As we already know, the liver has a LOT of functions, and these functions are vital to our survival. One of the largest jobs of a healthy liver is to produce enzymes required to metabolize particles in our blood stream. The purpose of this is to either break down molecules to forms that can be eliminated from the body (such is the case with alcohol and many other drugs/medications), or to change their original form to something that can be utilized by the body (such is the case with proteins like albumin and clotting factors). The liver also has many other functions, however, the components of breaking down and building molecules are the two most important when it discussing cirrhosis.
Cirrhosis is what occurs after repeated injury to the liver which destroys the normal, functional liver cells and replaces it with non-functional fibrosis, nodules and scar tissue. There are many causes of ‘repeated injury to the liver,’ which include alcohol intoxication, hepatitis viruses, autoimmune diseases and many others. Alcohol is the second leading cause of cirrhosis in the United States (the #1 cause is Hepatitis C).
As the liver loses its functional capacity, physical symptoms soon emerge. Some of the more notable symptoms are described below.
- Jaundice – yellowing of the skin due to inability of liver to eliminate bilirubin from the blood stream
- Itching – due to inability of liver to eliminate bile acids from the blood (there are other causes as well)
- Bruising – due to inability of the liver to produce clotting factors
- Spider angioma – small bruises on the body, due to elevated levels of estrogen that the liver is unable to break down
- Confusion – due to inability of liver to break down and eliminate ammonia products from the blood
- Asterixis – flapping of the hands when outstretched, also due to excess ammonia products
- Varices – this is the biggest concern for doctors because it can lead to large amounts of blood loss in a short period of time. In cirrhosis, the liver becomes so scarred that even blood has a hard time passing through it, thus causing an increase of pressure in the vessels that travel to the liver. These vessels that are now carrying an increased pressure find a way to release it by either of two means: taking a different path in order to get around the liver, or by bursting open. Hence the concern.
The most important symptom that we will be talking about today is ascites. It is the progressive buildup of fluid in the abdominal cavity that may not be noticeable at first, but eventually leads to an accumulation so great that the abdomen becomes disproportionately larger than the rest of the body.
The cause of ascites can be difficult for some people to explain because it can be tricky and there is a bit of physics involved. However, the physics is simple if explained properly and the small fine details are easy to understand.
The fluid that enters the abdominal cavity gets there via two separate means that are both induced by cirrhosis.
- The cirrhotic liver loses the ability to produce proteins that are released into the blood stream and travel within the blood vessels of the body. These proteins in the blood cause a force on any fluid outside of the blood vessel to enter the vessel. Basically, the proteins act to pull fluid surrounding a blood vessel in to it. When the liver doesn’t produce these proteins, then you lose that pulling force as well.
- As we saw with varices, the liver becomes so scarred and fibrotic that the blood that normally passes through the liver freely can no longer do so. Thus, the blood vessels that travel to the liver become congested with blood that has nowhere to go. The increasing amount of blood within the vessels causes an increased pressure on its walls. Since the blood vessels have microscopic passages in the walls, the increased pressure causes the blood to leak out at a higher rate than normal
The fluid that leaks out of the blood vessels due to the elevation in pressure is not able to be reabsorbed because the liver is not producing the proteins that cause the pulling force on the fluid to reenter the blood vessels. This fluid accumulates in the abdominal cavity and becomes the physical sign/symptom of ascites.
This really only demonstrates a small fraction of how important the liver is to us. As I’ve seen with so many people before, many will disregard this subject because they don’t think it pertains to them. These are often the people at the greatest health risk. I have yet to learn how to get their attention.