Cirrhosis
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Cirrhosis is end stage fibrosis of the liver.
General
- Cirrhosis is stage 4 (Laennec).
Etiology:
- Perisinusoidal fibrosis may suggest congestive hepatopathy.[1]
- In NAFLD portal-to-portal fibrosis (septal/bridging fibrosis) tends to be more common than perivenular fibrosis.[2]
- The etiology of late stage fibrosis (cirrhosis), may be impossible to determine.
Prognosis:
- The classic teaching is that cirrhosis is irreversible; however, there is increasing evidence that it regresses.[3][4][5]
Special types:
- Garland cirrhosis (AKA holly leaf cirrhosis) - see primary biliary cirrhosis.
Gross
Cirrhosis can be divided (in gross pathology) into:
- Micronodular cirrhosis - classically due to alcohol.
- Uniform, diffuse.
- Macronodular cirrhosis - classically due to viral hepatitis.
- Irregular.
Images
Microscopic
Formal Robbins definitions (all three required) is:[6]
- Bridging fibrosis.
- Nodule formation.
- Disruption of the hepatic architecture.
Images
Cirrhotic liver - trichrome stain. (WC/Nephron)
See also
References
- ↑ OA. September 15, 2009.
- ↑ Pathologic features associated with fibrosis in nonalcoholic fatty liver disease. Gramlich T, Kleiner DE, McCullough AJ, Matteoni CA, Boparai N, Younossi ZM. Hum Pathol. 2004 Feb;35(2):196-9. PMID 14991537.
- ↑ Wanless, IR.; Nakashima, E.; Sherman, M. (Nov 2000). "Regression of human cirrhosis. Morphologic features and the genesis of incomplete septal cirrhosis.". Arch Pathol Lab Med 124 (11): 1599-607. doi:10.1043/0003-9985(2000)1241599:ROHC2.0.CO;2. PMID 11079009.
- ↑ Kim, SU.; Park, JY.; Kim, do Y.; Ahn, SH.; Choi, EH.; Seok, JY.; Lee, JM.; Park, YN. et al. (2010). "Non-invasive assessment of changes in liver fibrosis via liver stiffness measurement in patients with chronic hepatitis B: impact of antiviral treatment on fibrosis regression.". Hepatol Int 4 (4): 673-80. doi:10.1007/s12072-010-9201-7. PMID 21286337.
- ↑ Casado, JL.; Quereda, C.; Moreno, A.; Pérez-Elías, MJ.; Martí-Belda, P.; Moreno, S. (Dec 2013). "Regression of liver fibrosis is progressive after sustained virological response to HCV therapy in patients with hepatitis C and HIV coinfection.". J Viral Hepat 20 (12): 829-37. doi:10.1111/jvh.12108. PMID 24304452.
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 439. ISBN 978-1416054542.