Effects of cerebral edema with alcoholism
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Alcoholism - complications (somatic, mental, neurological)
Part 1. Somatic (bodily) complications
Ethyl alcohol is a universal poison. There is not a single cell in the human body that does not damage alcohol, penetrating into it. All organs are affected, but some tissues - nervous and glandular, for example - are destroyed to a greater extent, since alcohol is easier to penetrate into them, and the cells of these systems are not adapted for the processing of harmful substances.
Defeat of the digestive system.
Mouth - Changes begin already in the oral cavity, wherealcohol suppresses secretion and increases the viscosity of saliva. Teeth alcoholics are destroyed for many reasons - this is the suppression of immunity, and violation of diet, and slovenliness.
Esophagus - Due to the fact that the protectivemechanisms, alcohol esophagitis develops (inflammation of the esophagus). The swallowing process is broken - food starts to be thrown from the stomach into the esophagus. This is due to the effect of alcohol on the esophageal sphincters. Heartburn, vomiting - the inevitable companions of an alcoholic. Veins of the esophagus with chronic ethanol poisoning expand (this is called - varicose veins of the esophagus), their wall becomes thinner and the moment comes when the veins burst at the moment of vomiting and bleeding begins. Only an emergency surgery saves the patient in this case. But more often death comes earlier than the patient is delivered to the surgeon.
Stomach - With alcoholism, secretion decreasesgastric juice, the protective gel of the walls of the stomach undergoes changes, the inflammatory process (gastritis) develops. The result is atrophy of stomach cells, disruption of food digestion, assimilation of nutrients, gastric bleeding, stomach ulcers develop, stomach cancer. Changes in the stomach are found in 95% of alcoholics.
Intestine - With chronic use of alcoholslowing the progress of food masses through the intestines. The intake of alcohol damages the membranes and contents of the intestinal cells. There is a destruction of the vessels of the intestinal walls, the blood supply of the villi responsible for absorption is impaired. Violated absorption of nutrients and the release of harmful, disrupted metabolism. On the walls of the intestine, erosions are formed (this is due to the fact that when blood supply is disturbed, the pressure in small vessels rises and they burst). Intestinal villi gradually shorten. Dying useful microorganisms - the inhabitants of the intestines, which produce vitamins of the group B. Ie. gradually, on the depletion of the vitamin depot (reserve of B vitamins), avitaminosis occurs. Namely avitaminosis is the main cause of severe nerve complications of alcoholism. The assimilation of all microelements, in the exchange of which vitamins are involved, breaks down the protein. At the same time, harmful microorganisms are multiplying - the inhabitants of the intestine, using nutritional substances for food and poisoning the body with the products of their vital activity. Developed alcoholic enteritis (inflammation of the intestines), the main manifestation of which is diarrhea (loosening of the stool).
Pancreas - Systematicalcohol abuse depletes the secretory processes of the pancreas. Secretory cells are replaced by supporting cells, there are fewer and fewer cells that can function. Develops acute or subacute pancreatitis. As is known, the pancreas produces insulin, a hormone responsible for the exchange of sugars in the human body. Its development naturally decreases with alcoholism. First, there is a condition that doctors call "a change in glucose tolerance" and then - acquired diabetes mellitus.
Liver - Alcoholic liver damage is a process,having several stages. At the first stage, due to the fact that the liver does not cope with the processing of toxins, its compensatory increase occurs. Then cells that constantly neutralize ethanol and its metabolites die from excessive work and their place is occupied by fatty tissue (alcoholic fatty hepatosis). Against the background of fatty liver degeneration, alcoholic hepatitis (inflammation of liver cells) develops. By changes in tissue, manifestations, consequences, alcoholic hepatitis is not distinguishable from viral hepatitis. Gradually, in certain areas of the liver necrosis (cell death) occurs. From this point on, the liver disease becomes irreversible; Even with the cessation of alcohol intake, the hepatic cells will not recover. Alcoholic cirrhosis of the liver, the third stage of alcoholic liver damage, can be characterized as follows. After the majority of the liver cells die, the remaining cells begin to form nodes that are chaotically located non-functioning liver cells. The liver becomes tuberous, decreases in size. The nodes compress the veins of the liver and the blood circulation of the whole body is disturbed. Veins of the esophagus, stomach, and intestines expand compensatively. Alcoholics who are diagnosed with cirrhosis quickly die, as poisoning with harmful substances that are no longer utilized by the liver; often patients die from bleeding from the dilated veins. From large nodes of the liver (if the patient survives to this time) cancerous tumors (hepatocellular carcinoma) are formed. Tumors develop due to direct toxic effects of alcohol and because of immunodeficiency.
