By Group#5: Kate Bratcher, Tamara Campbell, Tim Pittman and
What is the liver?
The largest organ in the abdomen.
It is comprised of four lobes, two major blood vessels,
It is the only human organ capable of regenerating
What are the functions of the liver?
There are three main
functions of the liver:
Formation of lymph
most medicines and
In carbohydrate metabolism: Gluconeogenesis,
Glycogenolysis, Glycogenesis, the breakdown of
insulin and other hormones
In protein metabolism: Deamination and
transamination of amino acids, removal of
ammonia by synthesis of urea, synthesis of non-
essential amino acids, synthesis of plasma
proteins, and synthesis of coagulation factors I,
III, V, VII, IX, and XI
2)Metabolic functions cont’d
In lipid metabolism: Cholesterol synthesis,
production of triglycerides, oxidizing
triglycerides to produce energy
In other areas: In the first trimester fetus,
the liver produces red blood cells and by
week forty-two of gestation, the bone
marrow does this task
3)Secretory and excretory functions
Produces and excretes bile for food
Stores glycogen, vitamin B12, iron, and
Only cells with the enzyme needed to
convert glucose-6-phosphate to glucose
which enters the blood stream
Now, let’s define liver cirrhosis!
What is Cirrhosis? Cirrhosis occurs
because of damage to liver cells
Damaged and dead liver cells are then replaced
by fibrous tissue which leads to scarring
This scaring causes liver cells to regenerate in
an abnormal pattern which will lead to
decreased blood flow to and through the liver.
It will also led to blood back up in the portal
The serious and sometimes deadly
complications of cirrhosis are because of
the decreased blood flow to the liver and
blood back up in the portal veins
Now, because of blood back up and cirrhosis,
you have an increase of pressure in the liver.
This pressure causes blood to flow backwards.
This can lead to varicose veins in the stomach
and esophagus and rectum (hemorrhoids).
Gastric and esophageal varicose veins can
rupture, bleed massively and sometimes cause
Hypertension in the liver can also lead to
accumulation of fluid in the abdomen (ascites)
and the peripheral tissue (peripheral edema).
Like we learned before, the liver cells are called
hepatocytes and they secrete bilirubin
In cirrhosis, you have a decrease in bilirubin
secretion which leads to backup of bilirubin in
This back up in the blood is what gives us
jaundice, the yellow discoloration of the skin and
Bilirubin can also spill into the urine giving it a
bright yellow to dark brown color.
Cirrhosis can cause abnormalities
in many organ systems
Brain-slowed function, eventually coma
immune system dysfunction- causing an
increased risk of infection
Ascites, fluid in the abdomen, often becomes
infected with bacteria normally present in the
Cirrhosis of the liver can also
cause abnormalities in organ
Kidney dysfunction- hepatorenal syndrome
Hepatorenal syndrome is almost always fatal
unless liver transplantation is performed
Causes of Cirrhosis
Alcoholic Liver Disease
Hepatitis C and B
Chronic Autoimmune Hepatitis
Inherited Metabolic Diseases
Primary Biliary Cirrhosis
Alcoholic Liver Disease (ALD)
Usually develops after
decades of heavy
Most common form of
cirrhosis in U.S.
The more you drink
the greater the risk of
Hepatitis C and B
Second major cause of cirrhosis and
chronic liver disease in the United States.
Causes inflammation along with low grade
damage that after several decades leads
Hepatitis B is the most common worldwide
and acts on the liver in the same way.
Chronic Autoimmune Hepatitis
Condition in which the person’s own
immune system attacks the liver causing
inflammation and liver cell death.
Symptoms include jaundice, fever, and
sometimes hepatic dysfunction.
Serum protein electrophoresis and
detection of auto antibodies can help
diagnose autoimmune hepatitis.
Inherited Metabolic Disease
Hemocromatosis is a genetic disease can alter
the body’s ability to regulate iron absorption.
A faulty mechanism causes the body to absorb
too much iron and over time the excess is
deposited into the liver causing cirrhosis.
The gene that causes hemochromatosis was
identified on Chromosome 6 in 1996.
Primary Biliary Cirrhosis
Classified as a chronic bile duct disease, it
causes slow destruction of the bile ducts.
