Cirrhosis: Pathology

Key points

• • Cirrhosis is defined by three features spread throughout the whole liver: bridging fibrosis, regenerative nodules and distorted architecture.
• • The common causes are chronic alcohol use, chronic viral hepatitis B and C, and metabolic dysfunction-associated steatotic liver disease (formerly non-alcoholic fatty liver disease).
• • Ongoing injury activates hepatic stellate cells, which lay down the collagen that forms the scar.
• • The scarring obstructs blood flow through the liver and raises pressure in the portal vein, which is portal hypertension.
• • Portal hypertension opens portosystemic collaterals such as oesophageal and gastric varices and caput medusae, and contributes to ascites and an enlarged spleen; anorectal varices may occur and are distinct from ordinary haemorrhoids.
• • Loss of working liver cells causes jaundice, a low albumin, a bleeding tendency and a build-up of ammonia that can impair the brain.