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CIRRHOSIS OF THE LIVER: LIVER HARDENING
Its Varieties, Causes, Symptoms and Treatment
While alcohol is a principal cause of Cirrhosis the disease may attack others than chronic alcoholics and other organs than the liver. The nature of the degeneration of tissue that occurs is explained here, the course of the disease traced and its possible consequences are indicated.
Cirrhosis is a form of degeneration of internal oryans characterised by the appearance therein of strands of fibrous tissue, which by their presence and subsequent contraction interfere very seriously with the function of the organ affected. It is met with in various organs as the result of inflammation or irritation. When the word cirrhosis is used rather than fibrosis, cirrhosis of the liver is usually meant. On the other hand it is more usual to speak of fibrosis of the lung or panereas or other internal organ.
Cirrhosis of the liver is met with in several forms, and various classifications have been used in describing these. There is no very aharp line of demarcation however, between the different types, and the features of one are found in greater or lesser degree in all. In spite of this similarity the following types are sufficiently clear-cut to be recognized as separato entities: multilobular cirrhosis, syphilitic cirrhosis, and hypertrophic cirrhosis (Hanot's biliary type).
 
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Multilobular, portal or atrophic cirrhosis is the most common form. The liver may be enlarged by excess of fat- the so-called beer drinker's liver; or shrunken and irregular, the hob-nail or gin-drinker's liver. In both these forms there is an extensive fibrosis of the organ and the liver tissue is split up into islands af compressed and degenerating cells by the contraction of the new fibrous strand, that has made their appearance throughout its bulk, as the alternative names suggest, considerable importance has been assigned to the role of alcohol in the production of this disease; probably this blame is not wholly deserved, for cases are sometimes seen in those who have never taken alcohol in any form. Poisoning of the liver cells by the toxins of disease, or by products from the bowel, probably play an important part. The fact remains, however, that alcohol is responsible in the vast majority of cases. Children appear peculiarly sensitive in this respect, and severe cirrhosis sometimes occurs from giving small doses of alcohol for medicinal reasons, or even from the minute quantities found in alcoholic tinctures of drugs.
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CIRRHOSIS: NORMAL AND CIRRHOTIC LIVER
Left upper surface of a healthy liver, with which may be contrasted the same view of a cirrhotic liver (right). The latter is diminished in size, and its surface is studded with knobs to which appearance is due the popular name of hob-nail liver.
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Venous blood from the alimentary tract and the spleen passes through the portal vein into the liver. Cirrhosis of the liver obstructs this fiow, causing passive congestion of the organs drained by the portal vein.
Portal cirrhosis produces many effects upon the body; these are in part mechanical an in part chemical; through the liver passes a the blood from the abdominal organs, carrying with it the products of digestion in the stomach and bowel; some of these are harmless, others are unsuitable for admission to the general circulation and are normally destroyed by the liver cells. In a condtion of cirrhosis the blood flow through the liver is obstructed and damming back occurs in the portal vein at the same time the strangling effect of the fibrous tissue impairs the efficiency of the liver cells, and poisons which should normally be destroyed are able to pass unchanged into the general blood stream, and give rise to serious symptoms of ill health.
As a consequence of obstruction to the portal blood stream, venous stagnation take place in the vessels of the abdominal organs, with effects varying according to its severity. Some engorgement and enlargement of the spleen is common; oedematous swelling of the wall of the stomach and bowel, with consequent impairment of digeetion and movement, is another result: dilatation of the veins and enlargement of the channels by which the internal abdominal vessels communicate with the external veins occur, and from these dilated veins bleeding_ is very liable to take place; from the engorged vessels or from the unhealthy lining of the abdominal cavity fluid poured out may cause ascites, giving serious complication.
Serious Consequences of Liver Degeneration
The general symptoms of cirrhosis include digestive disturbances, loss of appetite, pain after food, vomiting, diarrhoea, or irregularity of the bowels; wasting and depression of vitality, resulting very often in infection with tuberculosis. Many patients with cirrhotic livers die of pulmonary tubercle and in failure to resist acute illnesses such as pneumonia: some degree of fever, irregular and inconstant and due to the presence in the circutation of poisons that the hamperd Liver has failed to remove; jaundice varying in degree from a slight yellow tinting of the whites of the eyes to a deep yellow coloration of the whole body, or, in cases of long standing, an olive green appearance; slight oedema of the shins - a sign that is rarely absent even in the early stages of the disease.
When the condition is well established haemorrhage from the bowel or from the stomach is not uncommon; it may come merely from piles, which are a very usual accompaniment of cirrhosis, or from enlared veins at the junction of the stomach and the oesophagus, and may be of fatal quantity if hemorrhaged. Ascites is an almost constant feature of advanced cases of portal cirrhosis; its occurrence is a bad sign.
There are two sources for the ascitic fluid: soakage through the distended and unhealthy veins, and inflammatory irritation of the peritoneal lining of the abdominal eavity. Ascites is sometimes of surprising quantity: it is by no means unusual for it to approach two gallons. Its mechanical effect is considerable: by its mere bulk it can interfere to a dangerous extent with the action of the heart and with the movements of respiration. Generally it has to be removed by drainage through a hollow needle or trocar and cannula thrust through the abdominal wall. Unfortunately the fluid generally re-accumulates and fresh tappings have to be performed.
No treatment will restore the liver to healthy conlition but, in alcoholic cases which have not yet developed ascites, if alcohol is permanently given up there is a good chance that symptoms will abate and the disease will not progress.
Diet should be almost entirely of dairy produce, fruit and vegetables, and the bowels kept active with small doses of aperients.
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