Difference between revisions of "Cirrhosis"

Revision as of 17:49, 5 April 2023

Author: Mikael Häggström ^{[note 1]}
Cirrhosis of the liver:

In autopsy, make consecutive liver slices, such as in the sagittal or coronal plane.

Cirrhosis is characterized by pale areas. Categorize into either of the following: (1) micronodular, (2) macronodular, or (3) mixed:^[1]

Micronodular cirrhosis, with diffuse areas of pallor.

Micronodular or diffuse cirrhosis (uniform nodules less than 3 mm in diameter).^{[notes 1]}
Macronodular cirrhosis (irregular nodules with a variation greater than 3 mm in diameter).

Mixed cirrhosis (when features of both micronodular and macronodular cirrhosis are present): Usually micronodular cirrhosis progresses into macronodular cirrhosis over time.

Components:^[1]

Diagnosing cirrhosis. The diagnosis of cirrhosis by biopsy requires the presence of fibrosis and nodules.
Assessing the degree of inflammation (grade) and fibrosis (stage) of the disease.
Finding the most probable differential diagnoses that cause the cirrhosis (or correlating with a previously established diagnosis).

Correlate by information in the referral/requisition form, and preferably look in medical records as well.

No fibrosis, but mild zone 3 steatosis, in which collagen fibres (pink–red, arrow) are confined to portal tracts (P) (van Gieson's stain)^[2]
Histopathology of steatohepatitis with mild fibrosis in the form of fibrous expansion (van Gieson's stain)^[2]
Histopathology of steatohepatitis with moderate fibrosis, with thin fibrous bridges (van Gieson's stain)^[2]
Moderate fibrosis (H&E stain).
Histopathology of steatohepatitis with established cirrhosis, with thick bands of fibrosis (van Gieson's stain)^[2]
Trichrome stain, showing cirrhosis as a nodular texture surrounded by fibrosis (wherein collagen is stained blue).

↑ Micronodular or diffuse cirrhosis can be due to alcohol, hemochromatosis, hepatic venous outflow obstruction, chronic biliary obstruction, jejunoileal bypass, and Indian childhood cirrhosis.

↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

↑ ^1.0 ^1.1 Bashar Sharma; Savio John.. Hepatic Cirrhosis. StatPearls at the National Center for Biotechnology Information. Last Update: June 3, 2019.
↑ ^2.0 ^2.1 ^2.2 ^2.3 Boyd, Alexander; Cain, Owen; Chauhan, Abhishek; Webb, Gwilym James (2020). "Medical liver biopsy: background, indications, procedure and histopathology ". Frontline Gastroenterology 11 (1): 40–47. doi:10.1136/flgastro-2018-101139. ISSN 2041-4137.
-"This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license"

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 *Assessing the degree of '''inflammation''' (grade) and '''fibrosis''' (stage) of the disease.
 *Finding the most probable differential diagnoses that '''cause''' the cirrhosis (or correlating with a previously established diagnosis).
+:Correlate by information in the referral/requisition form, and preferably look in medical records as well.
 <gallery mode=packed heights=180>
 File:Histopathology of mild zone 3 steatosis without fibrosis (van Gieson).jpg|'''No fibrosis''', but mild zone 3 steatosis, in which collagen fibres (pink–red, arrow) are confined to portal tracts (P) (van Gieson's stain)<ref name="BoydCain2020">{{cite journal|last1=Boyd|first1=Alexander|last2=Cain|first2=Owen|last3=Chauhan|first3=Abhishek|last4=Webb|first4=Gwilym James|title=Medical liver biopsy: background, indications, procedure and histopathology|journal=Frontline Gastroenterology|volume=11|issue=1|year=2020|pages=40–47|issn=2041-4137|doi=10.1136/flgastro-2018-101139}}<br>-"This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license"</ref>