CIRRHOSIS OF THE LIVER
There are many diseases that affect the human digestive system. Some of these afflictions such as ulcerative colitis, the inflammation of the colon, and Crohn’s Disease (an inflammatory disease of the intestine) are treatable illnesses. In some cases like with dysentery, constipation, and hemorrhoids, the disorder can not only be treated but cured (although not always permanently). Unfortunately not every digestive disease is treatable or curable. Several disorders of the digestive system can be fatal. One of the most destructive and fatal diseases of the digestive system is cirrhosis of the liver. Sadly, it is also one of the most preventable.
Before discussing the disease that is cirrhosis it is important to understand the fundamentals of the liver including location, structure, and functions. The liver is one of the most important organs in the human body and unique in it’s ability to regenerate damaged cells and tissue. The largest glandular organ in the body weighing on average between 2.5 and 3 pounds, the liver is located in the upper right quadrant of the abdominal region. Unimpressive to the naked human eye, the liver is made up of a complex organization of cells, blood vessels, and bile ducts all of which play an intricate role in the liver’s many functions. One of the liver’s most important duties is the removal of dead blood cells, cell debris, bacteria, and nitrogenous waste from the blood. Along with cleansing the body of certain waste and bacteria the liver also inactivates ingested toxins. In other words, the liver serves as the body’s natural filter. Some other functions of the liver include the secretion of bile (necessary for fat digestion), storage of nutrients, glucose, amino acids and iron, production of clotting factors such as fibrinogen, and the synthesizing of enzymes and plasma proteins which control numerous cellular activities.
As stated in the previous paragraph, the liver is a complicated and vital organ that performs many necessary functions that enable humans to live normal lives. However, when cirrhosis occurs the liver can no longer function normally and many problems can arise from the destruction of such an important organ. Cirrhosis (meaning “hardening”) develops when healthy liver cells die and are replaced by fibrous connective tissue and scar tissue neither of which possesses any of the abilities of hepatic cells and vessels. The liver, in an attempt to regenerate, enlarges but eventually shrinks due to the contraction of the fibrous tissue. The normally smooth surface of the liver becomes hard and nodular. A cirrhotic liver, because of the nodular surface, is sometimes called a hobnailed liver.
Since the veins and hepatic artery are compromised the circulation in the liver is impaired. This leads to the swelling of veins in the esophagus, spleen, stomach, and pancreas. The swollen veins in the esophagus are known as esophageal varices and in many cases cause death if they hemorrhage (burst). Rupturing of veins in the stomach and intestines can lead to a condition called hematemesis or the vomiting of blood. Fluid normally circulated by the liver accumulates and leaks into the abdomen causing it to descend. Other fluid settles in around the ankles causing edema. Poor circulation can also lead to the swelling of abdominal veins and varicose veins in the legs (especially around ankles and throughout the feet). The impairment of the bile ducts in the liver, as stated earlier, leads to jaundice. However, this is not the only problem that can arise from compromised bile ducts. Increased amounts of bile can cause feces to acquire a clay-color and an unusual foul odor is present due to the lack of fat absorption. The excess bile in the blood that circulates through kidneys caused the urine to become very dark.
In addition to the numerous biological changes associated with cirrhosis of the liver many chemical imbalances occur as well, some with the potential to cause death. In males an accumulation of estrogen causes the feminization of hair distribution and breast enlargement or gynecomastia. The amount of estrogen in a male is limited in the case of a healthy liver. In the case of a cirrhotic liver the role the organ normally plays in chemical balancing and detoxification is severely impaired. The build up of harmful chemicals such as ammonia can lead to several neurological disorders and even coma (hepatic coma). A person can become severely disoriented and confused leading to hospitalization in the most advanced cases. Hepatic coma has been known to cause death in some instances. Other neurological complications include somnolence or abnormal sleepiness and tremors known as liver flap.
The causes of cirrhosis of the liver are numerous. Yet many are preventable. The most common cause of cirrhosis is chronic alcohol abuse. The exact effect of alcohol on the liver is still not known. Clearly alcohol is toxic to the liver and the malnutrition that is typically seen with alcoholism most certainly plays a role in the liver’s destruction. Simply not drinking or drinking in moderation will prevent alcoholic cirrhosis. Hepatitis, particularly types B and C, have been known to cause cirrhosis. However, since hepatitis is contracted through unprotected sexual contact (oral, anal, and vaginal intercourse) and the sharing of contaminated needles, it is quite possible to avoid such an occurrence by living a clean, healthy life. In some instances, contracting hepatitis is unavoidable as in the case of an accidental needle stick. Those with hepatitis need to seek treatment immediately in order to avoid developing diseases like cirrhosis. The abuse of certain drugs containing acetaminophen cause liver damage which can lead to cirrhosis. Illegal narcotics like heroin, crack cocaine, and crystal meth can severely impair liver function to the point of developing cirrhosis. In some cases an unhealthy diet, especially a high fat one, can lead to what is called fatty nutritional cirrhosis where the build up of fat deposits in the liver cause necrosis (death) of cells and tissue.
The diagnosis of cirrhosis involves several steps although only one or two may be necessary depending on the advancement of the disease and the healthcare provider’s assessment. A simple LFT or Liver Function Panel blood test can determine if liver function is compromised. However, this is usually not enough to rule out cirrhosis. The physician may also order an ultrasound of the liver or, in the most severe cases, a liver biopsy to determine cirrhosis and the extent of damage inflicted upon the liver. Once the stage of the disease has been determined the physician, usually a gastroenterologist or hepatologist, can better decide what course of treatment (if any) the patient needs.
Treatment for cirrhosis is very limited. If the disease is in it’s early stages it is possible the patient can lead a normal healthy existence by refraining from the activity that caused the onset of the cirrhosis (such as in the case of alcoholism or a high fat diet). Prescription drugs are not a recommended form of treatment since the liver is already weakened by the disease and cannot properly digest certain medications. Many prescription drugs, even those without acetaminophen, can cause liver damage if not taken properly. The most successful form of treatment and used in advanced cases of cirrhosis is a liver transplant. With this option the patient may be restricted from engaging in certain activities by the physician (no drinking of alcohol for example). Failure to follow protocol may lead to the patient’s ineligibility of receiving a new liver. Also, the wait for a healthy liver with matching blood type can be a long one and those with advanced cirrhosis do not have the luxury of time. A liver transplant is also an expensive procedure and, though necessary, will sometimes be denied by insurance companies. However, if performed and done so properly, a liver transplant has a high success rate and most patients go on to lead normal healthy lives.
Cirrhosis of the liver is a devastating disease and one of the most painful to endure. It is also one of the most preventable. Those with the knowledge of the disease and how to prevent it should do so. The liver is one of the body’s most important organs and necessary to sustain life. It is important to avoid doing harm to the liver as much as it is to prevent injury to the heart, brain, intestines, pancreas, lungs, and kidneys. Abstaining from drug and alcohol abuse and maintaining a healthy diet will most certainly allow the liver to function normally without the threat of cirrhosis.
Along with the physical changes the liver endures because of cirrhosis there are numerous signs and symptoms resulting from the destruction of hepatic cells and tissue. One of the most common signs of cirrhosis (or any liver disease for that matter) and usually the first one noticed by healthcare professionals is jaundice. This occurs due to the damaged bile ducts of the liver losing the ability to secrete a yellow-orange pigment known as bilirubin. Without the proper secretion of the bilirubin it becomes backed up and deposits in the skin. Jaundice can usually be seen first in the whites of the eyes which will appear a sickly yellow-orange hue. The redistribution of bilirubin is a mild complication compared to others that result from cirrhosis.