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Abstract: The patient had a history of alcohol consumption for more than 20 years. Recently, he had poor diet, diarrhea, involuntary trembling of the hands, panic attacks, liver function test back showed abnormal liver function, liver elastography suggested liver stiffness test value up to 39.7 kPa, combined with hepatobiliary, pancreatic and spleen ultrasound findings, the patient was diagnosed with alcoholic liver fibrosis. The patient was recommended to be hospitalized and given standardized drug treatment. The patient gradually recovered liver function, abdominal fluid subsided, slept better and was discharged.
[Basic information] Male, 64 years old
Disease Type】Alcoholic liver fibrosis
Hospital】The 988th Hospital of the PLA Joint Logistics and Security Forces
Date of consultation】March 2022
Treatment plan】Medication (magnesium isoglycyrrhizate injection + polyene-phosphatidylcholine capsule + thiopronin tablet + silymarin capsule + anlohybrid pill + montelukast) + alcohol withdrawal
[Treatment Period] Hospitalization for 26 days, review after 3 months
Treatment effect】The condition was controlled, the fluid in the abdominal cavity subsided, the sleep improved, and the liver function returned to normal.
I. Initial consultation
The first time I saw the patient, I could smell the strong smell of alcohol from a distance. The patient had a history of drinking for more than 20 years and had been unable to eat for more than a week. Outpatient liver function tests were given, and the results showed abnormal liver function, liver elastography indicated that the liver stiffness test value was as high as 39.7 kPa, and hepatobiliary, pancreatic and splenic ultrasound indicated cirrhosis, gallbladder wall thickening, and abdominal fluid accumulation, which were diagnosed as alcoholic liver fibrosis in combination with the patient’s alcoholism.
II. Treatment history
On the day of admission, the patient did not drink, but on the second day, the patient began to be obviously impatient, the trembling of hands and panic increased significantly, and appeared irritable during infusion, and withdrawal syndrome had appeared. medications, and also gave montelukast antidiarrheal to protect the gastrointestinal mucosa treatment. Communicate with the family that if the withdrawal reaction is too strong, a small amount of alcohol can be consumed to alleviate withdrawal symptoms, and at the same time comfort the patient and strengthen his confidence in quitting alcohol. The patient gradually got out of the withdrawal symptoms, his spirit improved, and his liver function index gradually recovered on review. He was discharged after 26 days of hospitalization, and his liver elastography hardness value decreased on review 3 months later.
III. Treatment effect
Although the 26-day hospitalization was arduous, the patient persevered step by step from the state of abstinence from alcohol, from the beginning of trembling hands, panic, restlessness, insomnia, gradually to mental improvement, panic disappeared, appetite restored, weight increased, diet also increased significantly, stool reduced from more than 10 times/day to 1-2 times/day, abdominal fluid subsided, especially sleep improved significantly, and the drop of alcohol during the hospitalization The liver function glutathione aminotransferase, glutamic oxalacetic aminotransferase, alkaline phosphatase and glutamyl transpeptidase all returned to normal on recheck. The liver stiffness value of liver elastography also decreased from 39.7kPa to 18.9kPa during the 3-month outpatient follow-up.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment. Although the patient recovered his liver function through 20 days of treatment and did not drink alcohol during his hospitalization, it is not so easy to say that the 20 years of drinking can be stopped. In the future, the patient still needs to have firm perseverance and the care and help of his family to remind him to pay attention to the following points.
1, quit smoking and alcohol, alcohol does not only cause damage to the liver, but also to the heart, brain, kidneys, stomach and intestines.
2, to take medication on time, and regular review of liver and kidney function, hepatobiliary, pancreatic and spleen ultrasound, liver hardness test, as well as blood sugar, blood lipids, blood routine changes.
3, the diet is mainly high protein, high vitamin, high calorie, avoid eating cold, hard and spicy stimulating food, drinkers themselves too much destruction of the gastrointestinal mucosa, eating cold and spicy food will increase the gastrointestinal burden, leading to diarrhea.
4, to quit drinking requires a strong heart, as little as possible to contact the drinking scene, to maintain a good state of mind, and to avoid “drinking to drown one’s sorrows” in case of distress.
5.Participate in associations that are good for physical and mental health, increase interest, and reduce the dependence on alcohol.
V. Personal insight
People know that drinking can hurt the liver, but not many people know that long-term heavy drinking can cause not only alcoholic hepatitis, but also alcoholic liver fibrosis, liver cancer, and the impact on the heart, brain and kidneys can not be underestimated. In alcohol-related liver disease, the only way to correct and sustainably improve the prognosis is to stop drinking and supplement it with medication to achieve stability. Once alcoholic liver fibrosis enters the decompensated stage of cirrhosis, it is irreversible, and a large amount of fibrous tissue replaces normal liver cells, which will make liver function increasingly poor.