Defeat of the cardiovascular system
Heart - Alcoholic heart disease developsdue to the direct effect of alcohol, acetaldehyde (the product of alcohol processing), deep structural rearrangements and physico-chemical disorders. With the systematic intake of alcohol reduced contractility and performance of the myocardium (cardiac muscle). Cells of the heart swell, collapse, the number of cell nuclei decreases, the structure of muscle fibers breaks, the cell walls break loose and break down, the synthesis of protein in the heart cells is disrupted. Then, cell degeneration, micro- and macronecrosis are detected. In patients with alcoholism, the whole range of conduction and excitability disorders is recorded. Most often there is an atrioventricular block, a syndrome of premature ventricular excitation and blockade of the conduction of the heart. Complicated alcoholic heart disease with hypertension and arteriosclerosis of blood vessels. The magnitude of blood pressure in people who abuse alcohol is initially higher (by 10-15%) than those who refrain from taking it. This is an additional burden on the heart. There is the concept of "alcoholic heart". They designate the typical type of heart of an alcoholic observed at the autopsy. The size of the heart is increased by increasing the cavities and proliferation of connective (not functional, muscular, and connective) tissue. The cessation of alcohol consumption in a state of compensation stops the toxic damage to the myocardium. If the impact of the damaging factor remains, decompensation develops. The strength and speed of heart contractions decreases, heart failure develops: edema of all organs. Recovery at this stage of alcohol damage to the heart is impossible.
Systematic abuse of alcoholDrinking causes a decrease in phagocytosis. Phagocytosis is one of the most important protective anti-infectious mechanisms of the body. With its help, microbes and altered, dangerous cells of the body are destroyed. Oppressive protective function of blood proteins. The level of lysozyme, a protein contained in many human secrets (saliva, tears, tissues of various organs, skeletal muscles) is reduced and is able to exert an antimicrobial effect, to split the membrane of microbes. The number of lymphocytes - immune cells decreases. This is due to both the direct toxic effect of ethanol on the bone marrow, where lymphocytes are produced, and liver dysfunction. Decreased immunity leads to the formation of persistent foci of chronic infection. Alcoholics more often than people who refrain from alcohol, are ill with infectious diseases (pneumonia, abscesses, etc.). But the main danger to the body is antibodies to its own normal cells (autoantibodies), which begin to be synthesized under the influence of alcohol. In particular, every second patient has autoantibodies to the liver, one in four to the spleen. There are autoantibodies to the brain tissue. The defeat of the nervous system. Alcoholism manifests itself in a variety of neurological symptoms, which are based on metabolic disorders in the nervous tissue, death of nerve cells, increased intracranial pressure, and destruction of the nerve trunks. The systematic use of alcohol leads to premature aging and disability. The life expectancy of persons prone to alcoholism is 15-20 years shorter than the average. The main causes of death of alcohol abusers are accidents and injuries. Patients with alcoholism die, as a rule, not from alcoholic illness, but from concomitant diseases developing in connection with a decrease in immunity, damage to the liver, heart, vessels.
Psychosis is a condition that occurs in 10% of patients onlate (second-third) stages of alcoholism, associated with impaired metabolism in the brain, oxygen starvation of nerve cells, toxic effects of alcohol and the addition of other diseases. There are psychoses, as a rule, not at the time of alcohol intoxication, and several days after stopping the intake of alcohol. In the patient with alcoholism, the obscuration of consciousness develops, a person lives in his fantasies, does not realize his actions. The patient is afraid, it seems that someone pursues him, wants to cause harm, all this is accompanied by severe painful experiences. From the state of affect, psychosis differs in that, under psychosis, a person lives "inside himself", does not understand that his experiences are not related to real problems. After each psychosis in the brain remains a trace, similar to a small scar. In turn, each new dose of alcohol leaves behind the destroyed nerve cells. When there is a lot of scarring on the brain, dementia occurs.
