Cirrhosis

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ΕΤΥΜΟΛΟΓΙΑ

Greek kirrhos meaning tawny (yellow - to describe the appearence). Although previously described, Laennec is credited with naming the process.[1]
Photomicrograph showing regenerative nodules surrounded by broad strands of fibrosis.

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.

Contents

Causes

10% of cases are cryptogenic. The other causes, which may co-exist, include:

  • Chronic viral hepatitides - B (+/- D) and C
    • Important because it is common world wide and specific treatments for the viral infection may be indicated to prevent
  • Alcohol hepatitis causing alcoholic liver cirrhosis
    • Common and directly related to total exposure to alcohol
    • PTEN immunostaining unchanged on normal
    • Acute-on-chronic liver failure (ACLF) in those with cirrhosis is commonest with alcohol related cirrhosis[2]
  • Non-alcoholic steatohepatitis (causing non-alcoholic fatty liver disease - NAFLD)
    • Increasing in incidence with the obesity epidemic
    • PTEN immunostaining decreased[3]
  • Autoimmune hepatitis

Biliary Tract Diseases

Metabolic/Storage

References

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