|
|
|
|
|
|
| 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. |
| 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. |
| Clinical Correlation •Clinical consequences of liver cirrhosis can be minimal, with cirrhosis being discovered accidentally at necropsy. •However, in most instances, cirrhotic patients have some evidence of hepatic cell dysfunction, including jaundice, anorexia and fatigue. •Patients may also experience easy bruising as a result of decreased production of coagulation factors by the liver cells. •Due to the disturbances in vascular flow through the fibrotic liver, a significant amount of portal blood is shunted through the veins surrounding the esophageal mucosa into the systemic circulation (porta-caval shunts). •These porta-caval shunts can rupture into the esophagus resulting in massive bleeding. •Terminal consequences of liver cell necrosis are the accumulation of ammonia resulting in encephalopathy. •Ascites can also result through a combination of decrease in albumin synthesis by the liver and an increase in portal pressure. •Therapy of underlying liver disease is primarily supportive and no specific therapy can be instituted, other than liver transplantation. |
| 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 |
| Cirrhosis |
| Synopsis by: T.V.Rajan, M.D., Ph.D. (T56000M49500)[489] |
| Search Medline at National Library of Medicine Please be patient during transfer. Medline will open in a new window. To return, close the Medline Window |
|
|
|
|
|
|