White delirium (Delirium, delirium tremens) is the mostfrequent from alcoholic psychosis. It arises, first of all, because of profound metabolic disorders in the whole organism. The first attack of delirium is usually preceded by a prolonged drinking or prolonged, lasting for months, continuous drunkenness. Subsequent psychoses may also occur after short periods of drunkenness. The defeat of the liver with alcohol abuse leads to a violation of its function, the breakdown of the compensatory mechanism. The processing of alcohol, which is in the body in significant concentrations, is stopped. Many intermediate toxic products of alcohol decomposition are formed. In addition, accompanying alcoholism avitaminosis (especially B vitamins) causes a disruption in the metabolism of such a substance as glutamic acid, which increases the pathological excitability of the nervous system. The triggering mechanism for white fever is 3-5 days of abstinence from alcohol, the moment when the concentration of alcohol in the blood decreases. More often white fever (delirium) develops in people with previously suffered craniocerebral trauma, with chronic diseases, in patients with late onset of alcoholism. What is the manifestation of the white fever? First, there are sleep disorders, nightmares, frightening dreams, fears. In 20% of patients, seizures occur at this stage of delirium. Then depression, anxiety, fear are replaced by a benevolent, upbeat mood, causeless merriment. Patients become talkative, restless, speak quickly, incoherently, easily distracted. There are bursts of vivid memories, even auditory hallucinations can be noted (hail, clicks, sounds), delusions (BRED - unshakable judgments and conclusions that do not correspond to objective reality, which do not lend themselves to psychotherapeutic correction and disrupt the patient's adaptation). Then there are visual illusions, hallucinations (HALLUCINATIONS - vivid representations, brought by the pathological process to the level of real perception). The dream is still intermittent, with awesome dreams. Having woken up, the patient can not distinguish dreams from reality. There is photophobia. Then there is complete insomnia. Microscopic motile multiple hallucinations predominate: insects or small animals. Significantly, there are hallucinations in the form of large animals or fantastic monsters. Patients are afraid. Often there are visual hallucinations in the form of cobwebs, threads, wires. The surrounding objects seem to swing, fall, rotate. The sense of time changes, the time for the patient is shortened or lengthened. Behavior, emotions, delusional statements correspond to the content of hallucinations. The sick try to escape, leave, hide, shake something off themselves, turn to the imaginary interlocutors. There are 3 options for further development of psychosis. Either psychosis ends, or goes into a chronic form, or deep defilement of consciousness, coma, and the patient dies. Memories of a psychosis that has been transferred are partially preserved. The psychosis lasts up to 10 days. Mortality in delirium is 1-2% according to different researchers. Among the causes of death are the main edema of the brain and the attachment of pneumonia, cardiovascular insufficiency.
Encephalopathy. Alcoholic encephalopathy is a general term for a particular group of mental disorders that develop, as a rule, at the third stage of alcoholism. With encephalopathy, mental disorders are always combined with impaired functioning of internal organs and nerve damage. Men are more often ill. More often the disease is preceded by psychosis.
For example, an acutely emergingEncephalopathy, called in medicine ENCEPHALOPATHYE VERNIKE. This encephalopathy begins after a white fever. The patient notes drowsiness, visual hallucinations and illusions, can occasionally shout out individual words, mutter something inarticulate; short-term conditions of immobility, "congealing" with the tension of all muscle groups are possible. Rapidly growing physical weakness, loss of appetite, the patient stops moving. After a few days, the consciousness is broken, down to the coma. From the very beginning of Wernicke's encephalopathy, tremors, spasms, involuntary limb movements, polyneuritis are observed. The appearance of patients is typical. As a rule, they are exhausted, their complexion is earthy-gray or yellowish with a dirty shade, the face is puffy, the peculiar greasyness of the face is characteristic. Skin is dry, flabby, scaly. Limbs of cyanosis, edematous, they are easily formed extensive necrotic bedsores (especially with insufficient care). A rise in temperature is an unfavorable sign. Arterial pressure is low, fainting is frequent. Often there is a loose stool. The fatal outcome in acute encephalopathy is not uncommon, death usually occurs in the middle or towards the end of the second week from the onset of psychosis. Most often this contributes to pneumonia. A psychosis that does not lead to death lasts 3-6 weeks. Variants of outcomes: the transition to Korsakovsky psychosis (described below), dementia, there are no other outcomes.
