Liver is one of the very important organs of body that participates in carrying out many important functions to sustain life of an individual. It can be affected with any disease or disorder and one of the commonest one includes cirrhosis.
Cirrhosis is a type of chronic liver disease where the liver tissue is being replaced by fibrosis, scar tissue and regenerative nodules that result in loss of proper functioning of this vital organ.
Alcoholism, fatty liver, hepatitis B and C are the major factors that are responsible for this chronic liver disease but other factors may also play minor role for example, viral infection, accumulation of toxic metals like iron and copper due to genetic disease and autoimmune disease.
Some idiopathic factors also contribute to liver cirrhosis.
Poor quality of life with increased risk of infection is basically responsible for the appearance of one of the most common complication of this disease identified as ascites. Hepatic encephalopathy and esophageal varices are other complications associated with cirrhosis. This chronic condition is generally irreversible and in advanced cases liver transplant is the only solution.
The term cirrhosis actually originated from a Greek word meaning diseased liver. René Laennec gave the term cirrhosis in 1819 while carrying out his work.
Liver is a very essential organ of human body as it carries out many critical functions out of which two are very important for example, it participates in the clotting of proteins in order to stop bleeding and it also aids in the removal of toxic materials like drugs that may be harmful for the human body.
It also partakes in regulating the regular supply of body fuels namely glucose and lipids. In order to perform these essential functions the liver cells must work properly and must be able establish a close connection with blood so that substances can be easily transported as well as removed from blood via liver. The relationship of liver with blood is a unique one. Arteries supply a very small amount of blood to the liver.
Major blood supply of liver actually comes from the intestinal veins as the blood returns to heart. The main vein that returns to heart from intestine is the portal vein. As this portal vein passes through liver it breaks up into smaller and smaller veins. The smallest veins are in close intimacy with the liver cells. This close relationship between the liver cells and the veins helps in addition as well as removal of materials from blood.
The liver cells also line up along the whole length of the sinusoids and when the blood passes through these sinusoids blood is collected in larger veins that collectively combine and form a larger single vain known as the hepatic vein that in turn finally returns to the heart.
In liver cirrhosis this intimate relationship between liver cells and blood is destroyed. The liver cells that survive or are newly formed may be able to add or remove substances to blood but their normal functioning is hampered so they no longer are able to maintain the close relationship with blood.
Formation of scars also hampers the regular blood flow from liver to the liver cells as result the pressure in the portal vein increases and the condition is known as portal hypertension. The second major problem caused by cirrhosis is disturbance in the relationship between the liver cells and the channels through which the bile flows. Bile is a fluid that is produced by the liver cells and it has two important functions for example, it helps in digestion as well as removal and elimination of toxic substances.
The bile produced by the liver cells is secreted into very tiny channels that run between the liver cells and also line the sinusoids known as canaliculi. These canaliculi empty into smaller ducts that open into larger ducts. Finally all these ducts open into a single duct that opens in the intestine. So in this way the bile entering the intestine aids in digestion.
At the same time the toxic substances present in the bile also enter intestine and are eliminated out from the body through feces. In cirrhosis, the canaliculi become abnormal and the relationship between the liver cells and these canaliculi is destroyed so the liver cells are not able to eliminate the toxic substance out from the body and they keep on accumulating inside the body. Digestion of food in the intestine is affected but on minor scale.
The symptoms of cirrhosis either develop due to the chronic liver disease or are the result of complications of cirrhosis. Many symptoms crop up which have no relation with cirrhosis. The chief symptoms include spider angiomata where vascular lesions develop that can be identified by a central arteriole surrounding many smaller vessels. This condition crops up because of higher secretion of estradiol.
Palmer erythrema is another symptom where altered sex hormone metabolism results in speckled mottling of palm. Changes in the nail structure also appear for example, Muehrcke’s lines identified by paired horizontal lines that are separated by normal color and this condition crops up due to hypoalbuminemia. Apart from this symptom the proximal two-thirds of the nail plates become white with one third portion red in color and this is also due to hypoalbuminemia.
This condition is known as Terry’s nails. Clubbing nails may also result where the angle between the nail plate and the proximal nail fold is greater than 180. Chronic proliferative periostitis of the long bones result in severe pain and the clinical condition is given the term hypertrophic osteoarthropathy. Dupuytren’s contracture can be characterized by thickening and shortening of the palmar facia resulting in the deformities of fingers.
This symptom is very common in 33% patients of liver cirrhosis. Benign proliferation of the tissue male of male breasts can also occur due to excessive secretion of estradiol known as gynecomastia and is common in 66% cases.
Hypogonadism characterized by impotence, infertility, loss of sexual drive and testicular atrophy may also occur due to suppression of the pituitary function. Liver may be enlarged, normal or shrunken.
Portal hypertension results in splenomegaly where the size of spleen is becomes very large than the normal. Accumulation of fluid in the peritoneal cavity results in the formation of ascites. In the portal hypertension the umbilical vein may be open and abnormality may result in a condition known as caput medusa.
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