ALCOHOLIC CIRRHOSIS

Naseem ap

CONTENTS

ALCOHOLIC LIVER DISEASE

It is the term used to describe the spectrum of liver injury associated with acute and chronic alcoholism.

There are three sequential stages:

¤ Alcoholic steatosis (fatty liver)

¤ Alcoholic hepatitis

¤ Alcoholic cirrhosis

ALCOHOLIC STEATOSIS

Grossly:

¤ Liver is enlarged, yellow , greasy & firm with a

smooth

glistening capsule.

Microscopically:

¤ Initial microvesicular droplets of fat in the

hepatocyte cytoplasm followed by

macrovesicular large

droplets of fat displacing the nucleus to the

periphery.

¤ Fat cyst may develop due to coalescence and

rupture

of fat containing hepatocytes

¤ Lipogranulomas (collection of lymphocytes

Central vein Fat

cyst

Micro vesicles

Macro vesiclesPortal triad

ALCOHOLIC HEPATITIS

¤ Develops acutely, usually following a bout of

heavy drinking.

Microscopically:

1. Hepatocellular necrosis – single or small

clusters of

hepatocytes , especially in zone 3 undergo

ballooning

degeneration & necrosis.

Also seen in other conditions such as

ø primary biliary cirrhosis

ø indian childhood cirrhosis

ø cholestatic syndromes

ø wilsons disease

ø intestinal bypass surgery

ø focal nodular hyperplasia

ø hepatocellular carcinoma

4. Fibrosis :

pericellular & perivenular fibrosis, producing a web

like or chicken wire like appearance

– creeping collagenosis.

3 . Inflammatory response:

areas of hepatocellular necrosis & regions of

Mallory

bodies are associated with an inflammatory

infiltrate

Neutrophilicinfiltrate

Fattychange

Mallory hyaline

Ballooning degeneration

ALCOHOLIC CIRRHOSIS

Laennec’s cirrhosis , portal cirrhosis , hobnail

cirrhosis , nutritional cirrhosis , diffuse

cirrhosis & micronodular cirrhosis.

Grossly ;

¤ Nodules are tawny yellow in color

l

¤ Begins as micronodular cirrhosis:

1. Nodules less than 3 mm in

diameter

2. Liver large ,fatty, usually

above 2 kg

¤ Macronodular cirrhosis:

Microscopically:

Nodular pattern- normal lobular architecture is

effaced & replaced with nodule formation.

Fibrous septa- divide hepatic parenchyma to

nodules are initially delicate. As the fibrous

scarring increases with time ,it become dense.

Necrosis , inflammation and bile duct proliferation-

Fibrous septa - sparse infiltrate of mononuclear

cells with

some bileduct proliferation.

Bile stasis & increased cytoplasmic hemosiderin

Hepatic parenchyma- regenerative nodules

are formed. As the thickness of fibrous

septa increase, fat in hepatocyte is decreased.

Fibrous septa

Uniform sizedmicro nodulesDuctular

proliferation

REFERENCE

¤Textbook of pathology-6th edition, Harsh

mohan

¤Robbins ,basic pathology- 9th edition-

students consult