Korsakov's psychosis is called "alcoholicparalysis. " As a rule, Korsakov's psychosis develops after severe severe delirium, but it can also occur without severe previous disorders of consciousness. Korsakovsky psychosis is a chronic encephalopathy. The patient is confused in the time sequence of events. He talks about the events that have just happened to him from everyday life or situations related to his professional activities (for example, a patient who did not leave the clinic for several weeks, said that yesterday he went to the country house, dug, planted seedlings, etc. .) Sometimes there are fantastic, adventurous utterances. Neuritis of the lower extremities is observed. The degree of damage to the nerves of the legs may be different, from slight gait disturbances to a complete disruption of the ability to move independently. Recovery, if it occurs, which happens very rarely, occurs within a year from the onset of psychosis, i.e. the disease is invariably chronic. More often a pronounced defect is formed - dementia. There are lethal outcomes from hemorrhages leading to softening in the cerebral hemispheres.
Alcoholic epilepsy - this is due totoxic brain damage convulsive seizures. It should be understood that seizures arise because of prolonged intake of alcoholic beverages. Most often they are formed on the 2-3 stages of alcoholism. Appear in the hangover stage. The most typical are convulsive seizures (with a person falling to the floor, seizures of the whole body, a bite of the tongue, urination), but others can be observed. Each seizure leaves a trace in the brain. With complete abstinence from alcohol, a small number of patients may have seizures.
Alcohol degradation develops at latestages of alcoholism. It is characterized by persistent deterioration of memory and intellect, emotional coarsening, ethical decline, loss of criticism to its abuse of alcohol and the state as a whole, the decline of the ability to work systematically and usually the loss of the former position in society. There are 3 types of degradation. Consider them.
Degradation with passivity - a patient sluggish,passive, bezinitsiativen, loses the former interests. Even in the circle of drinking companions, he remains a passive witness to what is happening; any activity arises only when it comes to the acquisition of alcoholic beverages. Such patients are prone to a dependent lifestyle.
Degradation with psychopath-like symptoms - inthe patient is noted increased irritability, anger, a tendency to hysterics and depression. Such patients are openly cynical, do not tolerate objections, are aggressive or, conversely, cowardly, obsequious and deceitful.
Degradation with euphoria - in a patient's conditiona carefree, benevolent mood prevails with a sharp drop in criticism towards one's behavior and position. Characterized by excessive frankness of patients in communicating with others, a playful tone and an abundance of stereotyped speech and stereotyped jokes. The alcoholic humor described in alcoholism is most pronounced in these patients. In these patients, "it is impossible to awaken pride, self-esteem, or a sense of dignity."
The most common neurological complication of alcoholism is polyneuritis.
Alcoholic polyneuritis. Inflammation of the nerves of the hands and feet associated with alcohol abuse. It manifests mainly in the form of pain and temperature sensitivity disorders in the lower extremities. The patient is disturbed by unpleasant sensations: "crawling crawling", "numbness", "contraction of muscles", "burning", "injections"; weakness of extremities "cotton feet". Possible skin lesions, sweating of hands and feet, swelling. The emergence of polyneuritis is associated with both the direct toxic effects of alcohol and the vitamin B and PP deficiency that occurs when alcoholism occurs. In some patients, due to the toxic effect of alcohol, the so-called Dupuytren's contracture is formed - the defeat of the tendons of 4 to 5 fingers, legs. The tendon shrinks in size and pulls the skin behind it, gradually a modified wrist (stop) is formed, which can not move. Treatment - elimination of alcohol and surgical correction.
The complications of alcoholism, described in this article, are typical for a far-gone illness. It is difficult to treat them. It is also difficult to prevent - you must refuse to take alcohol on time.