Unique Characteristics of the Liver: Alcohol Abuse (Nursing)

00:00 So, we've established that the liver is amazing, but it's also the organ that's most likely to suffer with alcohol abuse. Now, I'm not saying you shouldn't drink any alcohol, but a lot of our patients and sometimes even us as professionals take in a little more than is actually healthy for your body because the liver can only process 1 ounce of liquor per hour. That gives you a good kind of frame of reference, and greater than 90% of the people who drink heavily develop fatty liver disease. Okay, so let's compare those 2 facts together. Your liver can only process how much? Right, about 1 ounce of liquor per hour. If someone drinks liquor excessively, greater than 90% of those people are going to develop fatty liver. Now, we know why that's a bad idea. Right? Because you have all that extra fat build-up in the liver, then the liver can't function and do the things that it's intended to do. Chronic alcohol abuse causes all kinds of liver tissue damage, not just fatty liver, you can also develop cirrhosis. Now, we're trying to teach my nephew how to say that. He always used to say "cirrhosisss" but we're talking about cirrhosis. It's a scarring of the liver. It's damaged done to the actual tissue. We're talking about those lobules and hepatocytes. They become stiff and thick, and they just cannot work as well as they used to. So, alcoholic hepatitis causes a cellular mutation, and that may also lead to liver cancer. So, whoa, a lot of times when you start talking about alcohol, people get very defensive. So, try and keep an open mind as we go back through this section. The frame of reference is the liver can process about 1 ounce of liquor per hour. People who drink excessive alcohol, greater than 90% of them are risking developing fatty liver disease. If they're chronically abusing alcohol, then it can cause actual tissue damage, and we call that cirrhosis or scarring of the liver. Because of the alcoholic hepatitis, that's an inflammation of the liver caused by too much alcohol, that causes the cellular mutation in the liver that could lead to liver cancer. So, why does it matter that a healthcare professional understands the impact of too much alcohol in your patient's liver? Because you want to open up an intelligent and open-ended conversation with your patient. You don't want to be judgmental, but you want them to understand the risks they're undertaking if they're drinking excessive amounts of alcohol. Now, take a look at your screen. Look at those healthy hepatocytes. You see how everything is neat, orderly. They're all snug together. That's a well-functioning liver. As the patient begins to experience liver damage, those hepatocytes get all bloated, and you see that we've got some fat deposits in there. Then, eventually as the disease progresses and excessive alcohol abuse continues, those hepatocytes get all inflamed. Look at the difference in those hepatocytes than the ones in the healthy liver. They're inflamed, and they are dying.

03:16 Think about blood trying to filter through there. Think about bile trying to filter through there.

03:21 Everything is going to be congested and obstructed. Now, finally, you end up with dead, scarred tissue. Now, compare the difference between that one and the healthy hepatocytes.

03:36 Yeah, think about trying to move blood and bile through liver tissue that looks like what you see at the end there with the remnants of the dead cells and the scarring. So, most of us start with a healthy liver and it can progress through these stages based on our lifestyle. So, let's talk about all of the liver diseases that are caused from alcohol. Again, you want to be educated, but you don't want to be self-righteous. You just want to help your patient recognize how making some changes to move toward a healthier lifestyle could make a huge impact on their liver and their overall quality of life. So, too much alcohol can cause a fatty liver or steatosis. It can cause inflammation of the liver. That's called hepatitis. Now, this is not caused by a virus. This is the kind of hepatitis that comes from alcohol, and this is alcoholic hepatitis. I had a huge dramatic story for me as I had a friend who was my dear close friend.

04:42 When I first graduated from nursing school, we went through the night shift together. We just were like sisters. We kind of looked alike. We were always on shift together. She was my best work friend ever. And then fast forward about 20 years, I hadn't connected with her again.

04:57 We just went to different hospitals, and I got a phone call from a mutual friend who let me know that she was dying, and I was overwhelmed. When I went to see her, she was bright, she was funny, she was wonderful, but what took her life in the end was alcoholic hepatitis, and her family was not even aware of the extent of her drinking. So, when you see a peer and a colleague, and somebody your age go through this, it really makes an impact, and I know she was a wonderful person just like the people we care for every day. So, don't be judgmental.

