CIRRHOSIS

irreversible change in the normal liver tissue that results in the degeneration of functioning liver cells and their replacement with fibrous connective tissue. Cirrhosis can have a number of causes; the term is applied whenever the end result is scarring of the liver. The most common type of cirrhosis is known as Lannec's cirrhosis. Its primary causes are excessive and chronic alcohol consumption and malnutrition. The relationship between alcohol and cirrhosis is unquestioned, but the mechanism of injury remains unknown. Besides cirrhosis, the affected person may show jaundice, pneumonia, inflammation of the pancreas, or delirium. There is usually an increase in liver fat with this disease during the early stages; later there is little fat and total degeneration of the liver. In the early stage, the disease can be stopped or reversed by abstention from alcohol consumption and an adequate diet. In this stage, the liver first enlarges; its outer capsule becomes smooth and stretched, and its colour is yellow because of fat droplets. Fibrous tissue and extra bile ducts may develop. In the next stage, the liver is still fatty, but the quantity of fibrous tissue has increased so that the liver is granular. The blood vessels thicken and their channels may become obliterated, which reduces blood flow in the organ. Some persons die at this stage from coma, jaundice, infection, high blood pressure, and hemorrhages. In the advanced stage, the liver shrinks and the surface usually has a roughened appearance. The normal structure of the internal tissue is lost; there is no longer fat but only nonfunctioning scar tissue. There are several other types of cirrhosis. Postnecrotic cirrhosis is the result of viral infection or of toxins such as carbon tetrachloride. Necrosisi.e., death of areas of tissuemay develop quickly in these cases, a few weeks to months as opposed to years in Lannec's disease. In pigmentary cirrhosis there is an increased amount of iron deposition in the liver cells because of a blood disorder, too much iron in the ducts, or an accumulation of iron from blood transfusions. The liver becomes granular and nodular, and its colour is dark brown. The iron particles may be so dense as to obscure the cell and its function. There is fibrosis and there are sometimes fatty changes. In Wilson's disease, a hereditary condition, there is excess copper in the liver. The liver usually turns green from bile in the tissue, and enlargement, fibrosis, fat changes, and abscesses occur when the disease is chronic. Syphilitic cirrhosis is indicated by large, soft lesions in the liver, which erode the tissue and eventually leave masses of scar tissue and fissures. The final complications of cirrhosis are usually the same. There may be high blood pressure in the portal vein that can lead to hemorrhages in the spleen, liver, esophagus, and intestines; or hepatic coma may develop, in which the imbalance in blood chemicals from malfunctioning of the liver affects the brain. Hepatic coma usually starts with drowsiness and confusion and culminates in loss of consciousness. Jaundice may complicate any stage of cirrhosis. Edemafluid retention in the tissuesand great abdominal swelling also are commonly seen.