Elderly alcoholic liver disease

　　Alcoholic liver disease is related to the duration of drinking, the amount of alcohol consumed, and the type of alcohol. Generally, daily alcohol consumption over 40g for 5 consecutive years can cause liver damage. Drinking heavily for more than 20 years may result in cirrhosis in 40% to 50% of cases. The formula for converting alcohol content is: Ethanol (g) = Alcohol-containing beverage (ml) × Alcohol content (%) × 0.8 (alcohol specific gravity).

　　Alcoholic fatty liver can be seen with partial or all liver cells having large bubble-like fat infiltration, showing vacuolated, nuclear margination, and occasionally cholestasis in the capillary bile ducts, with rare inflammatory reactions. The pathological changes of alcoholic hepatitis include balloon-like change of liver cells, necrosis, fatty degeneration, and alcoholic hyaline bodies (Mallory bodies), as well as infiltration of inflammatory cells and fibrosis. Alcoholic cirrhosis is generally nodular, often with fibrosis and pseudolobule formation, and may also have changes such as fatty liver and alcoholic hepatitis.

　　If elderly patients with alcoholic liver disease are left untreated, complications such as alcoholic cirrhosis, esophageal varices, liver failure, hepatic encephalopathy, and upper gastrointestinal bleeding may occur, seriously affecting the health of the elderly. It is imperative to seek timely treatment.

　　Alcoholic fatty liver often has no symptoms or only mild discomfort, generally with discomfort in the liver area, easy fatigue, liver enlargement, soft texture, and tenderness; alcoholic hepatitis patients usually have decreased appetite, fatigue, nausea, vomiting, weight loss, splenomegaly, and tenderness in the liver area; severe cases may have ascites, hepatic encephalopathy, and so on; alcoholic cirrhosis is similar to viral cirrhosis, generally with decreased liver function and portal hypertension, such as spider nevi, palmar erythema, and gynecomastia in men are quite common; in the late stage, there may be ascites, esophageal varices, liver failure, and so on.

　　The main measure to prevent alcoholic liver disease is to abstain from alcohol. To quit drinking completely, it is best to eat more foods rich in B vitamins, such as oatmeal, whole wheat bread, animal internal organs, lean meat, peanuts, most types of vegetables, bran, milk, and so on. If you are used to it, you might as well have some oatmeal porridge in the morning, because the activity of alcohol dehydrogenase in the human liver is very low at noon, and drinking is easy to get drunk. Having some oatmeal porridge in the morning can help reduce the desire to drink in the afternoon. At the same time, porridge can also protect the gastric mucosa. It should be noted that B vitamins are not stored in the body, and the excess will be completely excreted from the body, so people who are giving up alcohol must supplement B vitamins every day.

　　Alcoholic liver disease lacks specific clinical manifestations, so the purpose of diagnosis is: ①To determine whether it is alcoholic liver disease; ②At which stage of clinical and pathological condition is the alcoholic liver disease; ③To differentiate it from other liver diseases. During the diagnosis process, it is necessary to inquire about the medical history in detail, especially the drinking history. This includes the type, amount, time, method of drinking, and eating habits, and pay attention to whether there are symptoms such as anemia, peripheral neuritis, and so on.

　　Experience Find varying degrees of anemia, occasional jaundice, liver enlargement; in the decompensated stage of alcoholic liver cirrhosis, there are splenomegaly, spider nevi, ascites, and other symptoms similar to other cirrhosis.

　　Laboratory examination AST/ALT>1, usually between 2-5; AKP, GGT increased, serum albumin decreased, globulin increased, prothrombin time prolonged, and vitamin K cannot correct. In the fatty liver stage, triglycerides, pre-β-lipoprotein, and cholesterol are slightly to moderately increased; in the stage of alcoholic liver cirrhosis, cholesterol is normal, but the ratio of cholesterol esters to total cholesterol decreases.

　　Imaging examination B-ultrasound and CT show changes in fatty liver or liver cirrhosis.
　　    

　　The diet of elderly patients with alcoholic liver disease should be light, reducing the intake of greasy, high-fat, high-sugar, and high-cholesterol foods, eating more fresh fruits and vegetables, reducing the intake of foods that damage the liver such as drugs and coffee, and absolutely abstaining from alcohol.

　　The primary method of treating elderly alcoholic liver disease is to give up drinking immediately. Abstinence, sufficient calories, vitamins, protein, and adequate rest are the principles of treatment for this disease. For those with anorexia, nausea, and vomiting, intravenous administration of calories should be supplemented, and a variety of vitamins including B, C, and K should be supplemented, and folic acid should be administered by intramuscular injection. At the same time, attention should be paid to maintaining water and electrolyte balance. When liver fibrosis occurs, traditional Chinese medicine, polyunsaturated lecithin, colchicine, and other treatments can be tried. When cirrhosis occurs, the treatment is the same as that for viral cirrhosis. However, the application of corticosteroids in alcoholic hepatitis is still controversial.

　　The prognosis of alcoholic liver disease varies with the different clinical and pathological stages. Alcoholic fatty liver generally has a good prognosis. If alcohol is given up and treatment is timely, the majority of alcoholic hepatitis can be recovered, but the prognosis of severe cases is poor. The prognosis of alcoholic cirrhosis depends on the severity of the lesion and the persistence of abstinence and treatment, which is generally better than that of cirrhosis caused by other reasons.