In the twentieth century, the pharmaceutical industry took a huge step forward. Various chemical compounds were synthesized, and clinical data on the efficacy and safety of the drugs used were accumulated. At the same time, it was noticed that some groups of drugs had a positive effect on the target organ, while causing inflammation in the liver cells. The first case was described after treatment with oxyphenisatin, a laxative. This pathology is called medicinal hepatitis.
ICD code 10 - K71 toxic liver damage.
What is drug hepatitis?
Drug hepatitis (drug induced hepatitis) is a liver damage that occurs due to the action of toxic compounds of drugs on hepatocytes with the subsequent development of an inflammatory reaction and even necrosis in them.
It is customary to distinguish 2 forms: acute and chronic. Acute is divided into cholestatic, cytolytic and mixed.
According to statistics, symptoms of drug-induced hepatitis may complicate the therapy in 28% of patients, 25% of cases can lead to cirrhosis.
Women are prone to such damage to the liver and suffer from it 3 times more often than men.
In addition to gender, the incidence may be affected by:
- genetic predisposition - if one of the parents after taking the drug has developed drug hepatitis, the child can also get liver damage from this substance,
- history of chronic hepatitis,
- combination of drugs. It has been proven that while taking six or more drugs at the same time, the probability of developing drug-induced hepatitis can reach 80%,
- alcohol consumption,
The mechanism of occurrence of drug hepatitis.
Why does inflammation occur in the liver cells? This is due to the detoxification function of the body. In hepatocytes, the neutralization and elimination of toxic compounds occurs with the participation of enzymes - special proteins that turn hazardous substances into metabolites, ready to leave our body. Often, these metabolites have a more pronounced damaging effect on the liver than the original chemical substances.
A long course of therapy, maximum dosages, a combination of drugs - factors that reduce the enzymatic activity of hepatocytes. The liver ceases to perform its function, toxic substances penetrate into the cells, destroy the structural formation, causing inflammation.
What medicines can cause liver damage?
Drug-induced hepatitis can cause any drug, but there are groups of the most hepatotoxic drugs:
- antibiotics - the most toxic compounds are those of the tetracyclic series (tetracycline, chlortetracycline, dixicylin), macrolides (erythromycin), penicillins (amoxicillin),
- anti-TB drugs (isoniazid, rifampicin). These substances, when applied simultaneously, can cause liver necrosis, possibly due to autoimmune reactions,
- cytostatic drugs (cyclosporine, methotrexate),
- antifungal agents (ketoconazole, fluconazole). Liver damage can occur with prolonged use of the drug (more than 4 weeks), more often in patients over 60 years old,
- nonsteroidal anti-inflammatory substances (diclofenac, aspirin),
- diuretic substances (furosemide, hypothiazide),
- hormonal drugs (oral contraceptives, steroids),
- antiarrhythmic compounds (amidarone),
- antidiabetic drugs
- proton pump inhibitors (omeprazole),
- agents for the treatment of epilepsy and seizures (clonazepam, carbamazepine).
Symptoms of drug hepatitis
Special, specific signs of this disease has not. Clinical manifestations are identical to hepatitis viral etiology.
The most common symptoms are:
- loss of appetite, belching nausea, vomiting, changes in the nature of feces (diarrhea, constipation), weight loss,
- general malaise, weakness,
- heaviness or pain of varying intensity in the right side,
- discoloration of the skin and visible mucous membranes (yellowing, gray),
- change of color of urine and feces (discoloration of feces, rich dark color of urine),
- itching of the skin, spider veins, rashes.
Since the symptoms are not sufficiently informative, in order to make an accurate diagnosis, one should resort to laboratory and instrumental methods of research.
Diagnosis of drug hepatitis
There are several principles of modern diagnosis of this disease. With the appearance of minimal signs of liver damage, a biochemical blood test is needed, in which the activity of transaminases, alkaline phosphatase, and bilirubin increases.
An ultrasound examination of the abdominal organs can reveal a diffuse enlargement of the liver. A biopsy can be used to diagnose drug-induced hepatitis, however, there are no specific histological changes. It is necessary to analyze the drugs used for hepatotoxicity. As a rule, the abolition of such drugs leads to the normalization of liver function.
With hepatitis, it is very important to eat fully, while completely eliminating alcohol, to limit the flow as much as possible.
- cholesterol (egg yolk, offal),
- essential oils (garlic, onion),
- purines (strong broths),
- oxalic acid (cocoa, chocolate, strong tea, coffee).
These requirements correspond to a special number diet - table number 5, developed by Russian scientist M.I. Pevznerom.
All dishes should be steamed or boiled.
Eating should be in equal portions, divided into 5 receptions.
Diet involves the following chemical composition:
- proteins 90–100 grams (of which 60 grams of animals),
- fats 80–90 grams (of which 30 grams are vegetable),
- carbohydrates 350-400 grams (sugar up to 80 grams).
How can you keep this balance of nutrients? What foods does this kind of diet allow? From meat products in food, you can use low-fat or fat-free meat: beef, rabbit, chicken, turkey. It is important to include fish in the diet because of the high nutritional value of protein: pike perch, hake, cod, pollock, tuna. You can alternate meat and fish dishes. Limit the amount of dairy products to 200 grams, using yogurt, kefir, low-fat cottage cheese. Diet involves the use of soups: vegetarian, dairy, fruit, cereals, pureed. The main condition - the lack of strong broth.
The carbohydrate component is replenished by porridge (buckwheat, oatmeal, rice, manna), pasta, bread (bran, rye, dried wheat of the 1st or 2nd grade), vegetables (potatoes, carrots, beets, cauliflower, squash, pumpkin).
Diet allows the use of creamy, refined vegetable oils. It is necessary to limit the use of salt to 4 grams.
Table No. 5 is a long-term diet that can be used for a long period, because it is a rational healthy diet.
Drinking regimen for drug hepatitis
In addition to the rules of nutrition, it is important to maintain water and electrolyte balance in the body.
Due to a sufficient volume of liquid, the viscosity of bile decreases, its acidity is normalized, which contributes to the attenuation of the inflammatory process.
Sulfate mineral waters can be used to help normalize bile formation and eliminate cholesterol and bilirubin from the body. This chemical composition stimulates intestinal peristalsis, thereby reducing the toxic load on the liver. Mineral waters with a high content of magnesium eliminate the spastic component in the biliary system, normalize the outflow of bile, its viscosity and chemical composition, which improves the neutralizing function of the liver. Drinking treatment is carried out dosed, 200 ml 3 times a day on an empty stomach, the water temperature should be in the range of 40-45 degrees. The total daily volume of fluid should not exceed 2 liters.
Mineral water can be used in the form of baths, when the action of chemical irritants on the skin and mucous membranes causes a response, the so-called neuro-reflex reaction from the internal organs and systems. The course usually does not exceed 12 procedures, the water temperature is 35–36 degrees, the duration is 10–12 minutes. It has been proven that microelements penetrate the vascular bed through the skin, enter the liver where they have an anti-inflammatory effect, and contribute to the normalization of the viscosity and chemical composition of bile.
However, to normalize the functions of the liver, not only the diet and drinking regime, but also moderate exercise, proper rest, normal sleep, and rejection of bad habits are important.
