Liver Cirrhosis Pathophysiology Sing-Along

SimpleNursing Editorial Team Dec 27, 2017
3D male figure holding stomach in pain

Memorizing becomes easier with a song. A topic so extensive requires a certain technique that would make it painless for students to remember.

At, Mike has created a song to the tune of “It’s Beginning to Look a Lot Like Christmas”, making it more fun and interesting for students to recall everything there is to know about the pathophysiology of liver cirrhosis. Cool!

The liver cirrhosis song goes:

It’s beginning to look a lot like cirrhosis

Jaundice of the skin

From the hyper-bilirubin

Waste products of hemoglobin

Due to a lack of bile-production

It’s beginning to look a lot like ascites

Fluid in the abdomen

From the portal hypertension

The lack of albumin

Increase capillary pressure causing third spacing

The liver acts like recycling company

With four major roles and responsibilities

Detoxing ammonia and drug metabolism

Storing glycogen, producing bile

Coagulation factors and albumin

It’s beginning to look a lot like encephalopathy

With altered LOC

Too much ammonia in the blood

A by-product of protein metabolism

Give lactulose to aid the excretion

It’s beginning to look a lot like cirrhosis

Soon we’ll do a paracentesis

Drain the fluid from the abdomen

Then give albumin

Bring the fluid back into the vascular spaces

If you are able to master this by heart, you are guaranteed 82% or higher on your next nursing exam!

Liver Mash-Up Discourse

Wasn’t that song entertaining? Now, to be able to figure out what it all means, let’s to go into the nitty-gritty details revolving around an ailing liver, mainly: cirrhosis, portal hypertension, ascites, encephalopathy, and all the other conditions. Full lectures are available at

Liver physiology

Before going into the factors that make your liver sick, let’s make a short detour and review what your liver does exactly.

Think of it this way – your liver as a recycling company. It’s called PDSM – People Drink So Much Recycling Company. We named it that because your liver acts as a detoxifier for a lot of different things, mainly alcohol. People who get intoxicated quite so often have a higher risk of developing liver problems.

What is PDSM?

P stands for produce.

The liver produces A, B, and C.

  • A is for Albumin. It has three responsibilities mainly:
    • fluid attraction in the vascular spaces
    • attracts and transports drugs
    • heavily bind with calcium

An easy way to remember the functions of albumin is to think of it as Al Pacino in the movie “Scarface”. It’s not a family-friendly movie but it would ease the burden of you remembering what albumin does. Al Pacino, in Scarface, is a drug lord of a drug cartel and his main goal is to transport drugs, living near Miami which will remind you of the body of water. Cocaine is what he transports which will remind you of calcium because, in its true form, calcium is white.

  • B is for Bile. The bile is the bus of the liver, transporting bilirubin. Bilirubin is a breakdown of old hemoglobin and red blood cells. The red blood cells advance to the spleen where it gets converted into bilirubin. Then, it goes back through the vascular system and into the liver where it gets converted into bile litter. The bile bus basically transports bilirubin and it also transports cholesterol.

As the body breaks down food or drugs, it gets metabolized and is sent directly to the liver to be detoxed in filters and is produced into something that the body can utilize. The liver also detoxifies the body of extra cholesterol to decrease its levels and flushing the excess out of the body in the form of feces. Which is why, if you have a malfunctioning liver, your cholesterol will shoot up and your LDL and HDL will be unbalanced. Bad cholesterol (LDL) will rise and your good cholesterol (HDL) will decrease. In most cases, total cholesterol skyrockets more than 200.

  • C is for Coagulation factors. This makes the blood clot; thus, decreasing the coagulation time. To determine if the clotting factors are in place, we have the PT, PTT, and INR. The absence of coagulation factors makes a person prone to bleeding. Scabs will not be formed. This means that if you have a liver abnormality like hepatitis or cirrhosis, profuse bleeding will occur.

For a person with liver cirrhosis, the laboratory results yield a low albumin and high bilirubin, causing jaundice. The cholesterol levels shoot up of more than 200; LDLs will go more than 100; HDLs will be less than 40.

D stands for detoxifies.

The liver basically detoxes our body from alcohol or what is also referred to medically as ETOH or toxicity. It acts as a detoxifier. Before your alcohol or whatever it is that you have consumed must first go through the liver which is more like your “customs” or your “border patrol”.

Kupffer cells or, as Mike would like to call them – Mr. Kupffer, is that group of cells inside the liver that are responsible for detoxification. So before any of your medications would go into the bloodstream to be distributed to the parts of the body, it would first have to be absorbed in the small intestine first and then that’s the time that it passes the liver – your customs. 

Exam tip: When asked, what is faster: onset of PO medication or intravenous medication? Since the intravenous medication does not have to go through the first pass phenomenon and it is administered directly into the bloodstream, the answer would be intravenous medication.

S stands for storage.

Glycogen storage is another function of the liver. Glycogen is a collection of glucose which is utilized by the body during activities for energy production. Glycogen is a huge wall of glucose and glucose is its building blocks.

How is this knowledge useful for our daily lives? When a person, an athlete, requires sufficient amount of energy before a race or a competition, he or she will undergo carb loading. Here, the athlete will consume tons of carbohydrates the night before so the liver would recognize that there is an abundance of glucose so it would store it collectively as glycogen. When the time comes that the person will need the extra energy, the liver would detect that and would then peel off bits of glucose for the body to use.

M stands for metabolism.

Metabolism is the process of conversion, the breaking down of elements for the purpose of utilization. Ammonia is metabolized into urea.

By principle, ammonium is a by-product of protein metabolism that is used up by the body for muscle building. Ammonium is transported to the liver to be metabolized into ammonia and gets converted into urea. Urea is excreted by your kidneys from your body in the form of urine.

Mechanism of urine production

Once urea gets launched into the bloodstream, it passes to the renal artery and goes in the kidneys. Within the kidneys, urea is processed by glomeruli for filtering and is then passed on to the ureters, down to your bladder becomes urine.

What happens when waste inside the body is not properly excreted?

They go into the bloodstream and your body will go into toxification, resulting in encephalopathy which is basically the brain being intoxicated with so many by-products. Clients who have encephalopathy display a wide array of signs and symptoms like the altered level of consciousness and unstable behavior.

Which is why the doctor will often ask if the ammonia levels of a client who is acting erratically with altered level of consciousness have been checked. The most common denominations would be your ALTs and ASTs.

So there you have it, the major functions of a normal liver. Next discussion will focus on the liver breaking down; thus the basis of the song above.

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