05:34 Support them, encourage them, and educate them in a way that they want to change, they want to see that change in their life. So, we've talked about fatty liver. We've talked about what my dear friend went through with alcoholic hepatitis. There's acute alcoholic hepatitis which means you've ingested. It's an event, a sudden thing because you had alcohol overload to really extreme level. There's cirrhosis or "cirrhosisss" if you're my nephew. There's liver failure and eventual death, and there's also a possible increased risk of liver cancer. Now, I know we have a lot of things up there for you to go through. Those are 6 end results of too much alcohol and their impact on your liver, but stop and take a look at those. How can you group those together? How is that best going to be encoded in your brain the way your brain works? So, let's look at steatosis. That's fatty liver. It's usually the earliest sign and is the most common form of alcoholic liver disease. Now, you can have a fatty liver and be a teetotaler, not a drinker, but it also comes along with alcohol abuse. So, this is the earliest sign. We're going to see this before you see the cirrhosis. So, it's this build-up of fat, and it stops the liver's ability to perform. It can't get blood and everything through there as neatly and orderly as it does if it wasn't surrounded by these deposits of fat. So, look at it again, look at the healthy hepatocytes, then look at what it looks like with the fatty liver. Even the outside of the liver kind of changes color and it depends on how many fat deposits there are, but it can actually change the look of the tissue. So, our first sign is going to be fatty liver, and it's just a build-up of fat which inhibits the liver from functioning. Now, hepatitis can be caused by alcohol abuse or it might be from a toxin or a virus. So, hepatitis just means -itis means inflammation of the liver. That's what hepat stands for. So, you need to know what is the cause of the patient's hepatitis. It might be alcoholic hepatitis. It could be toxic hepatitis, that could just be if I ingested an overdose of Tylenol, or it might be a virus like hepatitis B or A, but approximately a third of the people with steatosis will develop a mild or moderate liver inflammation. So, fatty liver is the first thing that we see then it will progress to a hepatitis about a third of the people, but the good news is if we can change their lifestyle when it's just fatty liver, we can help the liver become healthier and stronger again and minimize that fat in it. So, see why it's so important that you understand the progression. That's why you just don't want to kind of glaze over that the patient has evidence of fatty liver. You want to have that difficult conversation with them to help them lead a better life. So, fatty liver can lead to inflamed liver or hepatitis. The symptoms might not be obvious though until there's some really significant damage that's done. That's why patients need regular screening and check-ups with their healthcare professional. So, fatty liver can progress to hepatitis, and they may not show us external symptoms or seek care for those symptoms until a pretty significant amount of damage is done from the inflammation. Now, acute alcoholic hepatitis is much more serious than the mild to moderate alcoholic hepatitis. This patient is in crisis and needs to be hospitalized because it's potentially life-threatening. This could lead to liver failure and death. So, let's look at, that's right, I know you're saying it that way "cirrhosisss," alright. So, these are scarred liver cells. So, instead of the healthy cells, you see there the healthy hepatocytes, that's what we got, fatty cells, dead cells, trash laying everywhere around. Look at the difference in how those livers look. This is why people with cirrhosis, all the things the liver is intended to do, it's limping along and can barely do because the liver can't break down, it can't remove that scar tissue because it's had all these chemical changes from excessive alcohol. So, the normal maintenance that your liver does, a healthy liver does, a sick cirrhotic liver can't do because it's actually been chemically changed from alcohol abuse. Now, approximately 1 in 5 heavy drinkers have cirrhosis. So by now, I bet you're asking me. Alright, uhm, I drink alcohol, so how much is too much? Well, if you drink 3 standard drinks a day, you have 3 times the risk of liver disease. If you drink 6 standard drinks a day, you have 7 times the risk of developing liver disease. Now, most heavy drinkers have a buildup of harmful fat and inflammation in their liver, keep that in mind. But moderate and binge drinking, that's what we're talking about which is pretty common in certain age groups and social groups. So, we're going to call moderate and binge drinking 6 or more standard drinks in 1 sitting. That can also cause fat to build up in your liver, but drinking excessively roughly doubles your risk of cirrhosis, and that's also going to increase your risk of liver cancer. So, when you're thinking about, maybe just for yourself, how much is too much, know that your liver can only process 1 ounce of alcohol or liquor an hour. Know the difference between moderate and binge drinking, and drinking excessively.