This lesson will discuss cirrhosis, why it may occur, what it looks like, and how it may be treated. Additionally, you’ll learn about fibrosis, hypertension, and what signs to look for on diagnostic tests.

Yet Another Warning Not to Drink Alcohol

Whether you’re a big college partier, just enjoy going out, or prefer to drink bottle after bottle alone by the fireplace, then there is a big warning in store for you in this lesson, as if you haven’t gotten enough of those already! What we’re going to learn about is a consequence of numerous different disease processes but is most commonly associated with alcohol abuse.

What is Cirrhosis and What is It Caused By?

This overall consequence of liver disease is known as cirrhosis. Cirrhosis is hepatic fibrosis resulting in the conversion of normal liver architecture into an abnormal nodular form.

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Don’t be scared by that definition. ‘Hepatic’ just refers to the liver. Fibrosis is the scarring of an organ or tissue by way of connective tissue proliferation as a result of an injury. Just like you’ve certainly gotten a little scar on your skin from an accident when you were young and getting into all sorts of trouble, well, the same exact thing happens to your liver as well.

Additionally, the word ‘nodular’ refers to the fact that our liver begins to transform into a cluster of grape-like shape, with each grape representing a little nodule. Cirrhosis can be caused by just about anything that causes longstanding liver damage. This includes:

  • Alcoholism
  • Infection, such as due to a hepatitis B or hepatitis C virus
  • Non-alcoholic fatty liver disease, which is the buildup of fat within the liver not as a result of alcohol abuse

These, and any combination of them, account for about 95% of the causes of cirrhosis in the United States, and I want you to remember them verbatim. Other possibilities such as autoimmune disease, toxins, and genetic disorders are all possibilities as well, but less so numerically.

How Does Cirrhosis Occur?

At this point, I hope you’re wondering why nodules begin to form as a result of cirrhosis – because that’s what I’m going to explain. When something injures the liver, it causes inflammation. Longstanding inflammation begins to destroy the liver itself. As the cells that make up the liver die, scar tissue is formed in order to fill in the gaps left by the dead and dying cells that used to make up the normal liver. In between these areas of scar tissues are many times areas of liver cells that try to regenerate the liver back to normal structure and function.

So, with that, you’d think you should just drink away, be merry, and not worry about cirrhosis as you get older. Your liver can fix itself and regenerate! Drink away, you say!

Not so fast.

While the liver is actually able to restore and regenerate itself if a part of it is removed or if it is damaged due to inflammatory processes, there is a catch. It has been shown that alcoholism actually suppresses liver regeneration. One drink too many does not do a liver any good.

The other catch is that all of these nodules and scar tissue form a giant mess than can prevent proper inflow of blood to and within the liver, leading to hypertension, or increased blood pressure, or it can prevent the outflow of substances, such as bile, out of the liver.

All of these physical changes to the liver over the long run result in a cirrhotic-looking liver, which is stereotypically filled with nodules, is shrunken, and looks paler than usual. But do be aware that variations in size and color of the liver do exist in cirrhotic patients, depending on the timeline of events and the exact underlying cause of the cirrhosis.

Let’s see how the process of cirrhosis works by pretending the liver is like one of those long tube-like balloons clowns use to make animal shapes. Let’s also pretend that a rubber band represents a band of connective scar tissue. If you tighten one rubber band near one end, and then another one near the other end, and so on all over the entire length of the balloon, you’ll get bunch of air-filled nodules surrounded by rubber bands with a balloon that looks much smaller than it did before you began placing all of those rubber bands. This is similar to what actually happens in real life to the liver.

The Consequences of Cirrhosis

If you recall, I recently mentioned that all of this scar tissue formation and nodular regeneration leads to more problems for your liver as well as yourself. For example, because the normal architecture of the liver is disturbed, it cannot detoxify your body nearly as well as before. This leads to a back-up of toxins, such as ammonia, which can lead to life-threatening hepatic encephalopathy, which is a brain (‘encephalo’-) disease (‘pathy’) of liver origin (‘hepatic’).

Jaundice, or yellowing of the skin and eyes, may occur. On blood tests, elevated levels of bilirubin; increased levels of liver enzymes such as ALP, ALT, AST; increased prothrombin time; and decreased levels of albumin occur with cirrhosis.

A shrunken and nodular liver can be seen on ultrasound as indicative of cirrhosis, but the only way to definitively diagnose cirrhosis is by taking a biopsy, or small sample of the liver, and then slicing it for visualization under the microscope.

Treatment of Cirrhosis

Unlike other conditions, cirrhosis, you must remember, is a consequence of a disease process, which causes even further disease processes. Therefore, the underlying disease process must be addressed in addition to any consequences stemming from cirrhosis itself!

Alcoholics will need to enter treatment programs, antiviral medication for viral hepatitis may need to be given, and weight loss programs for fatty liver disease might be recommended as well.

Concurrently, a doctor will need to manage the consequences of the cirrhosis as well. For example, fluid may build up in your body as a result of a decrease in albumin production. This means low-sodium diets may be recommended. If portal vein hypertension occurs as a result of cirrhosis, blood pressure medication will need to be used, and so on down the line.

Lesson Summary

If this lesson didn’t convince you that alcohol consumption isn’t a very good idea, then I didn’t do a good enough job of describing how that poison kills your liver, and by extension, your body.

Just in case you need to be reminded, alcohol, among other things, can lead to cirrhosis. Cirrhosis is hepatic fibrosis resulting in the conversion of normal liver architecture into an abnormal nodular form. The word ‘hepatic’ just refers to the liver, while fibrosis is the scarring of an organ or tissue by way of connective tissue proliferation as a result of an injury.

In addition to alcohol abuse, cirrhosis can be caused by just about anything that causes longstanding liver damage. This includes non-alcoholic fatty liver disease, which is the buildup of fat within the liver not as a result of alcohol abuse. Cirrhosis can then lead to serious consequences to the body ranging from hypertension, or increased blood pressure, to brain damage. Fun!

Learning Outcomes

Following this lesson, you should have the ability to:

  • Define cirrhosis
  • Describe the causes of cirrhosis
  • Identify the symptoms of and treatment options for cirrhosis
  • Explain what it means that cirrhosis is a consequence of a disease process and how certain causes of cirrhosis can inhibit the liver’s ability to regenerate