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  • 00:05

    When cells are injured or damaged and die off, usually that dead tissue that was previously

  • 00:10

    full of living cells becomes fibrotic, meaning it becomes thickened with heaps and heaps

  • 00:15

    of protein and forms scar tissue.

  • 00:19

    So when your liver is constantly forced to process alcohol like in alcoholic liver disease,

  • 00:24

    or subject to a viral attack for a long time like in HBV, or anything else that causes

  • 00:29

    a long-term or chronic state of liver cell or hepatocyte destruction and inflammation,

  • 00:35

    your liver can become seriously scarred and damaged to the point where it’s no longer

  • 00:40

    reversible, at which point it becomes fibrotic and in the liver we call this process cirrhosis.

  • 00:49

    Because it’s usually irreversible, cirrhosis is often referred to as “end-stage” or

  • 00:55

    “late-stage” liver damage.

  • 00:57

    When liver cells are injured, they start to come together and form what are called regenerative

  • 01:01

    nodules.

  • 01:03

    You can think of these as colonies of living liver cells.

  • 01:07

    These are one of the classic signs of cirrhosis and are why a cirrhotic liver is more bumpy

  • 01:12

    as opposed to a smooth, healthy liver.

  • 01:15

    Also with cirrhotic liver tissue, you’ll see that in between these clumps of cells

  • 01:19

    or nodules, is fibrotic tissue and collagen.

  • 01:23

    Here’s a classic histology image of cirrhotic tissue, this clump of cells in the middle

  • 01:27

    is the regenerative nodule, and these blue stains surrounding it are the bands of protein

  • 01:32

    from the process of fibrosis.

  • 01:35

    If we zoom out a bit and look at it with the naked eye, we’ll again see these nodules,

  • 01:39

    which have fibrotic protein bands in between.

  • 01:42

    How do these bands of fibrotic tissue form though?

  • 01:47

    Well fibrosis is a process mediated by special cells called stellate cells, that sit between

  • 01:53

    the sinusoid and hepatocyte, known as the perisinusoidal space.

  • 01:58

    Here’s a pretty basic layout of the basic functional unit of the liver, you’ve got

  • 02:03

    the portal vein and hepatic artery that combine into a sinusoid, which then goes into the

  • 02:08

    central vein, and these are all lined with hepatocytes.

  • 02:12

    Along with these though you’ve also got a bile duct, and all three constitute a portal

  • 02:17

    triad.

  • 02:19

    So the perisinusoidal space, which literally means “around the sinusoidal space”, and

  • 02:25

    stellate cells are about here.

  • 02:28

    And usually in healthy tissue, these guys’ main function is to store vitamin A and are

  • 02:33

    otherwise considered quiescent, or sort of dormant.

  • 02:38

    When the hepatocytes are injured though, they secrete paracrine factors that “activates”

  • 02:43

    and changes the stellate cells.

  • 02:46

    When activated, the stellate cells lose vitamin A, proliferate, and start secreting secreting

  • 02:51

    transforming growth factor beta1, or TGF-beta, which then causes them to produce collagen,

  • 02:57

    which is the main ingredient in extracellular matrix, fibrosis, and scar tissue.

  • 03:03

    As this fibrotic tissue builds up, it starts to compress the central veins and sinusoids.

  • 03:08

    It’s thought that in a healthy, normal state, these cells play key roles in the natural

  • 03:14

    wound-healing process, but when the liver cells are constantly injured, the stellate

  • 03:19

    cells are constantly activated and so they constantly produce collagen and factors that

  • 03:23

    lead to fibrosis.

  • 03:26

    And this is when complications due to cirrhosis start to crop up.

  • 03:30

    As the central veins and sinusoids become compressed and push on the fluid inside, their

  • 03:34

    pressure starts to build up, leading to intrasinusoidal (or portal) hypertension, which is this higher

  • 03:42

    pressure in the portal veins.

  • 03:44

    Higher portal vein pressure means that fluid in blood vessels is more likely to get pushed

  • 03:48

    into tissues and across tissues into large open spaces like the peritoneal cavity.

  • 03:55

    That’s why cirrhosis leads to excess peritoneal fluid, a condition called ascites, and can

  • 04:02

    result in other complications like congestive splenomegaly and hypersplenism, where the

  • 04:07

    spleen becomes enlarged because all this fluid and blood can’t get into the liver, and

  • 04:11

    backs up into the spleen.

  • 04:13

    In the same way, your circulatory system starts diverting blood away from the liver because

  • 04:18

    of the high liver pressures, this is known as a portosystemic shunt.

  • 04:25

    Blood flow follows the path of least resistance and shunts away from the portal system and

  • 04:29

    towards the systemic system of circulation.

  • 04:33

    Though not fully understood, these changes in portal flow ultimately trigger renal vasoconstriction,

  • 04:40

    so increased resistance in the renal circulation, which decreases blood flow through the kidneys,

  • 04:45

    leading to decreased filtration hepatorenal failure, where kidney failure follows liver

  • 04:51

    failure.

