Cirrhosis...The Final Days.

   In our last post we described the battle being fought by the liver for survival in the face of continuous heavy drinking by an individual. After using up the limited supply of enzyme to break down alcohol, the liver resorts to tucking the alcohol into little Baggies called vacuoles within itself in a delaying action. Unfortunately, with continued drinking, even when the liver "catches up" and breaks down the stored alcohol, zipping up the Baggie leaves a tiny line of scar tissue. After years of creating and zipping up these Baggies the liver is rendered a shriveled knot of pale scar tissue which cannot function, even if it could receive blood. However, as we shall see here, the blood supply issue becomes the final battle. When the liver loses that battle for life, so does the individual.

   A healthy liver is like a healthy city. In a healthy city, traffic moves into and out of the city. It flows smoothly and rapidly. Imagine this liver-city with two major freeways entering from above and below. The one from the intestines with its blood loaded with nutrients brings in all the raw materials the liver uses in its various manufacturing plant to create just about everything the rest of the body needs to survive: the blood itself, complex proteins to build and repair cells, and, most important to this story, what physicians term "clotting factors." Clotting factors are a complicated range of cells and organic chemicals that basically plug up any holes that appear in the body.

   The big freeway coming from the north, the hepatic artery, delivers a steady stream from the heart and lungs. Here is the good clean oxygen-laden blood to stoke the furnaces of the plants doing the manufacturing throughout the liver. This blood is under high pressure, having just left the muscular chamber of the left ventricle of the heart, and has been cleansed of waste gases like carbon dioxide and metabolic wastes that accumulated during the last pass the blood took through the body.

   In a cirrhotic liver, both major freeways are constantly backed up with traffic, because the fatty tissue and scarring has blocked vessels throughout the liver...not only the major highways themselves, but even the thousands of smaller highways and short-cuts the liver has been using for years trying to keep itself working.

   So how does this all result in the symptoms of cirrhosis? Let's just focus here on those two freeways. Blood carrying only partially digested nutrients from the intestines is forced into the general circulation without the benefit of the liver's detoxification system. This material is called bilirubin. It is in some respects like liquid fecal material. Bilirubin itself is a red pigment that is left over after red blood cells are destroyed.

   This material being pumped throughout the bloodstream doesn't make your body feel very good. For example, when it is pumped through the brain, the patient becomes very tired and very grumpy. VERY grumpy. Also, bilirubin is what makes the skin appear bright yellow. This is jaundice. I saw a patient once who was as bright a yellow as a school bus during a training session in internal medicine my company sponsored at Hahnaman General Hospital in Philadelphia.

   Moving now to the other freeway, the nearest vessels available for the backup of the hepatic artery are those lining the esophagus. When all of that blood that should be going into the liver backs up into the small vessels lining the esophagus the pressure gets so great that they start to rupture. This causes what the medical professions terms esophageal varices. This is when the medical profession is faced with a losing battle, and some really tough decisions.

   Remember those clotting factors normally made by the liver? They are needed now more than ever. The first rupture of a good-sized vessel relieves the high blood pressure and creates another problem...a sudden DROP in blood pressure. Right away physicians start looking to find the biggest holes and pumping in units of blood from the hospital blood bank. In the back of their minds they know that every unit of this precious blood is going to be flushed quickly out through some holes somewhere. The most common place is through the bowel. Most people donnot reralize how much blood there is in a human being. This can end up all over everything!

   At some point the physician is faced with alcoholism's ultimate bad choice: either continue keeping this person alive using other peoples' donated blood, or stop the whole process and allow the patient to bleed out and die. Almost every hospital runs with a shortage of blood, but teaching hospitals, cancer centers, and most government-operated hospitals are just ALWAY in a panic for more blood. The family is right down the hall, and asking questions almost constantly. There are no good choices.

   As I ended my last post; being associated in any way with death due to alcoholism is not for the faint of heart.

   In Al-Anon one of our "Do's" is to "...learn the facts about alcoholism." You can help others do just that by passing this post to program friends, treatment centers, health-care professionals, or anybody whom it might help. Most professionals say that cirrhosis can start as early as after only ten years of drinking!

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cirrhosis
written by screen, September 14, 2008

Nice posts, (ALD). Alcoholic cirrhosis generally develops in most of the people who drink heavily for more than a decade, I think Government should take initiative to organize awareness among people about this which can save many lives.

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