Treatment of Medicinal Hepatitis
The first task in case of symptoms of liver disease is the detection and cancellation of the hepatotoxic drug. As a rule, after that for some time there is an improvement in liver samples and the condition of the patient. However, hazardous chemicals damage membranes and organelles of hepatocytes, therefore, to restore them and increase their resistance to toxic effects, it is necessary to use hepatoprotectors.
It is advisable to use those drugs, the action of which has been clinically proven, and safety confirmed in randomized studies. These drugs include essential phospholipids (Essentiale, Enertiv), which are directly integrated into the walls of the liver cells, restoring the activity of hepatocytes. The amino acid ademitionine (Heptral) promotes the synthesis of its own, internal, phospholipids. The treatment can be supplemented with ursodeoxycholic acid preparations (Ursofalk, Ursosan), which reduce the toxic effect of bile acids on the liver.
With long-term treatment with hepatotoxic drugs, it is important to use a cover-up therapy - immediately use drugs that have a positive effect on the liver, without waiting for the development of possible complications.
It is important to conduct enterosorption - the process of binding, inactivating and removing hazardous chemical compounds. The treatment is carried out with the help of sorbents: activated carbon, Enterosorb, Polysorb. Infusion therapy is used to enhance the detoxification effect - intravenous administration of sodium chloride, glucose solution, sorbitol.
Prevention of drug hepatitis
The development of this pathology directly depends on the use of drugs with a possible hepatotoxic effect, therefore, rational use of medicines, monitoring and monitoring blood counts, monitoring possible side effects contribute to the prevention and early detection of the disease. Refusal of bad habits, diet, preventive courses of hepatoprotectors reduce the likelihood of drug-induced hepatitis.
Timely rejection of the toxic drug, properly prescribed diet and treatment contribute to the full restoration of the functions of liver cells. However, especially severe cases of the disease have been described, which were accompanied by cirrhosis, the development of liver failure and death.
It is important to remember that medicinal hepatitis is a liver damage that can be avoided by taking proven drugs with a minimum of adverse reactions, strictly follow the instructions for selecting dosages and the duration of the course of treatment. If you feel the symptoms characteristic of liver damage, do not try to treat this pathology at home, consult a specialist.
Drug-induced (medicinal) hepatitis is the damage to the liver tissues as a result of toxic damage to hepatocytes by the metabolites of medicinal substances, with the development of reactive inflammation and necrosis of the liver cells. Drug hepatitis complicates the ongoing pharmacotherapy in 1-28% of cases and in 12-25% of cases lead to the development of liver cirrhosis and liver failure. Women suffer from drug-induced hepatitis 2-3 times more often than men. The study and treatment of drug hepatitis deals with a special section of gastroenterology - hepatology.
Causes of the development of drug hepatitis
The most important function of the liver in the body is the neutralization and neutralization of toxic substances entering it with blood. Metabolism and utilization of chemical and biological toxins occurs under the action of the enzymatic neutralizing system of hepatocytes, with the subsequent elimination of harmful products from the body. The process of utilization of toxic substances takes place in the liver in several stages, during which metabolites, intermediate products of biotransformation, are formed. Metabolites of some drugs are even more hepatotoxic than the drugs themselves. Long-term use of such medications or their high dosage leads to the depletion of neutralizing enzyme systems and damage to hepatocytes, as a result of which drug-induced hepatitis develops.
To date, there are more than a thousand names of drugs that lead to the development of drug-induced hepatitis. The toxicity of the action of drugs increases with the combined intake of 2-3 drugs, and with the simultaneous intake of 6 or more drugs, the likelihood of toxic damage to the liver increases to 80%. The rate of development of drug hepatitis while taking medication varies from several days to several years.
The risk factors for the development of drug-induced hepatitis include genetically determined hypersensitivity to any medication, the presence of chronic hepatitis, viral hepatitis, autoimmune hepatitis, ascites, alcohol or toxic effects of solvents, toxic gases on the background of drug therapy, pregnancy, deficiency protein in the diet, stress, kidney failure, heart failure, etc.
The main groups of drugs that cause drug hepatitis include:
- Tuberculosis treatment (rifampicin, isoniazid)
- Antibiotics: tetracyclines (tetracycline, chlortetracycline, dixicyline), penicillins (benzylpenicillin, amoxicillin, etc.), macrolides (erythromycin)
- Sulfonamides (sulfamethoxazole + trimethoprim, sulfadimethoxin, etc.)
- Hormones (steroid hormones, oral contraceptives, etc.)
- NSAIDs (diclofenac, ibuprofen)
- Anticonvulsant and antiepileptic drugs (phenytoin, carbamazepine, clonazepam, etc.)
- Antifungal drugs (amphotericin B, ketoconazole, fluorocytosine)
- Diuretics (hydrochlorothiazide, furosemide, etc.)
- Cytostatics (methotrexate)
- Preparations for the treatment of arrhythmias, diabetes, peptic ulcer and many others. other
The list of drugs that have a hepatotoxic effect is far from exhausted by these medicines. Drug-induced hepatitis can be caused by practically any drug, and especially a combination of several drugs.
Prognosis and prevention of drug hepatitis
In severe cases, with fulminant development of drug hepatitis or massive necrosis of the hepatic parenchyma, cirrhosis, hepatic insufficiency, and sometimes - hepatic coma and death develop. With the timely cancellation of the hepatotoxic drug in most cases, full recovery occurs.
Prevention of drug-induced hepatitis is the rational use of drugs, monitoring side effects, taking drugs only on prescription, excluding additional toxic effects. On the background of long-term drug therapy, the appointment of hepatoprotectors is recommended. Patients who are forced to take medication for a long time should periodically examine the level of transaminases in order to identify drug-induced hepatitis at an early stage.
The death of hepatocytes under the negative influence of toxic compounds in medicine is called drug or drug hepatitis. To provoke violations in the liver can receive any drugs. The disease is of 2 types: acute and chronic. Chronic drug hepatitis is also divided into several types:
According to statistics, drug-induced hepatitis occurs in 28% of patients with prolonged therapeutic courses, and a quarter of patients are at serious risk of developing cirrhosis of the liver. The factors that determine the risks of developing liver disease are:
- bad heredity
- alcohol abuse during treatment,
- stressful conditions
- poor nutrition
- chronic liver ailments,
- wrong selection of drugs
- advanced age
- medical hepatitis in history.
Medicinal hepatitis in older people affects the liver more often in women than in men.
Scientists have found that women are more likely to suffer from hepatitis C than women more than men. The reasons for this genetic predisposition to the disease are not clear. Drug hepatitis complicates the choice of the correct drug therapy. Люди пожилого возраста подвержены лекарственному гепатиту по причине снижения интенсивности кровообращения в печени.
Этиология и течение
Возникновение воспалительного процесса в печеночных клетках связано со сбоем в фильтрующей функции печени. Under normal conditions, hepatocytes neutralize and excrete toxic compounds from the body with the active participation of specific protein compounds. Toxic substances are converted to metabolites and excreted from the body. With a large accumulation in the liver, the metabolites damage the cells of the organ more strongly than the synthetic medications taken.
Long-term medication, high dosage, the combination of many drugs - the main factors leading to a decrease in the enzymatic activity of liver cells.
