Hepatology Review: Cirrhosis Pathophysiology

After going through the functions of the liver in our previous lecture, we’ll be discussing the different types of liver diseases like hepatitis, ascites, cirrhosis, and encephalopathy. We’ll also tackle the different ways on how clients with these diseases should be cared for.

We highly recommend that you go through the first liver lecture before continuing with this one because that talks about the liver’s general pathophysiology.

With this liver disease lecture, we’ll focus on liver cirrhosis. Let’s begin.

What Is Cirrhosis?

To easily remember what cirrhosis is, you can call it, “scarrhosis,” since the condition is basically the scarring of the liver.

Just a quick review and as mentioned in the first lecture, the liver acts like a recycling company that entails a first pass phenomenon; this company is called as the PDSM Recycling Company. PDSM stands for People Drink So Much Recycling Company. The liver’s primary functions are production, detoxification, storage, and metabolism.

The First Pass Phenomenon

When a person drinks alcohol, it passes through the mouth, stomach, and into the duodenum of the small intestine. The small intestine is divided into three parts – duodenum, jejunum, and the acetabulum (DJA). And once the alcohol has passed the intestines, blood will scoop it up.

However, before the alcohol is sent to different parts of the body, it first has to pass “customs” for detoxification. Because the last thing that you want is to have the alcohol or anything you’ve ingested to be circulated around the body without going through the liver to undergo filtering and detoxification.

Alcohol and Cirrhosis

Liver cirrhosis is a condition that is mainly caused by alcohol. When a person drinks so much alcohol, aside from increased toxins going into the blood, the liver also ends up being scarred. Increased scarring due to long-term alcohol consumption creates a barrier that prevents blood to pass through from the duodenum and into the portal circulation of the liver.

Critical Thinking Question

What happens if blood can no longer pass into the liver? Where does it go?

Answer:

If blood can no longer pass through the liver due to increased scarring, it backflows into the intestines, the spleen, and even into the esophageal tract.

Once backflow happens, there are a series of unfortunate medical conditions that occur, and the most apparent is that whatever organ that is affected by the backflow, gets enlarged. What are some instances?

1. Splenomegaly – spleen enlargement
2. Esophageal varices due to a swollen esophagus followed by vomiting of blood
3. Pancreatitis – inflammation of the pancreas
4. Portal hypertension due to the increased pressure of the blood being pushed on the portal vein

TIPS: A Medical Intervention

As medical professionals, you have to ensure that the liver is functioning optimally to resume the normal detoxification process. How is this done?

Schedule the client for a transjugular intrahepatic portosystemic shunt (TIPS) to put a stent into the liver and cause a bridge between the liver and the vein to decrease portal hypertension.

The stent now serves as a bridge to decrease portal hypertension which takes the pressure off of the spleen, pancreas, and the esophageal tract.

Liver Transplant

If the liver cells responsible for detoxification have been destroyed completely, a liver transplant is advised. However, getting a liver transplant requires a lot of effort from the medical team in terms of finding a healthy liver donor that would be a match for the client.

If your client is an alcoholic and has undergone liver transplant, you have to make the client understand that if he or she will continue, the transplanted liver will also get killed eventually. And it is the medical team’s responsibility to look for psychological issues when dealing with an alcoholic.

On our next liver lecture, we’ll talk about PDSM in terms of what the liver produces.