The liver has amazing regenerative abilities, but scarring is just too much for it to handle, why is that?
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Since this is ELI5 I’ll make a Lego comparison
Legos are pretty strong, if you play with them normally or even throw them around a bit theyll still be okay. However if you bash your Legos on the table for years they’ll probably develop irreversible bumps and dents in them, but still kinda work as Legos a while longer
That’s like your liver, it can handle a normal amount of alcohol and use just fine, but if you’re pushing it to it’s limit excessively it’ll start to irreversibly wear down as it just can’t keep up and has to make do
Alcohol, with its endless properties, can dilute and “break” the chemical mixture made by the liver to heal itself.
Your liver will actively try to heal itself while you are abusing alcohol, and since the alcohol makes this process fail, or atleast not be as potent, the liver fails to turn scar tissue into living cells, meaning it loses its healing capabilities everytime it is exposed to more alcohol than it can handle.
If, in some magical alternative universe, a livers healing capabilities were paused and essentially got whitewashed by pure alcohol for 20 years, it could still fix itself. However the owner of the liver would be dead very fast without a working liver that carries out a plethora of functions during that time but yknow, it is how it is.
It’s not the copious amounts of alcohol that damages your liver, it’s the liver itself trying to heal through that damage actively, during the consumption.
I am no way qualified to be the one to explain this but I hope it helps ✌️
Edit: misspelling
It’s not just because of alcohol. Any substance that damages the liver including viral hepatitis will do the same thing.
Imagine you get a cut on your skin. The cut will eventually heal but it’s not a perfect 100% replica of the original undamaged skin. There’s some scar tissue that forms which is just fibrous proteins that act as a filler in the spaces where there aren’t normal skin cells anymore.
Likewise, the liver gets inflamed and damaged, and the body attempts to heal it, but it’s not a perfect 100% replica of the original undamaged liver. There’s some scar tissue that’s basically just filler and not actual functioning liver cells. If you repeat this cycle over and over by drinking a lot over the span of years, your liver function progressively worsens.
Fibrosis (the scarring which you’re referring to) is a reaction to liver inflammation and/or damage. The fibrosis is very tough – imagine like a thick towel or burlap sack. Liver cells cannot traverse it. In the setting of chronic ongoing injury, the fibrosis makes bands across the liver (the fibrosis goes between structures called portal tracts if you’re interested). Eventually the fibrosis becomes so extensive that it surrounds groups of liver cells (maybe 100 or so) and creates nodules. This is called cirrhosis. This degree of fibrosis causes obstruction of liver ducts and blood flow which leads to liver failure.
I had an ultrasound for some racing heart issues (that turned out just to be stress and eating too much, no biggie).
The doctor started sliding the thingy around and I did register that it wasn’t near my heart.
He then exclaimed “That’s the most beautiful liver I’ve seen in a man your age”! Then explaining why, the shape, the lack of scar tissue etc.
Maybe it was just a trick to make the patient relax, still the best compliment I’ve ever had. And yes, I drink alcohol.
The liver can heal itself from scars. It’s only after long-term and extensive damage that the scars become too big to break down.
More specificly it’s about so-called Ito cells. These cells have a few specific jobs in the liver, the biggest one is that they store Vitamin A but they also help the immune defence.
When they become damaged and inflamed they produce collage (what scar tissue is made from). Normally the liver breaks down that scar tissue and regenerates, but if the process goes on for too long Ito cells will also produce proteins that tell the body to stop breaking up scar tissue.
So if you’re alcoholic for a few years? You’re probably fine. The body is probably not too damaged to repair itself. 10? 15? 20 years? You might have developed cirrhosis (ie, permanent scarring of the liver) and from that point on all you can do is not make it worse.
Question: I had liver failure four years ago from an unfortunate mix of prescription drugs that I was taking. I recovered and all my liver function gets have been normal for the last three years. Can I still drink the occasional glass of wine? My doctor says yes but I get paranoid.
Sometimes the damage is soo deep and bad that the only way to fix it is by supergluing what is left with connective tissue. Connective tissue can’t do what normal liver cells do.
Why is such an image that you have of alcohol permanent?
Scar tissue on your skin is like skin, but worse. It doesn’t regulate temperature well and the rest of your skin has to work harder to do the same stuff.
Scar tissue on your heart is like skin, but worse. It doesn’t help the heart work and the rest of the heart has to work harder to do the same stuff.
Scar tissue on your liver is like skin, but slightly better. It doesn’t filter as well as your normal liver, but it tries its best.
Your body only creates scar tissue when it is damaged and feels like it needs to repair quickly. For cuts your body wants to close it up quickly so that it doesn’t get infected.
For your liver, well your body doesn’t understand poison all that well. It doesn’t know if your being forced to consume poison every week to survive or if your just drinking for fun on the weekends. From its perspective it might think that your poisoned multiple times a week with some poisonings being much more dangerous than others. In between filtering your blood, it regenerates itself. If it expects that it might not have time to perfectly heal itself, it works faster and creates scar tissue. The more scar tissue it has, the more paranoid it becomes about its ability to keep you alive, and the more it will try and rush repairs. That can leads to serious liver diseases, alternatively some people have very confident livers that do not scar so easily.
Also sometimes liver scars are like skin, but worse. These scars do not help your liver do it’s job, and actually get in the way of your liver. When this happens it can become impossible for the liver to keep up with its normal jobs, let alone process alcohol.
Your liver is designed to repair itself well, but it isn’t designed to destroy scar tissue and replace that with healthy tissue. That is why your liver can repair itself really well, but also sometimes not so well.
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