When hepatocytes are damaged, the functioning of the whole organ is disturbed, toxic compounds penetrate into the tissues, destroying the structure at the cellular level, and cause an inflammatory process. Most often, the disease occurs due to self-medication and uncontrolled medication. Medicinal hepatitis is not contagious and is not transmitted from one person to another. Doctors identified a list of groups of drugs that are the most hepatotoxic:
- tetracycline, chlortetracycline, dixicycline antibiotics,
- medicines containing amoxicillin,
- primitive fungal medications,
- anti-inflammatory nonsteroid drugs
- hormonal drugs
- medications for diabetes, diuretics.
Reduced immunity during pregnancy with inflammation of the kidneys threatens the development of hepatitis.
The speed and degree of development of drug hepatitis depends on the properties of the drugs used and their quantity in the scheme, on the individual characteristics of the immune system, the duration of treatment. High risk of liver disease in women during pregnancy, with liver inflammation. Insufficient use of proteins during treatment is an additional factor in the appearance of the disease.
What are the symptoms?
Simultaneous unpleasant symptoms and medication treatment indicate abnormal liver function. Such characteristic signs speak about medicinal hepatitis:
- bitterness in the mouth
- poor appetite
- weight loss,
- yellow skin
- dark urine color,
- chronic pain in the right hypochondrium,
- chronic fatigue.
With symptoms of drug-induced hepatitis, the ability of the doctor to distinguish the disease from other hepatitis - A, B and C is important. Treatment should be prescribed exclusively by the doctor after testing and diagnostic procedures. Self-treatment leads to serious consequences: cirrhosis of the liver or liver failure, in the worst cases - to death.
To diagnose the disease, make a biochemical blood test. When violations of the liver in the blood revealed an increased amount of transaminase enzymes. This condition indicates pathological processes in the liver. The amount of bilirubin increases, alkaline phosphatase and globulin fractions have increased activity.
Differential diagnosis of drug-induced hepatitis is performed with varieties of other viral hepatitis, tumors in the liver, malignant tumors in the pancreas, cholelithiasis.
Patients who are forced to take medication for a long time should regularly take a biochemical analysis for the detection of AST and ALT. In case of suspected liver dysfunction, general blood, urine and feces tests are performed. Ultrasound examination of the abdominal cavity is prescribed. If necessary, the doctor prescribes an additional diagnosis.
Features of treatment
The main thing to do with medicinal hepatitis is to identify and eliminate the toxic drug from use. Progress is observed after some time - an improvement in the state of the liver is noticed. But damaged hepatocytes require recovery. To increase the resistance of liver cells to the negative effects of toxins, hepatoprotectors are prescribed.
Drug treatment of liver inflammation is performed with the help of hepatoprotectors. Hepatoprotectors include substances that are clinically proven and safe by randomized trials. These drugs belong to the essential phospholipids - "Essentiale-N", "Enertiv". Their property is to integrate into the cell walls, to heal and restore the cellular structure. Such drugs activate the activity of hepatocytes. Hepatoprotectors include Karsil, Legalon, Allohol. The drug and the duration of the appointment are prescribed by the doctor, based on the individual picture of the patient’s illness.
Diet and proper nutrition
The risk group includes people who have already had liver problems with medication, who use alcohol or drugs. Forced to take medications for various reasons, such patients should use the best preventive drugs for drug-induced hepatitis. One of the main preventive measures is diet. Must be excluded from daily life:
- binge eating,
- spicy, sweet food
- fatty dishes
- smoked meats
- canned food
Adhering to the specified diet, you can get rid of pain in the liver.
You can not eat a lot of sweets and pastries. When treating drug-induced hepatitis, the “Table No. 5” diet, developed by scientist Pevzner, is used. All dishes allowed in it, it is necessary to boil or cook only steamed. The use of this diet involves the use of such products, containing the necessary daily amount of all the vitamins and minerals. Food is taken in equal portions for 5 receptions per day. Based on the use of such products:
- fresh vegetables,
- cereals, bean porridges,
- chicken meat, poultry, fish.
Fresh vegetables can not be replaced with juice. Per day you need to drink at least 2 liters of liquid. Fasting with medicinal hepatitis is contraindicated, so the daily diet is divided into small portions. Treatment of drug-induced hepatitis includes a healthy, nutritious diet. The daily ration should include on average up to 100 grams of proteins, 90 grams of fat and 300-400 grams of carbohydrates.
Treatment of chronic hepatitis diet
The elimination of neglected diseases that cause complications on the part of many organs and systems is a long process that requires professional medical care. Treatment of chronic hepatitis diet is the standard method of therapy. The patient is prescribed not only medical nutrition, but also recommendations for changing habits and lifestyle in general.
Patients with chronic liver inflammation are prescribed diet No. 5. If the disorder is exacerbated, then the lighter form of the diet is used - No. 5a. Meals are based on a thorough machining of food and an increase in the number of meals.
The main characteristics of therapeutic diets for hepatitis:
Chronic hepatitis, cirrhosis, liver failure
Exacerbation of chronic hepatitis
Number of meals
Steaming, boiling, baking, stewing
Liquid, puree, solid
Liquid, puree, pureed
In addition to the above recommendations, hepatitis is an absolute contraindication to smoking and alcohol use. The patient should avoid overloading the liver.
Essence of the diet
Dietary nutrition implies the strict implementation of medical recommendations. The essence of the diet for chronic inflammation of the liver lies in minimizing the traumatic and irritating effects on the organ. All patients need to give up alcohol. Since about 70% of ethyl alcohol entering the human body is processed by the liver, causing disruption in its work and fatty dystrophy. Meals should be regular, an orderly mode of food intake will help synchronize the internal rate of digestion. Overeating should be avoided, especially before bedtime.
Food for chronic (active) hepatitis - diet number 5A:
- Rejection of spicy, fried, fatty and sweet.
- Meals must be steamed, boiled, baked or stewed, eating fried food is contraindicated.
- In the diet should not be products with coarse vegetable dietary fiber (cabbage, mushrooms, onions, leafy greens, garlic).
- Permitted products: lean meats and fish, boiled and fresh vegetables, cereals, fruits, dairy products.
Diet for inactive hepatitis - Pevzner's diet number 5:
- In the daily diet should be no more than 80g of fat, their excess can cause hepatic stagnation of bile.
- It is better to use products in boiled or baked form, you can steam and simmer.
- The use of non-acidic fruits and berries, fresh vegetables, greens is allowed.
- Permitted products: low-fat meats, fish, poultry, cereals, dairy products and food that does not cause flatulence.
Properly chosen diet will help ease the painful symptoms and speed up the healing process. Medical nutrition minimizes the use of drugs and restores the normal functioning of the liver.
Diet 5 for chronic hepatitis
Restoration of the health of the liver in the started inflammatory processes consists of a complex of medical procedures. Diet 5 for chronic hepatitis can be used for cholecystitis and gallstone disease. The main purpose of nutrition - the normalization of liver function, biliary tract and bile secretion. Sparing the diet involves the use of heat-treated food, which has a beneficial effect on the work of the intestine and stomach.
Diet 5 is physiologically complete. Patients need to abandon products rich in nitrogenous extractives, cholesterol, oxalic acid and essential oils. The diet should be food with high lipotropic factors and dietary fiber. All dishes are steamed or boiled; five meals should be taken daily.
