Question

1. Explain how the structure of the liver is altered by cirrhosis. 2. At which stage or stages is alcoholic liver disease reversible and why? 3. State the rationale for each of the following manifestations of cirrhosis- excessive bleeding, ascites, jaundice, and weight loss. 4. Explain why a transplanted liver (portion) is able to grow and function but a cirrhotic liver cannot.

Answer 1

1. Explain how the structure of the liver is altered by cirrhosis.
Cirrhosis changes the structure of the liver and the blood vessels that nourish it. The disease reduces the liver's ability to manufacture proteins and process hormones, nutrients, medications, and poisons. Cirrhosis gets worse over time and can become potentially life threatening. In Cirrhosis, there is destruction of liver tissue. This leads to destruction of lobular organization and nodules leading to diffuse fibrosis. Initially, when liver cells regenerate hepatocytes, there are more nodules formed but these cause an obstruction to the vascular supply. Also diffuse fibrosis leads to back up of bile as well leading to increased portal hypertersion. This cause and enlarged liver initially, but as fibrosis progresses macronodular changes takes place making the liver shrink and become small size.

2. At which stage or stages is alcoholic liver disease reversible and why?
Alcoholic liver disease is the result of excessive alcohol consumption over a period of time. It is a severe and fatal consequence of alcohol abuse. Alcohol abuse over the years leads to the replacement of healthy liver tissue with scar tissue. Considered as one of the biggest reasons for acute liver damage, alcohol is not only life-threatening but can also cause liver failure. Excessive consumption of alcohol can result in scarring of the liver and can cause ALD (alcohol-related diseases).

Here are 3 main stages of ARLD, although there's often an overlap between each stage. These stages are explained below.

Alcoholic fatty liver disease
Drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fats in the liver. This is called alcoholic fatty liver disease, and is the first stage of ARLD. Fatty liver disease rarely causes any symptoms, but it's an important warning sign that you're drinking at a harmful level. Fatty liver disease is reversible. If you stop drinking alcohol for 2 weeks, your liver should return to normal.

Alcoholic hepatitis
Alcoholic hepatitis, which is unrelated to infectious hepatitis, is a potentially serious condition that can be caused by alcohol misuse over a longer period. When this develops, it may be the first time a person is aware they're damaging their liver through alcohol. Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking). The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking permanently. Severe alcoholic hepatitis, however, is a serious and life-threatening illness. Many people die from the condition each year in the UK, and some people only find out they have liver damage when their condition reaches this stage.

Cirrhosis
Cirrhosis is a stage of ARLD where the liver has become significantly scarred. Even at this stage, there may not be any obvious symptoms. It's generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy. A person who has alcohol-related cirrhosis and doesn't stop drinking has a less than 50% chance of living for at least 5 more years.