According to the Centers for Disease Control and Prevention (CDC), there were 112,000 hospital cases in the U.S. in 2005 alone that had the diagnosis of either cirrhosis or chronic liver disease. In 2006, cirrhosis was responsible for 27,555 U.S. deaths. Lawrence Friedman, M.D., Professor of Medicine at the Harvard Medical School writes in "Current Medical Diagnosis & Treatment," that this makes cirrhosis the 12th most common cause of death in the United States.
Portal Hypertension
Portal hypertension is one of the most common characteristics of cirrhosis. As explained by Ramzi Cotran, M.D., Professor of Pathology at the Harvard Medical School in "Robbins Pathologic Basis of Disease," cirrhosis is the last stage of a damaged liver. There are fibrous scars and nodules, and a lot of fibrous tissue. All of this interferes with the normal structure of the liver. New blood vessels have been created, but these blood vessels cannot handle the normal amount of blood volume. Thus, the new blood vessels, fibrous scars, nodules and fibrous tissue all interfere with the normal flow of blood into and out of the liver. This leads to a backup of blood in the portal vein. The backed-up blood results in an increase of pressure within the portal vein and causes hypertension within that blood vessel. Blood from the spleen, through the splenic vein, normally drains into the portal vein. But portal hypertension can eventually cause the blood in the splenic vein to back up. This will lead to splenomegaly, or an enlarged spleen.
Jaundice
The normal lifespan of a red blood cell is 120 days. According to Elizabeth Corwin, Ph.D. in "Handbook of Pathophysiology," when the lifespan is over, the red blood cell disintegrates and some of its parts are recycled. Hemoglobin is a protein in the red blood cells that is used to carry oxygen. It is broken down and changed to a substance called bilirubin. Bilirubin is joined to a protein, called albumin, and sent to the liver. In a normal, healthy liver, the bilirubin would change once more, so the body could get rid of it through the bowel movements and urine. But in cirrhosis, the liver is too damaged to change the bilirubin. The bilirubin accumulates and causes what is referred to as jaundice. Symptoms of jaundice include a yellowish color to the skin and a yellow sclera of the eye--the sclera is normally white.
Hepatic Encephalopathy
Hepatic encephalopathy is the term used to describe abnormalities in the brain--encephalopathy--that are caused by cirrhosis; the word hepatic refers to the liver. One of the jobs of the liver is to detoxify waste products so they do not build up and become poisonous to the body. Stephen Herrine, M.D., Professor of Medicine at Thomas Jefferson University explains in "The Merck Manual for Healthcare Professionals," that the liver detoxifies ammonia, a product of the metabolism of protein. But in cirrhosis, it cannot detoxify the ammonia which then circulates through the bloodstream and enters the brain. The symptoms will include mental confusion, slurred speech, sleep abnormalities and memory problems. If untreated, it can lead to a coma.
References
- Centers for Disease Control and Prevention: Chronic Liver Disease or Cirrhosis
- "Handbook of Pathophysiology"; Elizabeth Corwin, MSN, Ph.D., FNP; 2000
- "Robbins Pathologic Basis of Disease"; Ramzi Cotran, M.D., Vinay Kumar, M.D., Stanley Robbins, M.D.; 1994
- The Merck Manual for Healthcare Professionals: Portal--Systemic Encephalopathy