Diet for drug hepatitis
Dosage form of the inflammatory process in the liver occurs due to the long-term use of hepatotoxic drugs. Diet for drug-induced hepatitis involves a gentle diet to restore the cells of an organ. The liver parenchyma is involved in many processes in the body, they are responsible for the synthesis of proteins, cholesterol, lipids and phospholipids, excrete endogenous elements from the body and are involved in bile formation. Drug metabolites contribute to the development of inflammation, provoke cirrhosis, liver failure and cell necrosis.
The diet is similar to the rules of nutrition recommended for other forms of the disease:
- Give up alcohol and nicotine.
- Minimize the use of sweets and muffins.
- The diet should not be fried, spicy, smoked, salted or pickled food.
- It is necessary to choose foods with the lowest possible level of fat and cholesterol.
- Eat fiber-rich vegetables and fruits every day.
- Avoid foods with saturated fats and trans fats.
- Drink a minimum of sugar and salt, drink a day at least 2 liters of fluid.
- Products better steamed, boil, bake or stew.
Most often, drug-induced hepatitis is diagnosed in women, men are less susceptible to this form of the disease. The disorder develops due to the long-term use of drugs that neutralize the enzyme system. To date, every third drug can cause hepatitis. The simultaneous use of several drugs increases the risk of developing the disease.
Alcohol Hepatitis Diet
Inflammatory damage to the liver due to prolonged use of alcohol leads to alcoholic hepatitis. It refers to the toxic form, but unlike the viral form, it is not transmitted from person to person. Intoxication causes an inflammatory process that destroys the liver and disrupts its functioning. The disease can last for a long period of time and does not manifest itself, which complicates the process of diagnosis and treatment.
Nutrition rules for alcoholic liver damage:
- Complete rejection of alcoholic beverages.
- Refusal from fat, fried, salty, strictly, pickled and smoked.
- The diet should be a lot of protein foods: meat, legumes, dairy products, fish.
- You need to eat in small portions, 4-5 meals a day.
- As a vitamin therapy, it is better to use fresh vegetables, fruits and herbs, herbal infusions and decoctions.
- Products are prepared with gentle heat treatment with minimal addition of vegetable oils and fats.
Diet for alcoholic hepatitis relieves painful symptoms. As a rule, therapeutic nutrition is prescribed in combination with other methods of therapy. The prognosis depends on the form and stage of the lesion, the presence of comorbidities and compliance with medical recommendations. If the disease is started, the only treatment is a liver transplant.
Diet for autoimmune hepatitis
Inflammatory disease of the liver of a chronic nature, of unknown origin is autoimmune hepatitis. This disease is most common in female patients at a young age. Without proper treatment, it leads to severe and irreversible organ damage. Diet for autoimmune hepatitis should be used from the first days of the lesion. This will minimize the destructive effect on the liver and relieve painful symptoms.
If the disorder appears on the background of a normal state of health, it may be asymptomatic. Very often, hepatitis is diagnosed in the late stages with serious changes in the hepatic parenchyma, insufficiency and cirrhosis. For treatment using diet table number 5 by Pevzner. Choleretic products, fresh pastries, fatty, fried, sweet, alcohol are completely excluded from the diet. Refined pastries and yesterday's bread, cereals, pasta, vegetables, fruits, berries, lean meats, fish, poultry and dairy products are allowed.
In addition to dietary nutrition, patients are prescribed corticosteroid hormones, which suppress the inflammatory process. If diet therapy and medications are not effective, then the option of liver transplantation surgery is considered.
- Breakfast: protein omelet with greens and herbal tea.
- Snack: apple or any other fruit.
- Lunch: boiled chicken fillet with buckwheat and tomatoes.
- Snack: a handful of dried fruit and green tea.
- Dinner: baked fish with rice and vegetables.
- Second dinner: a glass of kefir with crackers.
- Breakfast: low-fat cottage cheese with a banana, tea.
- Snack: galette cookies, fruit juice.
- Lunch: vegetarian vegetable soup with boiled grits and vegetable salad.
- Snack: fruit puree with a dry biscuit.
- Supper: mashed potatoes with chicken meatballs.
- Second dinner: a glass of kefir or herbal tea with crackers.
- Breakfast: vegetable salad, herbal tea.
- Snack: croutons with yesterday's bread with fruit juice or juice.
- Lunch: beet soup, oatmeal with young boiled beef.
- Snack: any fruit.
- Supper: fish baked in sour cream with any porridge.
- Second dinner: low-fat yogurt with biscuits.
- Breakfast: herbal tea, 1 egg and ½ grapefruit.
- Snack: yogurt and any fruit.
- Lunch: noodle soup on light chicken broth and fresh vegetable salad.
- Snack: a handful of dried fruit or nuts.
- Dinner: boiled macaroni and baked chicken meat.
- Second dinner: a glass of kefir with a dry biscuit.
- Breakfast: oatmeal with apple and a spoon of honey, herbal tea.
- Snack: banana and yogurt.
- Lunch: vegetable soup, pasta casserole with minced meat.
- Snack: a glass of fruit juice and biscuits.
- Dinner: baked fish with rice and vegetables.
- Second dinner: green tea with crackers.
- Breakfast: low-fat cottage cheese with sour cream, herbal tea.
- Snack: any fruit.
- Lunch: buckwheat, fish patties with tomato sauce.
- Snack: a handful of nuts and dried fruit.
- Dinner: boiled chicken fillet with vegetable salad.
- Second dinner: a glass of kefir and biscuits.
- Breakfast: protein omelet with sour cream, herbal tea.
- Snack: yogurt and any fruit.
- Lunch: rice soup with chicken, stuffed peppers.
- Snack: fresh carrot salad with sour cream and flax seeds or sesame.
- Dinner: boiled beef, baked eggplant with cheese.
- Second dinner: banana and herbal tea.
Fruit soup puree
- Apples 1 pc.
- Dried apricots 50 g
- Potato starch 5 g
- Honey 30 g
- Ground cinnamon, vanilla sugar - 0.1 g.
- Water 500 ml.
Peel and rinse the apples and rinse them. Put apples and sliced dried apricots into a pan with water. Boil the fruit on low heat until cooked, add honey, cinnamon and vanilla sugar.
Potato starch diluted in a small amount of fruit decoction. For mashing, it is better to use a blender or grind the fruit through a sieve. Mix puree with diluted starch and bring to a boil, cool.
Steamed omelet with greens
- 2-3 egg whites
- Milk 30 ml.
- Butter 3-5 g
- Dill or parsley
Separate the whites from the yolks, add the milk and beat until smooth and fluffy. Chop the greens and mix with the future omelette. Grease the baking pan with butter and pour the protein and milk into it. The dish can be cooked in the microwave, on a water bath or in the oven. Ready omelet has a light yellow color.
Pumpkin Casserole with Apples
- Peeled pumpkin 150 g
- Apples 100g
- Egg 1 pc.
- Sour cream 5 g.
- Butter 5 g.
- Honey 1 tbsp.
