Alcoholic hepatitis

　　Medicine shows that there are many factors that affect the progression or worsening of alcoholic liver injury, and the risk factors found in the research of foreign countries in China at present mainly include: drinking amount, drinking years, type of alcoholic beverage, drinking method, gender, race, obesity, hepatitis virus infection, genetic factors, nutritional status, etc. According to epidemiological survey data, liver damage caused by alcohol has a threshold effect, that is, when a certain amount of alcohol or drinking years is reached, the risk of liver damage will be greatly increased. However, due to significant individual differences, some studies also show that the dose-effect relationship between drinking and liver damage is not very clear.

　　There are many types of alcoholic beverages, and the damage caused by different types of alcoholic beverages to the liver also varies. Drinking method is also a risk factor for alcoholic liver injury, and drinking on an empty stomach is more likely to cause liver damage than drinking with meals. Women are more sensitive to alcohol-mediated liver toxicity than men, and smaller doses and shorter drinking periods may lead to more severe alcoholic liver disease. There is a significant difference in blood alcohol levels between men and women drinking the same amount of alcoholic beverages.

　　Race, genetics, and individual differences are also important risk factors for alcoholic liver disease. There are also individual differences among groups in the same region. The rising mortality rate of alcoholic hepatitis is related to the degree of malnutrition. Deficiency of vitamin A or a decrease in vitamin E levels may also worsen liver damage. A diet rich in polyunsaturated fatty acids can promote the progression of alcoholic liver disease, while saturated fatty acids have a protective effect on alcoholic liver disease. Obesity or overweight can increase the risk of progression of alcoholic liver disease. The synergistic effect of hepatitis virus infection and alcohol on liver damage, drinking alcohol on the basis of hepatitis virus infection, or the concurrent infection of HBV or HCV on the basis of alcoholic hepatitis, can accelerate the occurrence and development of liver disease.

　　Alcoholic hepatitis is a liver disease caused by long-term excessive alcohol consumption. Alcoholic hepatitis was originally a common liver disease in Western countries, but in recent years, there has also been an increasing trend in China. In addition to liver damage, alcoholic hepatitis is also prone to cause some complications.

　　1. Hepatic encephalopathy: It is the most serious complication of the disease and also the most common cause of death.

　　2. Upper gastrointestinal bleeding: Esophageal variceal bleeding is common, often causing hemorrhagic shock or triggering hepatic encephalopathy.

　　3. Hepatorenal syndrome: Manifested by oliguria or anuria, azotemia, hyponatremia, and low urinary sodium.

　　4. Alcoholic ketoacidosis: Related to alcohol consumption and malnutrition, manifested by nausea, vomiting, dehydration, excessive ventilation, fruity breath, acetoneuria, acetoneemia, and hyperglycemia.

　　5. Zieve syndrome: The triad includes jaundice, hyperlipidemia, and hemolysis, most common in 40-year-old males, often occurring after acute alcohol consumption, manifested by loss of appetite, nausea, vomiting, diarrhea, severe abdominal pain, etc.

　　6. Portal hypertension: Can be caused by the compression of hepatic sinusoids and hepatic veins by a large amount of fat deposition.

　　7. Hepatopulmonary syndrome: Manifested as melena, cyanosis, clubbing, and hypoxemia.

　　8. Infection: Spontaneous bacterial peritonitis is common, and skin, respiratory, gastrointestinal, and urinary tract infections may also occur.

　　The main symptoms of alcoholic hepatitis are as follows.

　　Before the onset of alcoholic hepatitis, there is often a history of heavy drinking within a short period, with obvious abdominal distension, general fatigue, loss of appetite, diarrhea, nausea and vomiting, abdominal pain, weight loss, and some patients may have fever, leukocytosis (mainly neutrophilic granulocytes), resembling bacterial infection. Lischner analyzed 169 cases of alcoholic hepatitis and found that 77% had loss of appetite, 55% had nausea and vomiting, 46% had abdominal pain, and 43% had weight loss.

　　In cases of alcoholic hepatitis, the duration of drinking was 8.5 to 41 years, with an average of 21 years. The equivalent alcohol intake was 60 to 200g/d, with an average of 117g/d. According to the aforementioned pathological grading, there were 15 cases of mild, 6 cases of moderate, and 3 cases of severe alcoholic hepatitis. There were no significant statistical differences in the average duration of drinking and the average alcohol intake among them.

　　Characterized by jaundice, liver enlargement, and tenderness, a few cases also have splenomegaly, ashy complexion, ascites, edema, and spider nevi. When liver function is impaired, ascites is more obvious, and some patients may develop neurological and psychiatric symptoms. In Lischner's report of 169 cases, 81% had liver enlargement, 77% had jaundice, 59% had ascites, 56% had fever, 55% had malnutrition, 22% had upper gastrointestinal bleeding, 12% had esophageal varices, and 10% had psychiatric symptoms. In the 24 cases at the China-Japan Friendship Hospital, 58% had liver enlargement, 50% had the appearance of a wine drinker, 46% had liver palms, 46% had weight loss, 38% had spider nevi, 33% had jaundice, 21% had splenomegaly, 12.5% had ascites, 1 case had esophageal varices, 2 cases had esophageal varices exposed, and 1 case had fever with a temperature of 38.1 degrees Celsius. Most patients with fever reported in the literature recovered within a few days after hospitalization with the cessation of alcohol consumption, but some patients' fever could last up to 4 weeks.

