Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Individuals with cirrhosis may have few or no symptoms and signs of liver
disease. Some of the symptoms may be nonspecific, that is, they don't suggest
that the liver is their cause. Some of the more common symptoms and signs of
cirrhosis include:
Yellowing of the skin (jaundice) due to the accumulation of bilirubin in
the blood
Fatigue
Weakness
Loss of appetite
Itching
Easy bruising from decreased production of blood clotting factors by the
diseased liver.
Individuals with cirrhosis also develop symptoms and signs from the
complications of cirrhosis.
What is cirrhosis?
Cirrhosis is a complication of many liver diseases that
is characterized by abnormal structure and function of the liver. The diseases
that lead to cirrhosis do so because they injure and kill liver cells, and the
inflammation and repair that is associated with the dying liver cells causes
scar tissue to form. The liver cells that do not die multiply in an attempt to
replace the cells that have died. This results in clusters of newly-formed liver
cells (regenerative nodules) within the scar tissue. There are many causes of
cirrhosis; they include chemicals (such as alcohol, fat, and certain
medications), viruses, toxic metals
(such as iron and copper that accumulate in
the liver as a result of genetic diseases), and autoimmuneliver disease in
which the body's immune system attacks the liver.
Why does cirrhosis cause problems?
The liver is an important organ in the body. It performs
many critical functions, two of which are producing substances required by the
body, for example, clotting proteins that are necessary in order for blood to clot, and
removing toxic substances that can be harmful to the body, for example, drugs.
The liver also has an important role in regulating the supply to the body of
glucose (sugar) and lipids (fat) that the body uses as fuel. In order to perform
these critical functions, the liver cells must be working normally, and they
must have an intimate relationship with the blood since the substances that are
added or removed by the liver are transported to and from the liver by the
blood.
The relationship of the liver to the blood is unique.
Unlike most organs in the body, only a small amount of blood is supplied to the
liver by arteries. Most of the liver's supply of blood comes from the intestinal
veins as the blood returns to the heart. The main vein that returns blood from the intestines is called the
portal vein. As the portal vein passes through the liver, it breaks up into
increasingly smaller and smaller veins. The tiniest veins (called sinusoids
because of their unique structure) are in close contact with the liver cells. In
fact, the liver cells line up along the length of the sinusoids. This close
relationship between the liver cells and blood from the portal vein allows the
liver cells to remove and add substances to the blood. Once the blood has passed
through the sinusoids, it is collected in increasingly larger and larger veins
that ultimately form a single vein, the hepatic vein that returns the blood to
the heart.
In cirrhosis, the relationship between blood and liver
cells is destroyed. Even though the liver cells that survive or are newly-formed
may be able to produce and remove substances from the blood, they do not have
the normal, intimate relationship with the blood, and this interferes with the
liver cells' ability to add or remove substances from the blood. In addition,
the scarring within the cirrhotic liver obstructs the flow of blood through the
liver and to the liver cells. As a result of the obstruction to the flow of
blood through the liver, blood "backs-up" in the portal vein, and the pressure
in the portal vein increases, a condition called portal hypertension. Because of
the obstruction to flow and high pressures in the portal vein, blood in the
portal vein seeks other veins in which to return to the heart, veins with lower
pressures that bypass
the liver. Unfortunately, the liver is unable to add or remove substances from
blood that bypasses it. It is a combination of reduced numbers of liver cells,
loss of the normal contact between blood passing through the liver and the liver
cells, and blood bypassing the liver that leads to many of the manifestations of
cirrhosis.
A second reason for the problems caused by cirrhosis is the disturbed
relationship between the liver cells and the channels through which bile flows. Bile is a
fluid produced by liver cells that has two important functions: to aid in
digestion and to remove and eliminate toxic substances from the body. The bile
that is produced by liver cells is secreted into very tiny channels that run
between the liver cells that line the sinusoids, called canaliculi. The
canaliculi empty into small ducts which then join together to form larger and
larger ducts. Ultimately, all of the ducts combine into one duct that enters the
small intestine. In
this way, bile gets to the intestine where it can help with the digestion of
food. At the same time, toxic substances contained in the bile
enter the intestine and then are eliminated in the stool. In cirrhosis, the
canaliculi are abnormal and the relationship between liver cells and canaliculi
is destroyed, just like the relationship between the liver cells and blood in
the sinusoids. As a result, the liver is not able to eliminate toxic substances
normally, and they can accumulate in the body. To a minor extent, digestion in
the intestine also is reduced.
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Hepatitis C is an inflammation of the liver due to the hepatitis C virus (HCV), which is usually spread by
blood transfusion, hemodialysis, and needle sticks, especially with intravenous
drug abuse. Chronic hepatitis C may be treated with interferon, usually in combination with anti-virals.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
The hepatitis B virus is a unique, coated DNA virus belonging to the Hepadnaviridae family of viruses. The course of the virus is determined primarily by the age at which the infection is acquired and the interaction between the virus and the body's immune system. Successful treatment is associated with a reduction in liver injury and fibrosis (scarring), a decreased likelihood of developing cirrhosis and its complications, including liver cancer, and a prolonged survival.
Hyponatremia is a condition where the level of sodium in the blood is low. Causes of hyponatremia can occur from excess fluid in the body, or a loss of sodium in body fluid. Some of the symptoms of hyponatremia include headache, muscle cramps or spasm, seizures, weakness and confusion. Treatment of hyponatremia depends on the cause.
