Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Cirrhosis is a complication of many liver diseases that
is characterized by abnormal structure and function of the liver. The diseases
that lead to cirrhosis do so because they injure and kill liver cells, and the
inflammation and repair that is associated with the dying liver cells causes
scar tissue to form. The liver cells that do not die multiply in an attempt to
replace the cells that have died. This results in clusters of newly-formed liver
cells (regenerative nodules) within the scar tissue. There are many causes of
cirrhosis; they include chemicals (such as alcohol, fat, and certain
medications), viruses, toxic metals
(such as iron and copper that accumulate in
the liver as a result of genetic diseases), and autoimmuneliver disease in
which the body's immune system attacks the liver.
The liver is an important organ in the body. It performs
many critical functions, two of which are producing substances required by the
body, for example, clotting proteins that are necessary in order for blood to clot, and
removing toxic substances that can be harmful to the body, for example, drugs.
The liver also has an important role in regulating the supply to the body of
glucose (sugar) and lipids (fat) that the body uses as fuel. In order to perform
these critical functions, the liver cells must be working normally, and they
must have an intimate relationship with the blood since the substances that are
added or removed by the liver are transported to and from the liver by the
blood.
The relationship of the liver to the blood is unique.
Unlike most organs in the body, only a small amount of blood is supplied to the
liver by arteries. Most of the liver's supply of blood comes from the intestinal
veins as the blood returns to the heart. The main vein that returns blood from the intestines is called the
portal vein. As the portal vein passes through the liver, it breaks up into
increasingly smaller and smaller veins. The tiniest veins (called sinusoids
because of their unique structure) are in close contact with the liver cells. In
fact, the liver cells line up along the length of the sinusoids. This close
relationship between the liver cells and blood from the portal vein allows the
liver cells to remove and add substances to the blood. Once the blood has passed
through the sinusoids, it is collected in increasingly larger and larger veins
that ultimately form a single vein, the hepatic vein that returns the blood to
the heart.
In cirrhosis, the relationship between blood and liver
cells is destroyed. Even though the liver cells that survive or are newly-formed
may be able to produce and remove substances from the blood, they do not have
the normal, intimate relationship with the blood, and this interferes with the
liver cells' ability to add or remove substances from the blood. In addition,
the scarring within the cirrhotic liver obstructs the flow of blood through the
liver and to the liver cells. As a result of the obstruction to the flow of
blood through the liver, blood "backs-up" in the portal vein, and the pressure
in the portal vein increases, a condition called portal hypertension. Because of
the obstruction to flow and high pressures in the portal vein, blood in the
portal vein seeks other veins in which to return to the heart, veins with lower
pressures that bypass
the liver. Unfortunately, the liver is unable to add or remove substances from
blood that bypasses it. It is a combination of reduced numbers of liver cells,
loss of the normal contact between blood passing through the liver and the liver
cells, and blood bypassing the liver that leads to many of the manifestations of
cirrhosis.
A second reason for the problems caused by cirrhosis is the disturbed
relationship between the liver cells and the channels through which bile flows. Bile is a
fluid produced by liver cells that has two important functions: to aid in
digestion and to remove and eliminate toxic substances from the body. The bile
that is produced by liver cells is secreted into very tiny channels that run
between the liver cells that line the sinusoids, called canaliculi. The
canaliculi empty into small ducts which then join together to form larger and
larger ducts. Ultimately, all of the ducts combine into one duct that enters the
small intestine. In
this way, bile gets to the intestine where it can help with the digestion of
food. At the same time, toxic substances contained in the bile
enter the intestine and then are eliminated in the stool. In cirrhosis, the
canaliculi are abnormal and the relationship between liver cells and canaliculi
is destroyed, just like the relationship between the liver cells and blood in
the sinusoids. As a result, the liver is not able to eliminate toxic substances
normally, and they can accumulate in the body. To a minor extent, digestion in
the intestine also is reduced.
Cirrhosis of The Liver - SymptomsQuestion: The symptoms of cirrhosis of the liver can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Individuals with cirrhosis may have few or no symptoms and signs of liver
disease. Some of the symptoms may be nonspecific, that is, they don't suggest
that the liver is their cause. Some of the more common symptoms and signs of
cirrhosis include:
Yellowing of the skin (jaundice) due to the accumulation of bilirubin in
the blood
Fatigue
Weakness
Loss of appetite
Itching
Easy bruising from decreased production of blood clotting factors by the
diseased liver.
Individuals with cirrhosis also develop symptoms and signs from the
complications of cirrhosis.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients
Hyponatremia is a condition where the level of sodium in the blood is low. Causes of hyponatremia can occur from excess fluid in the body, or a loss of
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include
The spleen enlarges if it is asked to do excessive work in filtering or manufacturing blood cells, if there is abnormal blood flow to it, or if it is invaded
Thrombocytopenia refers to a decreased number of platelets in the blood. There are many causes of thrombocytopenia such as decreased platelet production
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle
Gynecomastia, an enlargement of the gland tissue in the male breast is the caused by an imbalance of hormones. Certain medical conditions may also lead
Cystic fibrosis is a disease of the mucus and sweat glands. Cystic fibrosis is an inherited disease. The outcome of the disease leaves the body malnourished,
The hepatitis B virus (HBV, hep B) is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined
Pleurisy, an inflammation of the lining around the lungs, is associated with sharp chest pain upon breathing in. Cough, chest tenderness, and shortness
Pleural effusion is an excess fluid between the two membranes that envelop the lungs. There are two classifications of causes of pleural effusion; transudate
Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver disease ranging from simple fatty liver (steatosis), to nonalcoholic steatohepatitis
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins
Primary Biliary Cirrhosis is a chronic disease characterized by progressive inflammation and destruction of small bile ducts within the liver. The bile
Portal hypertension is most commonly caused by cirrhosis, a disease in which results from scarring of a liver injury. Other causes of portal hypertension
Primary sclerosing cholangitis (PSC) is a chronic, progressive disease of the bile ducts that channel bile from the liver into the intestines. There is
Alpha-1 antitrypsin deficiency is an inherited disorder that may cause liver and lung disease in adults. Signs and symptoms include shortness of breath,