Bile then builds up in the liver which can lead to
cirrhosis and even complete liver failure.
The cause is unknown but may be related to
immune system problems.
Ursodiol may be beneficial but it does not cure
the disease, a liver transplant may be necessary.
Inflammation due to accumulation of fat in the
Many times patients do not know they have
NASH because it has no symptoms, and there is
no specific treatment.
Losing weight along with maintaining control of
diabetes and elevated lipid levels are essential.
Low fat diet and avoiding alcohol completely
are also recommended.
Other causes of Cirrhosis
Wilson’s Disease is a genetic disorder that
causes excessive copper accumulation in the
Glycogen storage diseases can interfere with the
way the liver produces and stores enzymes and
proteins the body needs to function properly.
Long term exposure to environmental toxins and
severe reactions to prescription drugs.
Schistosomiasis is a disease caused by parasitic
worms, not found in the United States but
infects about two million people worldwide.
Prevention, Treatment, and
Ethical Issues of Cirrhosis
Presented by Kate Bratcher and
Main Causes of Cirrhosis in Need of
5% of the people in the U.S. are alcoholics
10-25% of those people will develop liver cirrhosis
Women develop cirrhosis at lower alcohol
levels than men
Viral Diseases – Hepatitis B and C
Prevention of Cirrhosis
Consume alcohol in moderation
How many drinks is considered ―moderate?‖
1-2 drinks maximum per day
Vaccination against Hepatitis B
Vaccine is safe and inexpensive
Extremely important for at risk groups:
Health care professionals, intravenous drug users,
Persons traveling to 3rd world countries, homosexuals
Common Symptoms of Cirrhosis
Yellow skin or eyes
Fluid in abdomen
Swelling of the legs, feet, and back
Fatigue and weakness Small, red spider-like
Loss of appetite vessels
Weight loss and Decreased urine
Whole body itching Pale or clay colored
Mental confusion Vomiting blood (portal
Redness of the palms hypertension)
of the hands Nosebleeds
Life style changes
Treat addiction, join AA
treat disorders of the brain
Treat excess abdominal
fluid, reduce sodium,
protein, Vitamin A
Bleeding or enlarged veins
Antibiotics– for treatment of infected ascites (called peritonitis);
treatment typically lasts 10 days and you may need to be
hospitalized if intravenous antibiotics are required.
Beta-blockers -- typically propranolol or nadolol, reduce the heart
rate and can lower the pressure in veins going to the liver. This
helps to reduce the likelihood of bleeding from these veins (called
Diuretics—usually spironolactone and furosemide help to reduce
Lactulose—reduces toxic levels of ammonia that cause hepatic
encephalopathy, which can result in disturbances in consciousness
or deep coma.
Somatostatin (a natural hormone) and similar (synthetic) agents,
as well as vasocontrictors – prevent bleeding from varices by
causing blood vessels to narrow
What happens when medicine
New liver is put in place and attached to the patient's blood
vessels and bile ducts. The operation can take up to 12 hours
Once registered with UNOS (United Network for Organ
Sharing), the wait time is 12-48 months depending on
severity of problem
Expensive procedure, health insurance needed
Liver Transplant Costs
Monetary Cost in
1996 – (Insurance
typically pays only
1st year: $314,500
Annual follow up
Medications for anti-
Important Sources for Treatment and
Abittan CS, Lieber CS. Alcoholic liver disease. Curr Treat
Options Gastroenterol. 1999;2(1):72-80.
Agency for Healthcare Research and Quality. Milk thistle:
effects on liver disease and cirrhosis and clinical adverse
effects. Summary, evidence report/technology
assessment: number 21, September 2000. Accessed at:
American Liver Foundation. Cirrhosis: Many Causes.
Accessed at http://www.liverfoundation.org
American Liver Foundation. Diet and your liver. Accessed
Ethical and Moral Issues
Alcohol is ―cash crop‖
Should alcoholics be denied
liver transplants due to their
Should patients with genetic
diseases receive organs before
patients with self-induced
Should insurance companies
pay for excessive alcohol
subsidize alcohol treatment
facilities and programs?