALT ratio is greater than 2.
Bilirubins, ALP, GGT are variable, can be high or normal. An increase in white blood cells (leukocytes) is seen in the blood.
The outcome of the disease is related to the severity of liver damage and whether or not alcohol use continues. If alcohol consumption is stopped, the disease regresses within 8-24 weeks and almost returns to normal in 6-12 months. If alcohol intake continues, it is reported that it progresses to cirrhosis within 24-42 months.
However, we cannot say that cirrhosis does not necessarily develop as a result of cessation of alcohol. However, in these patients, cirrhosis is encountered in 20% of cases at the time of diagnosis. In some patients, liver functions deteriorate rapidly, liver failure and death may occur. As can be seen, continued alcohol consumption leads to increased damage to the liver.
Treatment methods of alcoholic liver diseasecan be grouped under four headings.
In these patients, alcohol should be stopped immediately as soon as the diagnosis is made. Regardless of the stage of the disease, cessation of alcohol will certainly lead to good developments in the patient.
In patients with fatty liver disease, stopping alcohol is sufficient. It is very useful for patients to pay attention to their nutrition and to do sports. In addition, no drug treatment is required.
Hospitalization is appropriate for patients with alcoholic hepatitis and cirrhosis who have significant complaints (such as loss of appetite, nausea, vomiting, abdominal pain, jaundice, fever, fluid collection in the abdomen) and severely impaired liver tests. In this treatment, it is very important to include the patients in the nutrition program and to provide protein and vitamins in their diet.
In addition, minerals such as potassium, magnesium and zinc can be given, as well as vitamins C, K, folic acid and B.
Most patients with alcoholic hepatitis have malnutrition. Therefore, patients need nutritional support. If oral nutrition is not sufficient, intravenous nutrition solutions can be given.
Stopping alcohol is extremely important. Cortisone therapy is a good option in selected patients. As a result, those with significant complaints; Patients with jaundice, nausea, vomiting, abdominal pain, fever and loss of appetite should be hospitalized and treated. Cortisone therapy with nutritional support is beneficial in patients with alcoholic hepatitis.
About 15% of people with alcohol habits develop cirrhosis. In some patients, the alcoholic hepatitis process may take a short time and cirrhosis may develop rapidly. On the other hand, in some patients, the picture of alcoholic hepatitis is silent and the patient gets cirrhosis without realizing it.
This is the process that is dangerous for patients. It may be associated with fatty liver disease and hepatitis in patients with liver cirrhosis. In patients with cirrhosis, cessation of alcohol causes prolongation of life expectancy.
If a patient has long-term alcohol intake, has a large liver on examination, and has signs of alcoholism, alcohol is most likely the cause of liver disease. Anorexia, morning sickness and belching, diarrhea, fever, vague right upper quadrant pain and tenderness, bilateral parotid gland enlargement, enlargement of both breasts in men, testicular atrophy, infertility, loss of muscle mass, loss of memory and concentration, insomnia, restlessness, Tremors in the hands are common.
On examination, yellowing of the eyes, enlargement of the liver and spleen, and fluid accumulation in the abdominal cavity may be detected. Gastric bleeding may occur. Bleeding can be seen from varicose veins in the esophagus and stomach and duodenal ulcers.
The life expectancy of alcoholic cirrhosis is better than other types of cirrhosis. Life expectancy shows parallelism with the time of cessation of alcohol. Alcohol stopped at an early stage of the disease stops the progression of the disease.
The average life expectancy in alcoholic cirrhosis is 50 months and the 4-year survival rate is approximately 50%. On average, 5-year survival is 70% in fatty liver, 60% in alcoholic hepatitis, and 50% in cirrhosis.
