Alcohol-related liver disease deximed german expert information medicine

Jaundice can be recognized by a yellowing of the sclerae in the eye and the skin and occurs when bile pigments (bilirubin) are deposited in the skin because they can no longer be excreted from the body. The degradation and thus the excretion of bilirubin occurs v. a. via the liver; therefore jaundice u. a. in the case of severe liver damage.

Normally, the liver functions as a cleansing organ for other substances from the blood as well. Therefore, when liver failure occurs due to liver damage, more toxins circulate in the body and are not disposed of. Such toxins can have an adverse effect on the brain and in some cases cause affected individuals to show cognitive/mental changes or even impaired consciousness (hepatic encephalopathy = a disease of the brain caused by liver disease).

Increased bleeding can occur for several reasons: The liver is involved in the production of clotting factors in the blood, which are important for blood styling. In addition, cirrhosis of the liver can cause small veins in the area (e.g.B. The liver (which is the main organ of the stomach and esophagus) can become very dilated (varicose veins) and thus easily rupture. If a patient with severe cirrhosis of the liver vomits, blood is often mixed in, which is life-threatening in the case of major bleeding.

How is the clinical picture diagnosed?

First, the doctor will ask about and assess the above symptoms and examine the patient generally. Here it is v. a. Palpate the size of the liver and check the above symptoms on the skin and eyes.

When talking to the patient, the doctor will ask how much alcohol the person usually drinks and how long the (high) alcohol consumption has already existed.

The results of the clinical examination and numerous blood tests provide important information about the exact cause, the degree of liver damage, and the patient's general state of health. In most cases, an ultrasound examination of the liver is also performed to assess the size and structure of the organ and to rule out other diseases. Sometimes a needle is used to take a tie sample from the liver (biopsy), but only if this is absolutely necessary to clarify the diagnosis.

Fluid may already have accumulated in the abdomen due to severe liver damage (ascites); this can be seen by ultrasound. It may be useful to withdraw some fluid with a thin needle.

If the affected person reports blood in vomit, the physician will order a mirror examination of the esophagus: Veins in the esophagus can dilate significantly and bleed easily in cirrhosis of the liver. This bleeding can be fatal.

Treatment

Alcohol-induced fatty liver can heal completely if the person stops consuming alcohol.

If fatty liver has progressively developed into fibrosis and cirrhosis of the liver with progressive dysfunction, the goal of treatment is to stop the continued damage to the liver to prevent the development of liver failure. The most important and absolutely necessary measure is to stop alcohol consumption. Patients should also avoid other substances that are harmful to the liver; here, v.a. some drugs to be named. The doctor will be able to advise you here. Sufferers must also eat a healthy diet, as malnutrition is common, and drink enough fluids.

If liver function is also impaired due to other diseases (e.g.B. viral infections), these are additionally treated accordingly.

Complications of liver disease (z.B. severe bleeding, loss of consciousness) necessitate intensive medical therapy and are associated with a fairly high mortality rate.

Alcohol-related liver inflammation is a more severe condition; the acute condition requires immediate treatment and there is a fairly high mortality rate. Various treatment options have been investigated; patients can z. B. can be treated with cortisone or pentoxifylline, but this is only effective in some people. Numerous other drugs studied proved ineffective. A possibly existing infection must be treated, a substitution of the vitamin thiamine is useful.

If the liver damage is very severe, a liver transplant can be life-saving. For alcohol-related liver disease, however, a prerequisite for organ transplantation is that the affected patient must have been "dry" for at least 6 months beforehand Was.

Prognosis

1. Among those who drink>80 g of alcohol daily for a long time>90% eventually develop fatty liver, 10-35% develop steatohepatitis, and 8-20% develop cirrhosis of the liver. 2. In most cases, inflammation of the liver occurs first, before cirrhosis develops, but some people develop cirrhosis without prior inflammation of the liver. 3. If affected individuals completely stop consuming alcohol and other substances that stress the liver, they can often survive for a long time with impaired liver function.

So-called acute alcoholic hepatitis can develop especially during periods of particularly high alcohol consumption. Acute alcoholic hepatitis is associated with symptoms such as vomiting, diarrhea, fever, jaundice, and psychological symptoms due to the effects on the brain. In these cases the prognosis is poor and the disease is fatal in 15-50% of cases.

Prevention

Not all people who consume a lot of alcohol develop liver damage – z.B. in men who drink 60-80 g of pure alcohol daily for more than 10 years, cirrhosis of the liver eventually appears in 6-41% of cases (in women, this is the case with consumption of 40-80 g over 10 years). Still, alcohol is a major cause of liver damage. Moderate drinking an effective protection for the liver. As a guideline for "low-risk" alcohol consumption In Germany, an amount of 24 g of pure alcohol per day applies for men and 12 g for women, with at least 2 alcohol-free days per week. A bottle of beer (330 ml, 4.5%) corresponds to 12.7 g of pure alcohol, a small glass of wine (125 ml, 11%) to about 11 g of alcohol.

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