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PRINTED BY: [email protected] Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher's prior permission. Violators will be prosecuted. leading cause if death in the United States, killing about 26,000 people each year. Alcoholic cirrhosis, the most common type of cirrhosis, is described in detail. This disease is also called portal, Laennec, or fatty nutritional cirrhosis (an accumulation of fat often develops within the liver). The exact effect of excessive alcohol on the liver is not known, but it may be related to the malnutrition that frequently accompanies chronic alcoholism, or the alcohol itself may be toxic. In the normal liver, there is a highly organized arrangement of cells, blood vessels, and bile ducts. A cirrhotic liver loses this organization and, as a result, the liver cannot function. Liver cells die and are replaced by fibrous connective tissue and scar tissue. This tissue has none of the liver cell functions. At first, the liver is generally enlarged due to regeneration but then becomes smaller as the fibrous connective tissue contracts. The surface acquires a nodular appearance. This is sometimes called a “hobnailed” liver. In cirrhosis, circulation through the liver is impaired. As a result, high pressure builds in vessels of the abdomen and in other areas. The esophageal veins swell, forming esophageal varices. Abdominal organs like the spleen, pancreas, and stomach also swell. These organs and vessels may hemorrhage, causing hemorrhagic shock. Hemorrhage of vessels in the stomach or intestines may cause vomiting of blood, hematemesis . A characteristic symptom of cirrhosis is distention of the abdomen caused by the accumulation of fluid in the peritoneal cavity. This fluid is called ascites and develops as a result of liver failure. The pressure within the obstructed veins forces plasma into the abdominal cavity. This fluid often has to be drained. When the liver fails to produce adequate amounts of albumin, an albumin deficiency, hypoalbuminemia , develops and fluid leaks out of the blood vessels, causing edema. Because the necrotic cells of the cirrhotic patient fail to produce albumin, ascitic fluid develops, as does edema, particularly in the ankles and legs. Blockage of the bile ducts, like that of the blood vessels, follows the disorganization of the liver. Bile accumulates in the blood, leading to jaundice and, because bile is not secreted into the duodenum, stools are clay colored. The excess of bile, carried by the blood to the kidneys, imparts a dark color to urine. Prevention PLUS! Know Your Viruses The more you know about how a virus is transmitted, the better prepared you can be to prevent infection. Hepatitis A is transmitted primarily through contaminated food and water. Workers in the food-service industry must use sanitary procedures when handling food, including the simple task of washing their hands. You can protect yourself at home by thoroughly cooking meat and seafood. Hepatitis B and C are transmitted through blood transfusions, contaminated
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