Liver Cirrhosis: Overview (Nursing)

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.