B62 liver cirrhosis

Question 1

Main histology characteristics of liver cirrhosis:

Answer 1

Bridging fibrous septa separating micro or macronodules of liver parenchymal nodules. In viral/autoimmune hepatitis there is no evidence of fatty change, while in cirrhosis of alcohol or nafld, there may be some remaining fatty change but even in these cases at the cirrhotic stage it is minimal.

Capilarization of the sinusoids, closure/obstruction of the fenestrations in the sinusoidal epithelium, obstructing flow from the sinusoids into the Space of Disse.

Formation of a basement membrane under the sinusoidal epithelium further obstructing the hepatocytes from contact with the blood.

Porto-cental shunt formation further decreasing sinusoidal flow and hepatocyte contact with the blood.

Question 2

Gross morphology changes of cirrhosis

Answer 2

Classic, Laennec type: Atrophic, shrunken, retracted liver with fine nodules

Hypertrophic, Hanot type, medium size nodules, dark purple staining due to chronic congestion, resulting from constrictive pericarditis

Diffuse, irregularly nodular with large nodules, green colored, due to extrahepatic bile obstruciton.

Importantly, the pseudonodules usually lac contact with a central vein and are thus not functional.