00:00
Hi!
Welcome to our video
series on liver diseas.
00:04
Now we're going to dive into
an introduction to cirrhosis.
00:07
Cirrhosis is a progressive
problem in your liver.
00:11
It's a late stage
of chronic disease.
00:14
So before we show you
what that looks like,
I want to remind you what
a healthy liver looks like.
00:19
So up on the screen,
we've got a healthy liver for you.
00:22
Now those parts should look familiar if
you've been in a rest of our video series.
00:26
You see there's the two lobes,
the right one that's a little
larger than the left one.
00:30
You see the falciform
ligament in the middle.
00:33
Now, let's look at the
healthy cells of this liver.
00:36
We zero in down, we're going to
take a look at just one lobule.
00:40
Now see what you can remember from our
other videos talking about the liver
what's going on
with this lobule,
well first of all,
it's shaped like a hexagon
and there are six units around
the outside called portal Triads.
00:54
They're called Triads
because there's three tubes
in each one of those
six portal Triad.
01:01
One green one, one red
one, and one blue one.
01:05
Now, we've colored them
that so you can see that one
brings arterial blood,
one carries venous blood,
and the green carries the bile.
01:14
Okay,
then up through the middle,
you've got that central vein that
will connect to the paddock veins.
01:20
So that's a healthy
functioning liver.
01:23
The tissue is orderly
at structured,
blood can flow
freely through there.
01:28
Inside that lobular our cords
of cells called hepatocytes
are also surrounded by sinusoids
which are really special type
of capillary in the liver.
01:36
So the venous and arterial
blood mixed in those sinusoids
and they move
through that lobule.
01:43
So you end up having it feet
up through the central vein
back out through
the liver again.
01:48
Okay, so that's a healthy liver.
01:50
The reason we're talking
about this is because
unimpeded flow is critically important
in your liver functioning well.
01:58
In somebody that has cirrhosis,
they've got this scarring and
fibrosis a real thickening
of the cells inside the liver
that's after years of
chronic liver disease.
02:10
So you've got the normal liver.
02:12
Now, we're going to show you
one that's kind of struggling
that's experienced the signs
and symptoms of cirrhosis.
02:18
You'll notice that
the cells are just not
as organized as they once were.
02:23
It's hard for the blood to
flow through these areas
because that tissue is
now not as organized
and clean as it once was.
02:33
Now the very end
stage of cirrhosis
also put your patient
at an increased risk
for liver cancer
or hepatocellular carcinoma.
02:43
Okay, so we started
with a normal liver.
02:46
We showed you kind of what it
looks like with a cirrhotic liver.
02:49
You can tell just from
looking at our picture
that this liver is going to struggle
and it's going to have problems
with all of the processes
that the liver is involved in.
02:58
Now the last picture is tragic.
03:00
That is end-stage
cirrhosis or liver failure
and you're going to
have liver cancer.
03:06
Now this is not a quick process,
but sadly if the patient
doesn't have lifestyle changes
or get intervention,
they can end up
with liver failure.
03:16
So let's dig into how
that cirrhosis happens.
03:19
On the left, you see healthy liver
tissue with a little bit of a cutaway.
03:24
On the right,
look at the difference.
03:27
We just wanted to
give you a visual
of why it's so difficult
for the blood to make it through a
liver that's experienced cirrhosis
because see when there's significant
destruction of the liver cells
when they've taken a hit more explain
why they do but when they've taken a hit
from different processes in the
body, and now they are destroyed
when it tries to regenerate
those and repair itself,
but damaged cells
are not replaced
with the same tissue
that the liver came with.
03:56
Its this fibrotic tissue and you end
up with this fibrosis and scarring
or what we call cirrhosis.
04:03
All right, so we talked about how
in the beginning of a healthy liver
then you have chronic liver
disease and you develop cirrhosis
and at the end you had that
end-stage liver disease,
probably liver failure and
possibly even liver cancer.
04:18
Here, we've shown
you a healthy liver.
04:21
So it's pretty easy to see how
blood flows freely through that
and when you compare it
to the cirrhotic liver
or the liver with cirrhosis,
you can see why be so difficult
for blood to go through there.
04:34
So we are going to
have some issues
the pressure inside that long is
going to cost things to back up
through the entire
portal system.
04:44
Now as we talked about when the
liver tries to regenerate itself,
newer isn't always better.
04:49
So in the liver try said do that
after its experience damage,
then the cells just
aren't as well organized,
their abnormal blood vessels
and bile duct structures,
they don't flow freely,
and it's this kind of of
growth after the destruction
that makes these
distorted lobules,
and you have some level
of obstructed blood flow,
now depending on how far
advanced the cirrhosis is,
at first,
it might not be that noticeable
but as a cirrhosis and the damage
and the scarring progresses,
it will become very noticeable
in your patients symptoms.
05:21
So that's a concept we want
you to have laid down first
the difference between
a healthy liver
and the liver that
suffered from cirrhosis.
05:29
But cirrhosis is progressive.
05:32
It happens over
a period of time.
05:34
So earlier in the disease
but liver enzymes
might be normal,
so we would have a
normal AST or an ALT
because the body is
able to compensate
for the changes in the liver.
05:46
But if the liver
continues to be injured,
cirrhosis becomes worse and can
even become life-threatening.
05:53
Late in the disease,
look at that liver.
05:56
It's shrunken, it's hard and
it's very very low functioning.
06:00
I remember it's a super filter.
06:02
So in order to be
a super filter,
blood has to easily flow through those
lobules and all those structures.
06:09
A really cirrhotic liver has
regenerated not as organized,
the supplies are all changed
in a little bit distorted,
and that's why it makes it so
difficult for blood to go through.