Cirrhosis

From Libre Pathology
Jump to: navigation, search

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:

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]

  1. Bridging fibrosis.
  2. Nodule formation.
  3. Disruption of the hepatic architecture.

Images

See also

References

  1. OA. September 15, 2009.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.