Peel the pumpkin and apples from the peel and seeds, grate and fry over low heat with the addition of oil. Grind the puree obtained using a blender, add an egg, honey, sour cream and mix thoroughly. Pour the whole mixture on a baking sheet with baking paper or place it in a baking dish greased with butter. Bake until golden brown.
What can you eat with chronic hepatitis?
In the treatment of liver diseases, the patient is prescribed a special diet aimed at restoring the affected organ. Nutrition must be complete, contain all the substances necessary for the normal functioning of the body. Treatment involves reducing the amount of fat, salt, avoiding alcohol and nicotine.
Consider what you can eat with chronic hepatitis:
- Meat and fish dishes made from lean meats, poultry, fish.
- Various cereals, especially oatmeal and buckwheat.
- Fresh, baked and steamed vegetables.
- Fresh fruits and berries, made from them compotes, teas, soups and other dishes.
- Low-fat dairy products: cottage cheese, kefir, milk, hard cheese and eggs.
- Various dried fruits and nuts.
- Vegetable, olive and butter (no more than 6-8 g per day).
In addition to the use of the above products, it is necessary to drink at least two liters of fluid per day. Diet is divided into five meals. Food should not be cold or hot, that is, served only in the form of heat with a minimum amount of spices.
Infection and disease progression
The most important function of the liver is the disposal and elimination of toxic substances from the body. Usually the process takes place in several stages - a compound that enters the liver through the bloodstream is exposed to enzymes that are secreted by hepatocytes, and breaks down into intermediate substances.
Metabolism products are in many cases more toxic than the parent drug and affect the liver differently:
- cause depletion and cell death, provoke inflammation of the tissues and liver parenchyma,
- they change blood circulation in small capillaries, which causes fasting of tissues and their subsequent necrosis.
It is impossible to infect with medicinal inflammation of the liver, it develops due to pathological processes caused by the influence of toxins.
Arising from the use of pharmacological drugs hepatitis drug (drug), occurs in every third patient, taking funds from a particular group. Up to 25% of cases of pathology is complicated by cirrhosis or the formation of acute liver failure.
The list of drugs that provoke inflammation of the liver tissue when released into the blood, includes more than a thousand items. These include the following groups of drugs:
- antibiotics and sulfonamides (Ampicillin, Amoxicillin, Tetracycline, Amoxiclav, Sulfadimethoxin),
- antiviral drugs (Zinovudine),
- nonsteroidal anti-inflammatory drugs (Paracetamol, Diclofenac, Dykloberl, Indomethacin, Acetylsalicylic acid),
- hormonal drugs (steroids, contraceptives),
- funds for anesthesia Halothane,
- anticonvulsant and antiepileptic (Chlorpromazine, Clonazepam)),
- diuretics and cytostatics (Azathioprine, Furosemide, Methotrexate),
- antifungal agents (fluconazole),
- drugs that affect blood coagulation,
- for the treatment of cardiovascular diseases (nifedipine, methyldopa),
- anti-tuberculosis drugs (Isoniazid),
- anthelmintic (tiabendazole).
The development of drug hepatitis can be provoked by phytopreparations, in particular, turmeric and the means in which it is a constituent element.
Hepatitis drug does not develop in every patient who takes medication, this requires additional exposure to a number of factors. These include:
- increased sensitivity of the patient to the action of certain drugs,
- kidney and liver failure
- old age of the patient
- impaired blood microcirculation in the liver,
- Inherited disposition to diseases of the digestive and gastrointestinal organs,
- increased susceptibility to the toxic effects of a number of drugs on the liver,
- stay in a state of nervous stress, depressed mental state, which dramatically reduces the body's resistance,
- alcoholism and smoking
- liver pathologies - viral hepatitis, fatty hepatosis,
- errors in the treatment and selection of drugs,
- permanent residence in adverse environmental conditions.
High risk of getting drug-induced hepatitis in people who, by the nature of their activity, are in constant contact with toxic or medicinal substances., persons who survived poisoning with poisonous drugs.
Viral and toxic liver damage, its weakening due to old age makes people with such pathologies particularly vulnerable to the disease. Automatically patients who are forced to be treated for long periods with potent drugs (tuberculosis, neoplastic diseases) are at risk.
More and more doctors consider hereditary predisposition to liver damage to be an important factor in the development of drug-induced hepatitis. The reason is the peculiarity of metabolism and impaired production of enzymes by the body (they are not able to completely neutralize toxins).
Symptoms and possible complications
Signs of drug-induced hepatitis depend on the type of disease — it can occur in an acute or chronic form. Symptoms of acute drug inflammation of the liver are similar to manifestations of viral pathology, and manifest themselves in a period of several hours to 7 days after taking the drug. The patient complains of:
- intermittent stools and discoloration of feces,
- a sharp decrease in body weight
- yellowing of the skin and sclera.
The course of acute medicinal inflammation of the liver can be divided into two periods: anicteric and with manifestations of jaundice. In the initial period of the disease, hepatitis is manifested by symptoms common to all liver lesions.
- discomfort in the upper right quadrant of the abdomen,
- nausea and vomiting
- weakness, apathy, fatigue,
- fever and fever,
- decreased appetite
- burping air with the smell of rotten eggs,
- bitterness in the mouth
- itchy skin
- joint pain
These symptoms may indicate many pathologies, it is difficult to associate it with medication, especially if the drug is taken for the first time. The anicteric period can last from several hours to three days, the individual development of the organism, associated diseases and the doses and combinations of the drugs taken on affect the rate of development of the pathology. In women, drug-induced hepatitis manifests itself faster and in a stronger form - this is explained by the peculiarities of the metabolism.
After a severe organ damage, the disease passes into the icteric period, which is an indicator of liver inflammation and is observed in all types of organ lesions. Symptoms that appear at this stage of the disease:
- yellowing of the skin and sclera,
- discoloration of urine and feces,
- bleeding from the nose and gums,
- heaviness in right hypochondrium,
- enlargement of the liver and the exit of its edge from under the rib,
- the appearance of spider veins on the skin or rash in the form of nodules,
The chronic form of drug-induced hepatosis develops with long-term medication and is manifested by alternating periods of exacerbation and remission. Symptoms appear the same as in acute inflammation, but more mildly.
Children rarely develop drug hepatitis. and can be triggered by long-term treatment or poisoning with medicinal substances that fell into the hands of a child through the negligence of adults.
Symptoms in children are acute, pathology develops very quickly. Additional manifestations may be:
- frequent urination,
- severe damage to the immune system
- rapid development of necrosis.
Possible complications of drug-induced hepatosis can be:
- cirrhosis, or liver tissue degeneration, in which cells are replaced by coarse fibrous tissue,
- acute liver failure.
In these cases, the body irreversibly loses its ability to neutralize toxins, which leads to the death of the organism.
Treatment of folk remedies
Appointment of funds from the arsenal of traditional medicine for the treatment of drug hepatitis should be carried out by a doctor, since some of these funds can enhance the manifestations of pathology.
Proven in the treatment of drug inflammation of the liver folk remedies are:
- potato juice 100 grams three times a day before meals,
- carrot juice, diluted with water in equal parts, 100 grams three times a day before meals,
- juice from the whole dandelion plant at the rate of one tablespoon per 100 grams of warm water.
- raw beet juice mixed with water in a ratio of 1: 1 to 60 to 150 grams in the morning and evening after meals.
