Cirrhosis
From Ganfyd
ΕΤΥΜΟΛΟΓΙΑ
Greek kirrhos meaning tawny (yellow - to describe the appearence). Although previously described, Laennec is credited with naming the process.[1]Cirrhosis is primarily a histological diagnosis defined by diffuse, liver-wide fibrosis separating regenerating nodules of hepatic parenchyma. It is a result of chronic hepatotoxic processes (see below for causes). It is generally regarded as irreversible, although it is now recognised that a degree of fibrosis may resolve if the original insult is removed.
The pathogenesis involves stellate cells (also known as Ito cells) that reside in the the perisinusoidal spaces, i.e. the space between the hepatocytes and the sinusoids. They respond to chronic inflammation by depositing type 1 and 3 collagen which is normally only found within the portal tracts. A process of capillarisation and venulisation also occurs.
The main sequelae of cirrhosis are:
- Reduction in the functional capacity of the liver, in particular synthesis and elimination. Severe cirrhosis may result in hepato-renal syndrome and hepatic encephalopathy.
- Disruption of the architecture and microvasculature may lead to portal hypertension with resulting ascites and porto-systemic varices.
- In the longer term, cirrhosis predisposes to hepatocellular carcinoma.
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Causes
10% of cases are cryptogenic. The other causes, which may co-exist, include:
- Chronic viral hepatitides - B (+/- D) and C
- Alcohol hepatitis
- Non-alcoholic steatohepatitis (non-alcoholic fatty liver disease)
- Autoimmune hepatitis
