Gettysburg Medical News
 The Clinical View
 by P.E. Hoffsten, MD
7 June 2006

WHAT IS CIRRHOSIS OF THE LIVER?

            The lady was 45 years old and as far as she knew was healthy.  She came to the clinic because her mother had recently passed away from a disease called primary biliary cirrhosis.  The patient wanted to know what cirrhosis was and whether there was a chance that she might also develop this disease.

            I began by explaining how vital the liver is.  It only weighs three pounds on average or about 2% of the body’s weight.   Yet it receives 30% of the blood pumped out of the heart.  By contrast, the kidneys get about 25% of the blood supply from the heart and the brain gets about 25%.  Thus while the brain, kidneys, and liver all together weigh about 7 pounds, they get 80% of the blood supply pumped out of the heart.  Most of the blood that goes to the liver has first been through the intestines and picked up food and other nutrients that the body needs. The blood from the intestines then flows through the liver where impurities and toxic products are removed while sugar, vitamins, and other valuable products are added to the blood.  It is this purification and waste removal process that makes the liver so vulnerable to damage.  The liver is kind of like the body’s bomb squad; it is an important but dangerous job if one takes in too much toxic stuff like Tylenol or alcohol.

            As an example, the liver removes Tylenol from the blood and chemically changes the Tylenol into a harmless waste product that is then excreted into the bowel and out in the stool.  But the livers ability to do this can be overwhelmed when the person takes too much Tylenol.  For most adults, the maximum dose of Tylenol is only about 3 grams per day which would be 6 Extra Strength Tylenol tablets.  More than this, especially if the person also uses alcohol, overwhelms the liver’s ability to deal with the Tylenol and the liver cells then die and so can the person.

            Many other products such as excessive use of alcohol or exposure to carbon tetrachloride or a host of other medications can cause enough liver damage to cause the condition of cirrhosis.  A relatively common cause of cirrhosis in our society is hepatitis B or hepatitis C.  In addition, there is a host of hereditary diseases that can cause cirrhosis of the liver.

            I explained to the patient that cirrhosis is a final common pathway for any one of 500 or more causes that destroy liver tissue and leave the liver as a scarred organ.  The root of the word cirrhosis means “hard”.  And that is absolutely what happens when a liver develops cirrhosis.  Normal liver feels very much like the sloppy, floppy, slices of liver that you buy at the grocery store.  A liver that has cirrhosis feels like chicken fried steak.  It is stiff and yellow because it has relatively little blood in it and that is what causes the real problem.

            When the liver becomes hard, the blood vessels that run through it are destroyed by scar tissue.  The quart and a half of blood that runs through the liver every minute can no longer go through the liver.  Instead it has to go around the liver through very large veins that develop in the esophagus and the back of the abdomen.  The esophageal veins are called esophageal varices and they very commonly bleed and are the cause of death in patients that have cirrhosis.  The lady commented that her mother had passed away when esophageal varices had lead to uncontrollable bleeding and her mother bleed to death.

            The lady then asked whether there was a chance that she could get cirrhosis like her mother had.  I told her that in patients with primary biliary cirrhosis there is a very weak link where female family members tend to have an increased frequency of this disease as compared to the general public but the link is so weak that there would be no predictable likelihood that this patient would develop primary biliary cirrhosis.  As a precaution, we did a set of liver function tests to see if the abnormality marking primary biliary cirrhosis was present. The test was normal.

            The patient was cautioned that excessive alcohol intake is a very common cause of cirrhosis of the liver.  Specifically, individuals drinking more than a third of a bottle of liquor per day or a quart of wine per day run a very high likelihood of developing cirrhosis of the liver.  Women tend to be more susceptible than men.  Usually the cirrhosis from alcohol occurs very slowly and then is found suddenly when the person’s esophagus veins rupture and they bleed a large amount in hurry.  There are a host of drugs that can cause chronic liver disease in individual patients even though they don’t cause that problem in every patient.  Monitoring the person’s medications on a periodic basis is an important step in insuring that medications the patient takes are not causing liver damage and potentially cirrhosis.

            The healthcare providers at your local clinics are well aware of the problems that patients with cirrhosis develop, how to diagnose them, treat them and help relieve the problems that come from cirrhosis of the liver.