Nonalcoholic fatty liver disease (NAFLD) refers to a wide spectrum of liver disease ranging from simple fatty liver (steatosis), to nonalcoholic steatohepatitis (NASH), to cirrhosis (irreversible, advanced scarring of the liver). All of the stages of NAFLD have in common the accumulation of fat (fatty infiltration) in the liver cells (hepatocytes).
Thrombocytopenia refers to a decreased number of platelets in the blood. There are many causes of thrombocytopenia such as decreased platelet production (viral infections for example rubella, mumps, chickenpox, hepatitis C, and HIV); increased platelet destruction or consumption (for example sulfonamide antibiotics, heparin, blood transfusions, and lupus); or increased splenic sequestration (enlarged spleen due to conditions for example liver disease, blood cancers, and more). Treatment of thrombocytopenia depends on the cause.
The spleen enlarges if it is asked to do excessive work in filtering or manufacturing blood cells, if there is abnormal blood flow to it, or if it is invaded with abnormal cells or deposits. Symptoms of an enlarged spleen may include weakness and fatigue, easy bleeding, and poor white blood cell function. Treatment of an enlarged spleen is focused toward the cause of the splenomegaly. Surgery may be required to remove the spleen.
Pleurisy, an inflammation of the lining around the lungs, is associated with sharp chest pain upon breathing in. Cough, chest tenderness, and shortness of breath are other symptoms associated with pleurisy. Pleurisy pain can be managed with pain medication and by external splinting of the chest wall.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Hereditary hemochromatosis (iron overload) is an inherited disorder in which there is excessive accumulation of iron in the body. Individuals may have no symptoms or signs, or they can have severe symptoms and signs of iron overload. The most effective treatment for hemochromatosis is therapeutic phlebotomy.
Cystic fibrosis is a disease of the mucus and sweat glands. Cystic fibrosis is an inherited disease. The outcome of the disease leaves the body malnourished, bulky and fouls smelling stools, vitamin insufficiency, gas, painful or swollen abdomen, infertility, susceptible to heat emergencies, and respiratory failure. There is no cure for cystic fibrosis, treatment of symptoms is used to manage the disease.
Hepatitis is most often viral, due to infection with one of the hepatitis viruses (A, B, C, D, E, F (not confirmed), and G) or another virus (such as those that cause infectious mononucleosis, cytomegalovirus disease). The main nonviral causes of hepatitis are alcohol and drugs. Many patients infected with hepatitis A, B, and C have few or no symptoms of illness. For those who do develop symptoms of viral hepatitis, the most common are flu- like symptoms including: loss of appetite, nausea, vomiting, fever, weakness, tiredness, and aching in the abdomen. Treatment of viral hepatitis is dependant on the type of hepatitis.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
Pleural effusion is an excess fluid between the two membranes that envelop the lungs. There are two classifications of causes of pleural effusion; transudate and exudate. The treatment of pleural effusion depends on the cause.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Primary Biliary Cirrhosis is a chronic disease characterized by progressive inflammation and destruction of small bile ducts within the liver. The bile ducts transport bile from the liver to the intestine for the absorption of fat and elimination of waste products. The causes of Primary Biliary Cirrhosis may involve autoimmunity, infection, or genetic predisposition, acting alone or in combination. There are many medications and treatment options available for those with this and other associated diseases of Primary Biliary Cirrhosis.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
Coma is the inability to waken or react to the surrounding environment. The Glasgow Coma Scale is frequently used to measure the depth of coma. Causes of coma include trauma, bleeding, edema, lack of oxygen, poisoning, or hypoglycemia. Prognosis for a patient in a coma depends on the cause of the coma.
Gynecomastia, an enlargement of the gland tissue in the male breast is the caused by an imbalance of hormones. Certain medical conditions may also lead to gynecomastia such as cirrhosis, malnutrition, disorders of the male sex organs, kidney failure, thyroid disorders, and medications. Gynecomastia is generally treated with medication, and if necessary surgery.
Portal hypertension is most commonly caused by cirrhosis, a disease in which results from scarring of a liver injury. Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry the blood from teh liver to the heart, and a parasitic infection called schistosomiasis.
Primary sclerosing cholangitis (PSC) is a chronic, progressive disease of the bile ducts that channel bile from the liver into the intestines. There is an association between primary sclerosing cholangitis and ulcerative colitis and Crohn's disease. Symptoms of primary sclerosing cholangitis include abnormal liver blood tests, itching, fatigue, and jaundice. Primary sclerosing cholangitis is treated with medications and in some cases, liver transplant.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Hereditary hemochromatosis is an inherited (genetic)
disorder in which there is excessive accumulation of iron in the body (iron
overload). It is a common genetic disorder among Caucasians in the United
States, affecting approximately one in 240 to 300 Caucasians. Individuals affected
with hereditary hemochromatosis may have no symptoms or signs (and have normal
longevity), or they can have severe symptoms and signs of iron overload that
include sexual dysfunction, heart failure,
joint pains, liver
cirrhosis ,
diabetes mellitus,
fatigue, and darkening of skin.
The normal iron content of the body is three to four grams. The
total amount of iron in the body is carefully controlled. The body loses one mg of
iron daily from sweat and cells that are shed from the skin and the inner lining
of the intestines. Women also lose one mg of iron daily on average from. In normal adults the intestines absorb one m...