In addition to juices, you can use:
- decoction of dill seeds,
- an infusion of mint leaves and herb wormwood, taken equally.
- decoction of grass and flowers of Hypericum,
- infusion of immortelle flowers, chicory root and dandelion, taken equally.
An excellent way to support and restore the liver is honey and pollen.
Prevention and Diet
Medicinal hepatitis can not be cured without the use of a special, sparing damaged liver diet. The diet should correspond to the ration of table number 5. Mandatory elements of the diet are:
- frequent meals in small portions,
- reducing the amount of fat and increasing the protein intake in the diet,
- the exclusion of salted, smoked, spicy food,
- the inclusion of large amounts of vitamins and diet
- water balance and the inclusion of clean water, herbal teas, vegetable juices in the menu.
Cooking mode - boiling, stewing, steaming. Food should be served warm on the table.
Early diagnosis of drug-induced hepatosis and timely treatment can completely eliminate the manifestations of the disease and ensure the restoration of the liver.
Medicinal hepatitis. Treatment of drug hepatitis folk remedies.
What is pathology
Drug hepatitis is an inflammatory process in the liver, which was caused by the negative effect of certain drugs on its tissue.
The phenomenon under consideration is a frequent problem in medicine. Self-medication, the sale of medicines without a prescription by a specialist, non-compliance with instructions and dosages - all this adversely affects the patient's health and can cause him significant harm.
It is worth considering that the inflammation of the liver of the drug nature is not contagious and not dangerous to others, because it is provoked by a specific substance, and not an infection.
This condition can make itself felt a couple of hours after taking the medicine, and can accumulate in the body for years and manifest at any time.
If you go deeper into the study of the problem, you can prevent the risk of irreversible processes in the liver.
Classification of drug hepatitis
According to the nature of the course, drug-induced hepatitis is of two forms. They are:
- The acute stage, with the development of which the person has characteristic symptoms. This form of pathology is well treated.
- Chronic stage that can go on hidden for many years. Such hepatitis is difficult to treat and often leads to cirrhosis of the liver.
Despite the factor that triggered the drug-induced hepatitis, the pathology should be immediately treated to avoid serious consequences.
Causes of Medicinal Hepatitis
The liver is an organ that neutralizes, neutralizes and removes from the body all the harmful substances that enter it.
A similar function of the body is provided by the enzymatic neutralizing system of the liver cell.
The process in question is not as easy as it may seem. It is divided into certain stages, during which partial processing of toxic substances takes place, which is excreted in the form of metabolites - products of biotransformation.
But it should be borne in mind that the compounds that occur in the liver during the processing of body waste are the most active toxins of a biological nature - they act as a threat to hepatocytes.
This suggests that only timely disposal of these compounds can protect the body from destruction by metabolites.
The reasons that provoke disruptions in the body and the depletion of the enzymatic system, can be the following factors:
- Long-term therapy with hepatotoxic drugs.
- Regularly repeated courses of treatment with these agents.
- The use of large dosages of medicinal substances, if it is required in case of a freelance clinical picture.
- Self-medication with these drugs, without periodic blood and urine tests.
- Available chronic liver disease.
When treating with hepatotoxic drugs, the forms of drug hepatitis can develop both instantly and over 2-3 years.
There are cases of fulminant damage to the liver, which occurred after a single dose of any means.
Pathologies provoking the considered form of hepatitis
There are several major diseases that can cause drug-induced drug hepatitis in humans. They are:
- The presence in the body of chronic, viral or autoimmune hepatitis.
- The appearance of ascites - fluid in the peritoneum.
- The presence of bad habits: smoking, passion for alcohol or drugs.
- Regular contact with solvents and toxic gases or substances.
- Malnutrition, lack of food rich in protein.
- Regular stress.
- Renal failure.
- Pathologies of the cardiovascular system.
- Blood disorders.
In addition, the risk of developing drug-induced hepatitis increases in these situations:
- Recovery period after severe abdominal surgery.
- After illness.
- During the growth of malignant neoplasms with metastases, fired into the liver.
- Transferred chemo - or radiation therapy.
- Long-term chronic pathologies in a sluggish form.
- Combination of several chronic diseases.
- The presence of autoimmune pathologies.
Sometimes it happens and such that the neutralizing enzyme system works without failures, and the body is poisoned due to untimely withdrawal of metabolites.
What drugs cause the dosage form of hepatitis
Currently, there are a lot of drugs that can provoke this type of hepatitis.
You should study them in more detail:
- Substances from the group of TB drugs: isoniazid, rifampicin.
- Antibiotics that are highly toxic: tetracycline, penicillin, macrolides.
- Sulfonamides: sulfamethoxazole, trimethoprim, sulfadimethoxine.
- Hormonal substances: the steroid hormone prednisone and almost all oral contraceptives.
- Nonsteroidal anti-inflammatory drugs: ibuprofen, naproxen, diclofenac.
- Anticonvulsant and antiepileptic drugs: phenytoin, carbalex, clonazepam.
- Funds fighting fungus: griseofulvin, fluorocytosine.
- Diuretic drugs: furosemide.
- A group of cytostatics that prevent the uncontrolled spread of methotrexates and antiarrhythmics: disopyramide.
- Drugs used for the treatment of diabetes mellitus: metformin.
- Drugs that fight gastric and duodenal ulcers: omez.
If a patient combines 2 or 3 of these drugs at the same time, their toxicity increases several times, provoking the development of drug-induced hepatitis.
Symptoms of pathology
Symptomatic, the pathology under consideration is similar to the manifestations of all other forms of hepatitis. The clinical picture observed in a patient is as follows:
- Soreness and heaviness in right side above navel.
- Nausea with vomiting.
- Admixture of bile in vomit.
- Weakness, apathy.
- Problems in the gastrointestinal tract.
- Diarrhea after eating fatty foods.
- The weight in the stomach without overeating.
- Yellowing of the skin and eyes.
- Itching of the skin.
- Severe darkening of urine.
- Discoloration of feces.
- An increase in the size of the liver and spleen.
It is worth considering such a moment that chronic drug-induced hepatitis may not be symptomatic for quite a long time.
Sometimes a person, after taking medication, can feel discomfort in the abdomen and problems with the gastrointestinal tract.
But these symptoms disappear on their own after undergoing a course of treatment, so latent toxic hepatitis is often diagnosed at advanced stages.
Due to the fact that the symptomatology under consideration does not in all cases indicate that the patient manifested the exact dosage form of the pathology under consideration, it is forbidden to engage in self-medication.
This is explained by the fact that taking medication can only aggravate the situation and provoke many other diseases. In rare cases, but the patient may die.
How pathology is diagnosed
If a person has several of these symptoms, he is recommended to seek the help of specialists.
The doctor will examine the patient and prescribe a complete examination of the body.
Standard diagnostics consists of several stages:
- Taking a general and biochemical blood test.
- Analysis of urine.
- Conducting coagulogram.
- Ultrasound examination of the abdominal cavity.
- Perform a liver biopsy.
Due to the fact that the symptoms may indicate other liver pathologies, a differential diagnosis should be performed.
During its conduct, the physician must exclude or confirm the presence of an oncological process, cholelithiasis pathology, tumors in the liver, and viral forms of hepatitis.
