CIRRHOSIS OF LIVER (Robbins pp 852, Fig 19-6)

• Cirrhosis is simply the fibrosis of the liver. It is end stage liver disease and is not reversible.
• Cardinal microscopic features:
  
• diffuse parenchymal nodules of regenerating hepatocytes that are encircled by fibrosus tissue. If nodules are<3mm>≫ micronodular cirrhosis, >3mm ≫ macronodular cirrhosis,
  
• central vein not found anymore.

• Patchy fibrosis does not characterise cirrhosis. The fibrosis must be throughout the liver. Active disease is characterised by fatty changes and inflammation.
• Aetiology: 60-70% - alcoholic liver disease, 10% - viral hepatitis (HBV, HCV), 5-10% haemochromatosis, 5% biliary cirrhosis, Wilson’s disease (copper storage disease), a11-antitrypsin deficiency, cryptogenic cirrhosis.
• Pathogenesis: Normally, collagen is found around the portal tracts and central veins (Types I-III). Reticulin (Type IV) is found in the space of Disse. In cirrohosis, Types 1-III collagen are deposited in the parenchyma. New blood vessels form within these fibrous tissue connecting to portal areas, and they shunt blood into the lobules from around them. The sinusoids lose their fenestrations, so exchange of solutes between hepatocytes and plasma is lost (i.e.: albumin, clotting factors etc). The collagen product comes from hepatic stellate cells. The remaining hepatocytes proliferate and form nodules. Because of all the fibrosis, liver blood supply is severely impeded.

Cirrhosis can also be caused by damage to the INTRA-HEPATIC BILIARY TRACTS. (Robbins pp 877, Fig 19-28)

• Damage to the biliary tracts can cause cirrhosis ≫ biliary cirrhosis. This is divided into primary & secondary classes.

1^st biliary cirrhosis: This is when there is destruction of the intrahepatic biliary tree, resulting in inflammation (granulomas formed)≫ scarring ≫ cirrhosis. Serum antimitochondrial antibodies are present in patients with this type of cirrhosis, but no one knows how it results in the disease. This type of cirrhosis is focal as opposed to the “original” cirrhosis.

WHAT ARE THE COMPLICATIONS OF CIRRHOSIS? KNOW THIS!!

Liver failure: failure to produce plasma protein albumin ≫ hypoalbuminaemia, coagulopathy ≫ bruise easily

Portal hypertension: fibrous tissue squeezes the hepatic circulation ≫ oesophageal varices, haemorrhoids, ascites

Hepatic encephalopathy

Renal failure

Liver cell carcinoma: in patients with chronic hepatitis.

Category: Pathology Notes