5-15
Some of the signs the students
find, such as the artery ‘spiders’ and
swollen veins on the stomach, are not
mentioned in their book (WTND) and
may puzzle them. The instructor can
help them figure out how the different
signs fit together, and why they
occur. But for this, they need to learn
something about the liver and how it
works.
This (earning can take place through
questions and answers. The instructor
provides some facts, but tries to
encourage students to figure out the
answers for themselves:
Facts (F): The liver serves, among other things,
as a filter to clean poisons and waste material
from the blood. Blood coming through veins
from the gut passes through the liver before
going back to the heart.
Question (Q): Now who can say why alcohol
harms the liver?
Response to students’ answers (R): Right!
Alcohol is a poison. The liver works hard to
remove it from the blood. If the person drinks
a lot over many years, the liver itself becomes
poisoned. The damage is greater if the person
does not eat well.
F: The damaged liver is like a clogged filter.
Blood cannot pass through it well, so it must
find other ways to get back to the heart. Also,
because the blood is dammed up by the liver,
the pressure in the veins is higher. So clear
liquid or ‘serum’ begins to leak out of the veins
and smaller blood vessels (capillaries).
Q: Which of the signs of cirrhosis do these facts
explain?
R: Swollen veins on the belly; swollen, fluid-
filled belly. (The veins in the esophagus also
swell, and sometimes burst, causing dangerous
bleeding.)
F: The swollen feet (and, in part, the liquid
in the belly) can be explained by looking
at another job the liver performs. The liver
builds new proteins from foods that have been
digested. One of the functions of proteins
in the blood is to prevent too much liquid
(serum) from leaking out through the walls
of the veins. This is why, when the damaged
liver fails to produce protein normally, the feet
often swell.
A picture like this will probably make
sense to students only if they use it to help
explain problems they actually see.
veins
returning
blood
from
body to
heart
veins
returning
blood
from
liver
liver
galbladder
esophagus
heart
stomach
spleen
intestine
(gut)
Q: Why do persons with cirrhosis often have
such severe wasting (loss) of muscles and
weight loss?
Clue; Muscles, like meat, are mostly protein.
F: One of the waste materials the liver
removes from the blood is a yellow dye
called bilirubin, which is left over when red
blood cells die. (Red cells normally live only
a few weeks.)
The waste materials collected by the liver
become part of a green liquid called bile. Bile
collects in the gallbladder and empties into the
gut, where it helps digest fatty foods.
A sick or severely damaged liver cannot
remove enough bilirubin from the blood.
Q: How does bilirubin affect the appearance of
a person with severe liver damage? Why?
R: Yellow skin (and eyes)-’jaundice’.
F: When the sick liver does not remove
bilirubin effectively or the bile cannot empty
from the gallbladder, some bilirubin is removed
by the kidneys.
Q: How do you suppose this affects the urine?
For a way to help the students find out, see
the next page.