Cirrhosis is end stage liver disease. There are many potential causes of liver damage and disease (e.g. viral infection, toxins/medications, infiltration, fluid congestion of the liver); however repeated damage to the liver will unfortunately lead to cirrhosis.

The repeated damage to the liver despite the cause, leads to both a loss of hepatocytes (at a rate that is faster than the regenerative or mitotic rate) and the laying down of extracellular fibrous scar tissue.  This scar tissue does not have the same properties nor function as hepatocytes, resulting in a firmer, less functional liver that causes resistance to blood flow.  This resistance, known as portal hypertension, is great enough that the the portal vein can not deliver blood, from the intestines and spleen, to the liver.  The result is a back up of the blood back into the spleen causing splenomegaly, and into the intestinal veins causing ascites.  This shift in fluid will have profound changes in blood composition (i.e. anemia, thrombocytopenia, and leukopenia) and fluid levels (i.e. hepatorenal syndrome).

This repeated damage to the liver will lead to an increased loss of hepatocytes.  As such, the liver can not perform its normal functions.  This manifests as changes in cognition, confusion (i.e. excess ammonia irritating brain), excessive bleeding (i.e. due poor clotting abilities), swelling in all body parts (i.e. edema due to low albumin and venous congestion), signs of malnutrition (i.e. low storage of minerals and vitamins), jaundice (i.e. impaired conjugation of bilirubin, resulting in hyperbilirubinemia, and reduced elimination of bilirubin through feces).

Liver damage and cirrhosis are diagnosed through a combination of blood tests that assess liver function, as well as ultrasound imaging. The definitive diagnosis is by liver biopsy.

There is no cure for cirrhosis, other than a liver transplant. However, the disease can be managed by addressing the prementioned manifestations and implementing pharmacological & lifestyle changes in order to reduce the demands on the liver.

Credits

Author:  Dr. Jennifer Kong (BCIT & UBC)

Author of questions and exercises: Yimei Qin & Andy Zhao (UBC Undergraduate students)

Gross anatomy video:  Dr. Jennifer Kong (BCIT & UBC)

Histopathology video:  Yimei Qin (UBC Undergraduate student) with supervision of Dr. Gang Wang (UBC, Director of DHPLC)

Sonographer:  Kenneth Marken (Diagnostic Sonography, BCIT)

Videoproducer:  Ian Whittlesey (BCIT)