  • 04:54

    The fibrotic tissue, pressure buildup, and diversion of blood from the hepatic circulation

  • 04:59

    essentially reduces the number of functional sinusoidal veins, and the number of functional

  • 05:04

    portal triads in general.

  • 05:06

    As you have less and less of these basic liver functional units, your liver becomes less

  • 05:11

    and less able to do its job of detoxification.

  • 05:14

    When your liver isn’t detoxifying your blood, these toxins can get into the brain and start

  • 05:19

    causing mental deficits, a condition known as hepatic encephalopathy.

  • 05:24

    Although there are several neurotoxins that are thought to contribute to the development

  • 05:28

    of these mental changes, the best understood factor is ammonia in the blood, which is produced

  • 05:33

    mainly in the gastrointestinal tract; usually the liver plays a vital role in removing ammonia

  • 05:38

    and stopping it from going into the systemic circulation.

  • 05:42

    As more of these and other toxins get into the brain, patients might develop asterixis,

  • 05:48

    where they have tremoring or jerky hands when outstretched, and as even more toxins build

  • 05:53

    up, eventually patients can progress to a coma.

  • 05:56

    Also, since the liver plays a big role in metabolizing estrogen into inactive metabolites

  • 06:02

    that can be removedn from the blood and excreted, patients can also experience complications

  • 06:06

    due to increased estrogen in the blood, like gynecomastia, spider angiomata, and palmar

  • 06:13

    erythema.

  • 06:14

    And, since the liver usually conjugates bilirubin, increased unconjugated bilirubin in the blood

  • 06:21

    from a less-functional liver can lead to jaundice.

  • 06:25

    Another important job of the liver is producing albumin, so again, if the liver’s not functioning

  • 06:30

    right, you can have a decreased amount of albumin in the blood, or hypoalbuminemia.

  • 06:35

    Finally, the liver helps in making clotting factors or proteins that help coagulate your

  • 06:41

    blood, so when you aren’t producing these coagulation factors, you can develop issues

  • 06:45

    related to your ability to coagulate blood, which you need in order to stop blood loss

  • 06:49

    after an injury.

  • 06:53

    To recap the general symptoms of cirrhosis, early on, with a small amount of scarring

  • 06:57

    and fibrosis, we call it compensated cirrhosis, meaning the liver can still do a lot of its

  • 07:03

    job.

  • 07:04

    In this case, somebody with cirrhosis might not have any symptoms, or have nonspecific

  • 07:09

    symptoms like weight loss, weakness, or fatigue.

  • 07:13

    Later on, though, with extensive scarring, the liver progresses to decompensated cirrhosis,

  • 07:19

    and can’t function properly.

  • 07:22

    At this point many of the described symptoms start to develop, like jaundice and pruritus

  • 07:27

    or itchy skin, ascites, hepatic encephalopathy leading to confusion, and easy bruising from

  • 07:34

    low coagulation factors.

  • 07:36

    For diagnosis, the “gold standard” is a liver biopsy, taking a tiny sample of the

  • 07:43

    liver tissue examine under a microscope.

  • 07:47

    Common lab findings include elevated serum bilirubin, as well as elevated liver enzymes

  • 07:52

    like aspartate aminotransferase, (AST) and alanine aminotransferase (ALT), where AST

  • 07:59

    is usually more elevated than ALT, alkaline phosphatase (ALP), and gamma glutamyl transpeptidase,

  • 08:13

    and thrombocytopenia, or low platelet count.

  • 08:18

    As to treatment, generally the scarring in cirrhosis is irreversible, so first of all

  • 08:23

    it’s important to prevent continued liver damage by identifying the underlying cause

  • 08:27

    and treating that, for example stopping alcohol consumption or antiviral treatment for those

  • 08:33

    with hepatitis C. With advanced cirrhosis, though, where the liver stops functioning,

  • 08:39

    a liver transplant might be needed.

  • 08:41

    Alright, as a quick recap, cirrhosis is when inflammation and liver damage causes the liver

  • 08:47

    to become fibrotic and develop scar tissue.

  • 08:52

    Causes include things like excessive alcohol consumption or prolonged viral attack like

  • 08:56

    from hepatitis B or hepatitis C virus.

  • 09:00

    Over time as the liver becomes less functional, symptoms like jaundice, ascites, easy bruising,

  • 09:06

    and hepatic encephalopathy develop.

  • 09:09

    Diagnosis is often done with a biopsy or through lab tests, and treatment for advanced cirrhosis

  • 09:13

    is to treat the underlying cause, but sometimes a liver

  • 09:34

    transplant is required.

