Alcoholism is not the only cause of damage to liver

On Call

July 23, 1996|By Dr. Simeon Margolis | Dr. Simeon Margolis,SPECIAL TO THE SUN

I thought cirrhosis of the liver was caused by alcoholism, but a close business associate developed cirrhosis even though he doesn't drink. Why would cirrhosis make it necessary for my friend to stop working at age 46?

Cirrhosis is initiated by the death of liver cells with the subsequent build-up of fibrous scar tissue that interferes with the blood flow through the liver.

Alcoholism is the most common cause of cirrhosis in the United States, but only 15 percent to 20 percent of chronic alcoholics develop the disorder, and many other causes of liver cell damage can result in cirrhosis. Infection with hepatitis B, and especially hepatitis C, viruses are among these. Cirrhosis also can develop from exposure to toxic chemicals or the use of certain medications.

Inherited diseases that cause cirrhosis include excessive liver accumulation of iron (hemochromatosis), copper (Wilson's disease) and glycogen (glycogen storage disease). Glycogen is the starch-like form of stored carbohydrate energy in the liver. Yet another inherited cause is a deficiency of alpha-antitrypsin, a protein that protects the liver (and lungs) from the ravages of a powerful digestive enzyme normally found in tissues.

Injury to and destruction of the ducts that drain bile from the liver into the gall bladder is the abnormality in primary biliary cirrhosis, which is much more common in women than men and is likely an autoimmune disorder.

Cirrhosis can produce a large number of health problems including generalized weakness, chronic fatigue, poor appetite, weight loss and loss of sex drive. Patients with cirrhosis develop jaundice, tend to bleed easily and lose muscle mass.

The most troublesome and dangerous complications of cirrhosis result from the increased pressure within the portal vein (portal hypertension), which carries blood from the intestines through the liver. Portal hypertension, present in about 60 percent of patients with cirrhosis, leads to an enlargement of veins that serve as alternate routes for the blood. The most dreadful result is esophageal varices (large, grape-like clusters of thin veins within the lower esophagus), which can rupture and lead to massive bleeding.

A second major consequence of massive, alternative route blood flow to the portal vein is the shunting of blood around liver cells. Toxic substances build up, particularly ammonia, and alter the function of brain cells. The result is hepatic encephalopathy with symptoms of lethargy, confusion and even coma. Other complications of portal hypertension include hemorrhoids, ascites, (accumulation of large amounts of fluid within the abdominal cavity), bleeding and anemia. Cirrhosis also is associated with an increased rate of liver cell cancer.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

Pub Date: 7/23/96

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