A specialist can prescribe a treatment regimen only after a full examination, making a final diagnosis and determining the cause that provoked the development of drug hepatitis.
Therapy of the disease under consideration begins with the urgent cancellation of the problem drug that causes inflammation in the liver.
If it is required to continue the treatment of hepatitis or primary pathology, then the specialist should prescribe a new drug - an analogue of the previous one. Self-medication in this case is unacceptable.
The basis of drug therapy lies in several tasks: ridding the body of toxic substances after a certain group of drugs, protecting liver tissues and repairing damaged areas.
In order to carry out detoxification treatment, it is common to use infusion therapy or plasma exchange.
In the treatment of infusion therapy, the patient is put droppers with protein preparations, saline solutions and blood components.
When plasmapheresis is taken blood is cleaned and poured back. If the pathology is badly started, and the considered methods did not bring the desired effect, the physician can prescribe hemodialysis - the process of cleansing the blood using a special apparatus that replaces the kidneys.
To restore damaged hepatocytes, doctors use drugs from a number of hepatoprotectors. For example, Essentiale or Methionine.
Acute chronic or acute hepatitis drug can cause massive acute liver necrosis. This suggests that the pathology should be healed in a timely manner.
In addition to drug therapy, the patient should be assigned a special therapeutic diet, which implies the rejection of the following products:
- Oily fish and meat.
- Cocoa, coffee, black tea.
- All kinds of chocolate.
- Foods with high cholesterol and oxalic acid.
The diet should include lungs, but at the same time, nutritious foods containing:
- 400 grams of carbohydrates.
- Less than 90 grams of fat.
- 100 grams of protein.
- Not more than 5 grams of salt daily.
Food is better to steam or boil. It should be consumed warm, not hot or cold.
Experts recommend to give preference to liquid, grated and puree dishes. One should eat often, but divide the usual rate into several visits.
Therapy folk remedies
The use of funds from the people, too, should be carried out under the strict supervision of the attending physician, because some substances included in the prescriptions can aggravate the situation.
Manifestations of drug hepatitis will help alleviate the following remedies:
- Potato juice, taken daily, three times - in the morning, afternoon and evening.
- Carrot juice, diluted with water and taken 3 times a day before meals.
- Dandelion juice mixed with warm water
- Beet juice, which added water.
In addition to the juice, you can use decoctions of dill seeds, infuse mint and wormwood, make decoctions of St. John's wort, drink tincture of immortelle, use chicory root.
In addition, the symptoms of hepatitis can be eliminated with honey and pollen.
Hepatitis prevention and prognosis
If the pathology is severely neglected and a severe case has appeared before the eyes of physicians, then we can talk about the form of fulminant hepatitis and liver necrosis.
As a result of such phenomena, there is a high risk of cirrhosis, liver failure, coma, or death.
If the problematic medicine is stopped in time to drink, then there is a high probability that the body will cope with the problem on its own.
There are several basic preventive measures that will help avoid the development of hepatitis. They are:
- Rational use of drugs.
- Surveillance of health and immediate response to failures in the work of any organ or system.
- Refusal of self-treatment - only a qualified specialist should prescribe medications.
If a long course of taking any medications is planned, then you should worry about the condition of the liver in advance and start taking hepatoprotectors in a timely manner.
In addition, people who are on long-term treatment should periodically monitor transaminase parameters, which strongly affect the liver.
With timely detection of failures in the test results, it is possible to prevent the development of the effects of drug hepatitis.
Hepatitis is a dangerous disease that requires special attention. But do not despair, because the medicinal form of pathology can go away on its own, without any additional intervention by medical personnel.
If this does not happen after the drug is discontinued, then it is worthwhile to appear to the attending physician, undergo a full diagnosis of the body and get an accurate diagnosis on his hands, allowing him to begin treatment.
Causes of Hepatitis
The liver can be called the perfect filter in all of nature. It is responsible for the neutralization and elimination of toxic substances that enter it with blood. When the blood for a long time contains a large number of drug metabolites, liver cells begin to break down. The removal of harmful substances from the body occurs in several stages. In the process of this, the formation of metabolites (intermediate products of biological transformation) occurs. Medicinal drugs contain too hepatotoxic elements that have a detrimental effect on the cells and the liver as a whole.
If a person takes such drugs for a very long time, depletion of the neutralizing enzyme system and damage to the hepatocytes occur. As a result, drug or drug hepatitis begins to develop. Today, there are about 1,000 medications that can cause hepatitis. The risk of inflammation of liver cells is increased tenfold if several drugs are taken at once. Simultaneous administration of 8–9 medications increases hepatocyte damage by 93%. The development of the disease can take from 2 days to 1 year. Also reasons may be:
- hereditary factors
- chronic drug hepatitis
- wrong medicine combinations
- some antibiotic groups
- drugs used to treat tuberculosis,
- hormonal medications,
- non-steroid drugs
- drugs used to treat epilepsy, seizures,
- sulfa drugs,
- heart drugs
- diuretic drugs
- medications used to treat diabetes,
- kidney disease, liver,
- individual intolerance to drugs
- autoimmune, viral hepatitis,
- low levels of protein in the body
- alcohol, nicotine, narcotic drugs,
Medicinal hepatitis occurs mainly if the dosage of the medication is disturbed or if the wrong combination is taken.
Treatment of drug (drug) hepatitis
Treatment of drug hepatitis begins with a diagnostic examination and testing. It is very important to understand that a person actually has medicinal hepatitis, because the course of treatment depends on it. Diagnosis is carried out by methods such as:
- general blood and urine analysis
- biochemical blood test (determination of the level of bilirubin in the blood, bilirubin and protein fractions),
- blood coagulation system (coagulogram),
- Ultrasound of the liver.
In the event that the disease is confirmed, doctors cancel the drug, which is toxic to liver cells. In the future, prescribed a set of therapeutic measures that will help remove the poison and neutralize the body. In medicine, such procedures are called detoxification therapy. For cleansing the body use special preparations.
To restore the liver there are substances that contribute to the rapid and efficient regeneration of liver cells, their division.
When there are severe necrotic and cirrhotic lesions of the liver cells, organotherapy is used, which contributes to the rapid restoration of liver tissue.
What can not eat with chronic hepatitis?
Inflammatory liver damage implies dietary restrictions. Diet therapy is necessary to ensure a sparing diet, correcting and improving metabolic processes, reducing dystrophic and destructive processes. The basis of treatment is diet No. 5, according to which the energy value of the diet should not exceed the energy costs. In the daily diet should be 4-6 g of carbohydrates, 1.2-1.4 g of fat and 2.3 g of proteins. These proportions are calculated per kilogram of patient weight.
Consider what you can not eat in chronic hepatitis:
- Fatty meat, fish and poultry.
- Kidneys, liver and brains.
- Broths, canned food, pickled products.
- Fatty dairy products.
- Spicy spices and seasonings.
- Mustard, pepper, horseradish.
- Sorrel, green onions, garlic, mushrooms, spinach.
- Sour fruits and berries, red currants, cranberries and gooseberries.
- Chocolate, ice cream, muffins and other sweets.
Foods that stimulate the secretion of the stomach and pancreas, fried foods with a high content of cholesterol and purines are excluded from the diet. Products with oxalic acid and nitrous extractive substances are banned.