All

The example sentences of FIBROSIS in videos (15 in total of 29)

remember verb, base form that preposition or subordinating conjunction we personal pronoun want verb, non-3rd person singular present to to avoid verb, base form long adjective - term noun, singular or mass amiodarone noun, singular or mass due adjective to to its possessive pronoun toxicity noun, singular or mass like preposition or subordinating conjunction pulmonary adjective fibrosis noun, singular or mass .
well adverb fibrosis noun, singular or mass is verb, 3rd person singular present a determiner process noun, singular or mass mediated verb, past participle by preposition or subordinating conjunction special adjective cells noun, plural called verb, past participle stellate noun, singular or mass cells noun, plural , that wh-determiner sit verb, base form between preposition or subordinating conjunction
so adverb if preposition or subordinating conjunction the determiner patient noun, singular or mass were verb, past tense to to have verb, base form a determiner condition noun, singular or mass such adjective as preposition or subordinating conjunction pulmonary adjective fibrosis noun, singular or mass , which wh-determiner causes verb, 3rd person singular present
have verb, non-3rd person singular present been verb, past participle performed verb, past participle managing verb, gerund or present participle cystic adjective fibrosis noun, singular or mass can modal be verb, base form very adverb complex adjective so adverb consider verb, base form getting verb, gerund or present participle treatment noun, singular or mass at preposition or subordinating conjunction
genetic adjective condition noun, singular or mass proper noun, singular such adjective as preposition or subordinating conjunction sickle noun, singular or mass cell noun, singular or mass anemia noun, singular or mass or coordinating conjunction cystic adjective fibrosis noun, singular or mass proper noun, singular or coordinating conjunction you're proper noun, singular in preposition or subordinating conjunction
pulmonary adjective fibrosis noun, singular or mass where wh-adverb people noun, plural get verb, non-3rd person singular present scarring verb, gerund or present participle in preposition or subordinating conjunction their possessive pronoun lungs noun, plural much adjective in preposition or subordinating conjunction the determiner same adjective way noun, singular or mass that wh-determiner happens verb, 3rd person singular present
the determiner developing verb, gerund or present participle fibrosis noun, singular or mass in preposition or subordinating conjunction the determiner liver noun, singular or mass can modal eventually adverb reach verb, base form a determiner specific adjective level noun, singular or mass , which wh-determiner we personal pronoun call verb, non-3rd person singular present cirrhosis noun, singular or mass .
2 cardinal number years noun, plural later adverb smith verb, non-3rd person singular present passed verb, past participle away adverb of preposition or subordinating conjunction cystic adjective fibrosis noun, singular or mass and coordinating conjunction the determiner building noun, singular or mass was verb, past tense
on preposition or subordinating conjunction the determiner membrane noun, singular or mass of preposition or subordinating conjunction this determiner airway noun, singular or mass cell noun, singular or mass , we personal pronoun can modal find verb, base form the determiner cystic adjective fibrosis noun, singular or mass transmembrane proper noun, singular conductance noun, singular or mass
like preposition or subordinating conjunction in preposition or subordinating conjunction cystic adjective fibrosis noun, singular or mass or coordinating conjunction tay proper noun, singular - sachs proper noun, singular disease noun, singular or mass , where wh-adverb one cardinal number type noun, singular or mass of preposition or subordinating conjunction protein noun, singular or mass is verb, 3rd person singular present misfolded proper noun, singular and coordinating conjunction
in preposition or subordinating conjunction reducing verb, gerund or present participle inflammation noun, singular or mass and coordinating conjunction inhibiting verb, gerund or present participle the determiner formation noun, singular or mass of preposition or subordinating conjunction fibrosis noun, singular or mass in preposition or subordinating conjunction your possessive pronoun lung noun, singular or mass all determiner right noun, singular or mass guys noun, plural
pulmonary adjective fibrosis noun, singular or mass really adverb means verb, 3rd person singular present scarring verb, gerund or present participle of preposition or subordinating conjunction the determiner lungs noun, plural and coordinating conjunction we personal pronoun do verb, non-3rd person singular present n't adverb know verb, base form why wh-adverb you personal pronoun have verb, non-3rd person singular present it personal pronoun
like preposition or subordinating conjunction pulmonary adjective fibrosis noun, singular or mass where wh-adverb you personal pronoun have verb, non-3rd person singular present scarring verb, gerund or present participle of preposition or subordinating conjunction the determiner lungs noun, plural it personal pronoun can modal cause verb, base form non verb, base form - infectious adjective types noun, plural
hello interjection , in preposition or subordinating conjunction this determiner healthsketch proper noun, singular we personal pronoun want verb, non-3rd person singular present to to talk verb, base form to to you personal pronoun about preposition or subordinating conjunction idiopathic proper noun, singular pulmonary proper noun, singular fibrosis proper noun, singular or coordinating conjunction ' ipf' proper noun, singular
knowing verb, gerund or present participle it personal pronoun this determiner is verb, 3rd person singular present things noun, plural like preposition or subordinating conjunction taste noun, singular or mass sex noun, singular or mass cystic adjective fibrosis noun, singular or mass spinal adjective muscular adjective atrophy noun, singular or mass or coordinating conjunction even adverb blood noun, singular or mass

Use "fibrosis" in a sentence | "fibrosis" example sentences

How to use "fibrosis" in a sentence?

  • While there is no cure, cystic fibrosis is so close to being a livable disease. There is a lot of hope.
    -Max Carver-

Definition and meaning of FIBROSIS

What does "fibrosis mean?"

/fīˈbrōsəs/

noun
thickening and scarring of connective tissue, usually as result of injury.
other
Medical; a thickening and scarring of connective tissue.