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Answer to Puzzler #43

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The Scenario:

Eddie had been a pretty regular drinker all his life. It was not that he appeared intoxicated a lot, or that he became argumentative or difficult when he drank. It was more that he managed to keep a steady flow of alcohol going most of the time. There was always a drink in his hand, yet he always seemed to be in control.

His daughter, Emily, worried about his drinking -- and sometimes said so. But he dismissed her concerns and didn't want to hear about it. This went on for many years. One day, she realized that his abdomen had recently been getting larger and larger. It really stuck out. It caused him no discomfort, so she wasn't sure what to make of it. In general, he was perhaps more sedentary than before, and he no longer had his old ambition to do things. But at the same time he didn't act very sick. Then Emily observed some faint yellow discoloration in the whites of his eyes, and she became seriously concerned.

Question:

What is happening to Eddie?

Answer:

Eddie is experiencing one of the many dreaded complications of alcoholism, the same one that took Mickey Mantle's life: liver failure. In liver failure, many things go wrong. One common problem is the accumulation of fluid, or what is called ascites, in the abdominal cavity. This happens for the following reasons: Normally, fresh blood travels to all parts of the body and returns through the veins to the heart. An exception to this rule involves the intestinal tract. Here, blood returning from the stomach and intestines travels first to the liver through the portal circulation. It allows the liver a first crack at detoxifying any toxins (or medications for that matter) absorbed from the digestive tract, and allows the liver to carry out its job of regulating and managing all amounts, concentrations, and varieties of food elements such as sugars, fats, and proteins ingested in the diet.

In chronic liver failure due to alcoholic cirrhosis, there is so much scarring of the liver that blood from the portal circulation can no longer get through. This results in "portal hypertension," or elevated pressure within the portal system. When the pressure gets high enough, fluid weeps off of the surface of the liver and through the walls of the veins. An accumulation of many quarts of acsites is typical, the fluid appearing yellow and clear if aspirated with a needle. Removal of the fluid with a needle or catheter tends not to be helpful as it rapidly recollects. One can only hope that with time some degree of liver function returns, and Eddie is able to mobilize the fluid. Diuretics may be used to remove the excess fluid. But over-aggressive use may lead to the development of kidney failure and other complications.

The yellow in Eddie's eyes was recognized by most Puzzler respondents as being a sign of jaundice, or the accumulation of bilirubin in the blood, that results from liver failure or from acute hepatitis.

Eddie's risk of dying from liver failure is quite high at this point, even if he quits drinking. Amazingly, the disease of alcoholism is so powerful that many alcoholics, sick and facing imminent death from cirrhosis, will still be unable to quit drinking.