Hepatitis are the most common among the diseases. Acute hepatitis has an infectious origin. And if viral hepatitis E and hepatitis A (Botkin's disease) have a favorable course and do not become chronic, then hepatitis b and WITH, despite significant progress in diagnosis and treatment, lead to chronic liver damage. They are characterized by the most frequent development. cirrhosis and liver cancer.
Chronic hepatitis results from acute hepatitis, as well as chemical intoxication, alcoholism or chronic infections. Chronic hepatitis ends with recovery or goes into cirrhosis of the livermay develop liver failure. The base table for these diseases is Diet number 5 and its varieties.
Diet for hepatitis depends on the stage of the disease. In acute hepatitis, a protective-sparing regimen is prescribed, which includes hospitalization, bed rest or bed rest hepatic encephalopathy) and diet food. When jaundice subsides the patient is transferred to the ward. For all acute hepatitis, the first time is prescribed more benign Diet number 5A. Diets differ in the degree of sparing, methods of cooking and therefore are appointed in different periods of illness.
The mechanical effect of dishes is determined by their consistency and volume, degree of grinding and processing (cooking or frying). Chemical effects are substances that make up the products. Strong irritants are extractive substances and essential oils.
The purpose of the appointment of a sparing diet is the sparing of all the digestive organs. It causes rest to the digestive tract organs and, first of all, the liver, which is important in the acute period, and contributes to the normalization of its function. In order to detoxify for the first time increase fluid intake (2-2.5 liters).
The diet is complete in protein (100 g) and carbohydrates (400 g), but its fat content is limited to 70 g. In the presence of dyspeptic symptoms (nausea, vomiting, aversion to food, bloating, constipation or diarrheaa) the amount of fat is further reduced (50 g), and in case of intolerance exclude vegetable oils. Food is enriched with sources of proteins, lipotropic substances (cottage cheese) and of vitamins (berries, vegetables, fruits, juices). It is not recommended to increase the content of easily digestible carbohydrates, as this may impair biliary function. Organized 5-6 meals a day.
Meals in the acute period include:
- Steam and boiled dishes of twisted meat and chopped boiled vegetables. Excluded are sautéing, stewing and frying.
- Reduced amount of refractory fats and salt.
- The amount of lipotropic products (cottage cheese, buckwheat, whey, fiber, buttermilk, polyunsaturated fatty acids) has been increased.
- Soups cooked in vegetable broth with grits and ground vegetables. Vegetables can not be fried for dressing soups. Puree soups are allowed. Season soups with butter, sour cream, milk or cream.
- Stale wheat bread (I and II varieties) and lean biscuits.
- Low-fat meat and fish in boiled and steam form and only chopped products. Fish can be cooked piece.
- Semolina, buckwheat porridge, rice, oatmeal and oatmeal, from which porridge is boiled in water (you can add milk). Kash fray to semi-liquid consistency. Fine boiled vermicelli and small pasta are allowed.
- Low-fat dairy products, semi-fat cottage cheese (natural and dishes from it). Milk and butter - only in dishes. Sour cream is used as a seasoning for dishes.
- Protein omelets.
- Vegetable oil only with good portability (in ready meals).
- Vegetables (potatoes, cauliflower, pumpkin, carrots and beets) boiled and ground, and also in the form of mashed potatoes.
- Ripe, sweet fruits in their raw form are consumed only with pureed, baked and boiled.
- Tea with lemon, tea with milk, dogrose infusion, water without gas.
- Refractory fats, spices, spices, pickles and pickles, canned food.
- Coarse fiber (legumes, swede, nuts, seeds, mushrooms, cabbage), vegetables with essential oils (radishes, onions, garlic, green onions, radishes).
- Fatty meat, offal and fatty fish.
- Cream confectionery, black bread, muffins, millet.
- Coffee, ice cream, chocolate, cocoa.
- Egg yolks.
- Sour fruits and berries, vegetables and fruits in their raw form.
- Alcohol and drinks with gas.
In the absence of complications Table number 5A appoint to 6 weeks. Next, the patient is transferred to the base Table number 5which is recommended for 6-12 months. Diets differ in the degree of mechanical and chemical sparing, methods of cooking, therefore, are appointed at different periods of the disease. After acute hepatitis, it is recommended to limit sports and hard physical labor, night work and long business trips are excluded.
Hepatitis Diet and liver cirrhosis with chronic course and in the period without exacerbation - this Table number 5which will be discussed in detail below. They make corrections to the diet if there are signs of stagnation of bile: they limit sugar and introduce more vegetables, fruits, vegetable and fruit juices, as well as vegetable oils. The total amount of fat in this case increases slightly, and vegetable fats make up 35% of all fats in the diet.
With a benign course of disease is permissible Diet number 15 - a common table, but being on it the patient must exclude fatty meats, smoked meats, savory snacks, spices, dough (butter and flaky), vegetables with essential oils. Alcohol is prohibited. During exacerbation of the patient is temporarily transferred to Table number 5A.
If cirrhosis has a benign course and the patient's condition remains satisfactory for many years, the base table is shown. With dyspeptic symptoms - № 5А. If marked diarrhea and steatorrhea (signs of violation of the absorption of fat), then limit the amount of fat to 50-60 g, exclude milk and laxative products.
With cirrhosis occurring with ascites, recommended diet low energy (up to 2000 kcal), containing protein 70 g and not more than 0.5 g of salt. All dishes are prepared without salt. Salt-free bread and butter are allowed. Also reduce the amount of fluid and injected potassium-containing products. Meals should be predominantly vegetarian. It is advisable for several days (up to 10) to transfer the patient to salt-free Table number 7.
With the accumulation in the blood of nitrogenous slags, the amount of animal proteins further reduce, but increase the content of easily digestible carbohydrates. In the absence of appetite, fresh vegetables, fruits, their juices, fermented milk products should prevail in the diet. Sometimes spices and weak meat broths and soups on them are allowed in a small amount.
The use of hepatotoxic drugs that are metabolized in the liver can lead to toxic hepatitis. These drugs are methotrexate, paracetamol, amoxicillin/clavulanate, flucloxacillin, non-sterioid anti-inflammatory drugs, tetracyclinesulfonamides co-trimoxazole, Nifurantine.
Toxic hepatitis causes the abuse of alcohol and its surrogates. The toxic effect of ethanol is directly dependent on the concentration of acetate in the blood and acetaldehydewhich has a hepatotoxic effect, disrupts the function of cell membranes. Taking alcohol on the background of taking any medication that is used in therapeutic doses, leads to increased sensitivity to them and toxic liver damage.
Some industrial poisons have an affinity for liver tissue and produce effects, even if they are given in small doses. it halowax, chloroformazo dyes styrene, benzene, phosphorus, organophosphate pesticides, arsenic. Acute liver damage with poisons is extremely rare.
When toxic hepatitis of the liver, pain in the hypochondrium, nausea, weakness, progressive jaundice, changes in liver function and its increase. Treatment is to exclude contact with a toxic substance, the appointment of detoxification therapy, enterosorbents, hepatoprotectors, of vitamins and choleretic drugs. When toxic hepatitis recommendations for clinical nutrition do not differ from the above.