　　Regarding the relationship between the degree of pathological changes, mild, moderate, and severe, and clinical symptoms, this group of 24 cases showed laboratory examination results including the increase of ALT, AST, ALP, and GGT values (mild alcoholic hepatitis is 43%-72%; moderate 60%-80%; severe 100% increase), and a decrease in prothrombin activity. Clinical signs include fatigue, pain in the liver area, reduced sexual function, impotence, liver enlargement, etc.

　　The most effective preventive measure for alcoholic hepatitis is to abstain from alcohol or control the amount of alcohol consumed, try to drink low-alcohol or alcohol-free beverages. It is not advisable to rely too much on the currently available preventive health products, as there are many brands of health products on the market, the treatment mechanism is unclear, and the efficacy is difficult to determine.

　　If there is really no way to refuse a social engagement, it is best to avoid drinking on an empty stomach, and you can take some milk or yogurt orally before drinking, which can help protect the gastric mucosa and reduce the absorption of alcohol. It is strictly forbidden to induce vomiting after drinking to prevent aspiration into the lungs, as well as tears in the gastric and esophageal mucosa, causing acute hemorrhage.

　　Even after several weeks of stopping alcohol intake, jaundice and fever can disappear, but ascites and hepatic encephalopathy may last for several months or even years. If jaundice or renal failure continues to occur, it means a poor prognosis. However, even if alcoholic hepatitis patients receive medical treatment from all aspects, it cannot guarantee complete recovery. Therefore, everyone must do a thorough prevention in this aspect.

　　What tests should be done for alcoholic hepatitis?

　　1. Hematological examination

　　Anemia, leukocytosis, and the appearance of atypical red blood cells such as target, spiny, mouth-shaped, and macrocytes may occur, with an increase in mean corpuscular volume (MCV).

　　2. Biochemical examination

　　Serum bilirubin levels rise, aspartate aminotransferase (AST) activity is significantly elevated, while alanine aminotransferase (ALT) activity only slightly rises or remains normal. Therefore, the AST:ALT ratio increases, and if the ratio is greater than 2, the sensitivity to the diagnosis of alcoholic liver disease is 68%, the specificity reaches 91%, the positive predictive value is 82%, and alkaline phosphatase and r-glutamyl trans***ase (r-GT) activity increase. r-GT is a sensitive but not specific indicator. The combined detection of MCV, r-G, and alkaline phosphatase is an ideal laboratory indicator for the diagnosis of alcoholic liver disease.

　　3. Liver B-ultrasound and CT examination

　　It helps to detect fatty liver. Diagnosis depends on liver biopsy, as liver damage is diffuse, non-localized puncture biopsy can be performed.

　　(1). Alcoholic liver disease is suitable for eating low-fat foods: high-fat foods will increase the burden on the liver, which is unfavorable to the condition, while a low-fat diet can appropriately alleviate symptoms such as nausea, vomiting, and abdominal distension, so people with alcoholic liver disease should eat more low-fat foods.

　　(2). Alcoholic liver disease is suitable for eating foods that enhance immunity: such as yam, turtle, mushroom, kiwi, fig, apple, sardine, honey, milk, and pork liver, to enhance the body's immune function and enhance the body's ability to resist diseases, thus benefiting the body's early recovery.

　　(3). Alcoholic liver disease is suitable for eating foods rich in vitamins: vitamins are not only important active substances for maintaining human life activities and health, but also can accelerate the repair and regeneration of liver cells, and have the effects of assisting in anti-tumor and anti-cancer, so people with alcoholic liver disease should eat more foods rich in vitamins, such as fresh fruits and vegetables.

　　(4). Alcoholic liver disease is suitable for eating foods rich in minerals: research has found that minerals such as selenium and iron have anti-cancer and anti-tumor effects, so it is advisable to eat more selenium and iron-containing foods such as mushrooms, eggs, spinach, meat, and seafood if you have alcoholic liver disease.

　　The main treatment principles for alcoholic liver disease are: ① reducing the severity of alcoholic liver disease, ② preventing or reversing liver fibrosis, ③ improving existing secondary malnutrition, and ④ treating alcoholic cirrhosis.

　　The diagnosis of alcoholic hepatitis depends on: ① determining whether there is liver disease, ② determining whether the liver disease is related to alcohol, ③ determining which stage it belongs to in terms of clinical and pathological aspects, and ④ excluding other liver diseases. During the diagnosis process, medical history should be carefully inquired, especially the drinking history, including the type, amount, time, method, and eating conditions of drinking. Generally, drinking 80 to 150g of alcohol per day [the specific calculation method is: alcohol (g) = alcohol-containing beverage (ml) × alcohol content (%) × 0.8 (alcohol density)] for 5 consecutive years can cause liver damage. Excessive drinking for more than 20 years will cause liver cirrhosis in 40% to 50% of cases. Liver biopsy has definite value for alcoholic liver disease.

　　Other biochemical and special examinations help to understand metabolic abnormalities in the liver and play a role in the treatment of alcoholic hepatitis. This disease should be distinguished from viral hepatitis, non-alcoholic fatty liver, cirrhosis due to other causes, obstructive jaundice, hepatic encephalopathy, and alcoholic delirium. In alcoholic liver disease, there is an inflammatory response in the liver, swelling and necrosis of liver cells, and collagen synthesis and deposition. As previously mentioned, immune factors are involved in the onset and development of alcoholic liver disease, and antibodies against Mallory bodies can be detected in the patient's blood. Glucocorticoids can inhibit the lipoxygenase and cyclooxygenase pathways involved in arachidonic acid metabolism, thereby inhibiting the pro-inflammatory effects of leukotrienes and prostaglandins, and can also promote albumin synthesis and prevent the generation of type I collagen. Therefore, some people propose that glucocorticoids can be used to treat alcoholic liver disease, but many research results are inconsistent at present.