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| Cirrhosis | ||
| Etiology •Cirrhosis is the terminal sequel of alcoholic liver disease or viral hepatitis, particularly hepatitis C. Other, less frequent causes include some parasitic infections (such as Schistosomiasis), some metabolic disorders (such as Wilsons disease), toxic chemicals and unknown conditions. | ||
| Pathogenesis •Cirrhosis of the liver is the terminal sequel of prolonged repeated injury to the hepatic parenchyma. •The end result is the formation of broad bands of fibrous tissue separating regenerative nodules that do not maintain the normal organization of liver lobules. •Pathogenetically, liver cirrhosis should be regarded as the final common pathway of chronic liver injury, which can result from any form of intense repeated prolonged liver cell injury., | ||
| Epidemiology •Common disease in U.S., predominantly associated with alcohol abuse. •In Asia and Africa, cirrhosis is also common but more likely to be associated with hepatitis. •Due to recent mass immunization efforts in Taiwan the incidence of cirrhosis is declining steeply. | ||
| General Gross Description •Grossly, there has been a tendency to separate liver cirrhosis into two forms, a micronodular form and a macronodular form. •The former was regarded as synonymous with alcoholic cirrhosis and the latter with viral cirrhosis. •However, the lines between them are blurred and both causes can give rise to either form of cirrhosis. •In the classical literature, micronodular cirrhosis, also referred to as Laennec's cirrhosis was characterized as fine scarring separating small liver nodules, whereas post viral, or macronodular cirrhosis was characterized by broad bands of fibrosis separating nodules of varying sizes. •The liver is misshapen and nodular, instead of presenting the normal smooth, even surface. •The cut surface is characterized by areas of depressed pale scars, separating bulging areas of liver parenchyma, that can show evidence of bile staining. •The liver is shrunken and can weigh less then 1 kg in some extreme cases of cirrhosis. •Examples: | ||
| General Microscopic Description •Microscopically, the lesion is characterized by fibrous tissue bands of varying sizes separating regenerating liver nodules. •Bile retention within the nodules is prominent. •The fibrous bands can often contain proliferating bile ducts. •Examples: | ||
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 834 • Harrison's Principles of Internal Medicine, 13th Ed: Isselbach et. al. (eds). New York, McGraw-Hill, 1994, pp. 1483 This link will directly take you to the relevant new literature Cirrhosis
| Synopsis by: T.V.Rajan, M.D., Ph.D. (T56000M49500)[489]
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