liver and gallbladder disorders
Cirrhosis of the Liver
Introduction
Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The scar tissue develops when the liver is damaged repeatedly or continuously. Cirrhosis was once considered irreversible, but it now appears to be reversible in some cases. Chronic excessive , Symptoms, when they occur, include poor appetite, weight loss, fatigue, and a general feeling of illness. Many serious complications, such as accumulation of fluid within the abdomen ( Ascites ), The diagnosis is based on symptoms and results of a physical examination, blood tests, imaging studies, and sometimes a biopsy. Doctors treat complications, but the damage due to cirrhosis is usually permanent. People who have cirrhosis are at risk of liver cancer, so ultrasonography and, if needed, magnetic resonance imaging (MRI) or computed tomography (CT), and blood tests are done regularly to check for cancer. Cirrhosis is a common cause of death worldwide and was the 16th leading cause of death worldwide in 2019. Various disorders, medications, or toxins can damage the liver. If damage is sudden (acute) and limited, the liver commonly repairs itself by making new liver cells and attaching them to the web of connective tissue (internal structure) that is left when liver cells die. Repair and full recovery can occur if people can survive long enough. However, with repeated damage, the liver's attempts to replace and repair damaged tissue lead to scarring ( Fibrosis of the Liver ). The scar tissue performs no function. When fibrosis is widespread and severe, the scar tissue forms bands throughout the liver, destroying the liver’s internal structure and impairing the liver’s ability to regenerate itself and to function. Such severe scarring is called cirrhosis. Because Functions of the Liver is impaired, the liver is less able to Break down and remove medications, toxins, and waste products made in the body Process bile Produce proteins that help blood clot (clotting factors) Producealbumin(a protein that helps keep fluid from leaking out of blood vessels) The liver processes many medications, toxins, and body waste products. It breaks them down into substances that are less harmful and/or easier to remove from the body. The liver removes the substances by excreting them in bile, a greenish yellow digestive fluid produced by cells in the liver. When the liver is less able to process these substances, they accumulate in the bloodstream. As a result, the effects of many drugs and toxins, including sometimes serious side effects, are increased. Such side effects may develop even when people are taking a dose that they previously took with no ill effects. Medications may need to be stopped or used at lower doses and more cautiously. Some examples include opioids and some medications used to treat anxiety or insomnia. Bilirubin is an important body waste product that the liver processes and removes. If the liver cannot process bilirubin quickly enough, it builds up in the blood and is deposited in the skin. The result is Jaundice in Adults (a yellow coloring of the eyes and skin). Within the liver, the bile moves into small channels (bile ducts) that join to form larger ducts. These large ducts eventually leave the liver and connect to the gallbladder (which stores bile) or to the small intestine. Bile helps make fats easier to absorb in the intestine and carries toxins and waste products into the intestine so that they can be excreted in stool. When scar tissue blocks bile flow through the bile ducts, fats, including fat-soluble vitamins (A, D, E, and K), are not absorbed as well. In addition, fewer toxins and waste products are eliminated from the body. Normally, a large part of bile (bile salts) is reabsorbed into the bloodstream from the intestine and circulated back to the liver. The liver extracts the bile salts and reuses them. However, in cirrhosis, the liver cannot extract bile salts normally. As a result, the liver cannot produce as much bile, further interfering with digestion and elimination of toxins and waste products and the absorption of fats and fat-soluble vitamins. In addition to interfering with liver function, scar tissue also can block blood flow into the liver from the portal vein (which carries blood from the intestine to the liver). The blockage results in high blood pressure in the portal vein ( Portal Hypertension ). Portal hypertension leads to high blood pressure in the veins connected to the portal vein, including veins in the stomach, esophagus, spleen and rectum. As scarring progresses, the liver shrinks and becomes stiffer. Cirrhosis can cause the skin and eyes to turn yellow. 