By the end of this chapter, you will be able to:
- Describe morphological changes in liver during cirrhosis
- Explain why there are fatty changes and nodules in liver.
Cirrhosis is classified based on morphology or cause. Morphology is not as clinically useful as classification by cause (etiology) when determining treatment options.
Morphologically, cirrhosis has bumps (nodules) which can be micronodular (<3mm), macronodular (>3mm), or mixed.
Micronodular cirrhosis have uniform nodules less than 3 mm in diameter. Micronodular cirrhosis is most often associated with high alcohol usage, hemochromatosis, hepatic venous outflow obstruction, and chronic biliary obstruction.
Macronodular cirrhosis have irregularly sized and shaped nodules, greater than 3 mm in diameter. Macronodular cirrhosis is most often associated with chronic hepatitis infection (e.g. hepatitis B and C), alpha-1 antitrypsin deficiency (see Emphysema chapter), and chronic inflammation of bile ducts (primary biliary cholangitis).
Mixed cirrhosis (when features of both micronodular and macronodular cirrhosis are present): Usually, micronodular cirrhosis progresses into macronodular cirrhosis over time.
Cirrhotic livers presented by Jennifer Kong using DHPLC specimens M0313 Liver Cirrhosis with fatty changes; M0311 – Macronodular cirrhosis (post-necrotic); and M0303 – cirrhosis and acute viral hepatitis
Cirrhotic livers will have obvious morphological changes regardless of the cause. Cirrhotic livers tend to be smaller due to loss of hepatocytes and stiffer due to the presence of fibrotic scar tissue. This scar tissue is responsible for the nodular pattern seen inside and on the surface of the liver. Sometimes, cirrhotic livers have fatty accumulation which makes the liver more pale and yellow compared to the normal rich red/brown.