1) Progressive diffuse necrosis of liver cells, associated with framework destruction
2) Repair by both regeneration ( in the form of nodules) and fibrosis – normal hepatic architecture and lobular pattern cannot be restored
3) Restoration of the normal liver does not occur since regeneration nodules have no regular relation to portal tracts, absence or eccentric veins and irregular sinusoids. Hepatocytes in these regeneration nodules are commonly degenerated.
Secondary biliary cirrhosis Primary biliary cirrhosis
Aetiology Obstruction of extra-hepatic bile ducts 1.Congenital biliary atresia 2.Gall stones 3.Cancer head of pancreas 4.Compression by large lymph nodes Autoimmune destruction of intra hepatic bile ducts
Sex Equal female to male ratio Female to male ratio 9 : 1
Microscopy 1.Extra and intra hepatic bile ducts show bile stasis. The bile ducts show neutrophils. 2. Prolonged bile stasis leads to progressive liver cell necrosis eventually cirrhosis. 1. Intrahepatic bile ducts are surrounded by lymphocytes and granulomas. Basement membrane disruption, bile duct injury & bile duct infiltration by lymphocytes. 2. This is followed by ductopenia, liver cell necrosis & cirrhosis.
Gross Size : enlarged Consistency : firm due to fibrosis Surface & cut section : micronodular cirrhosis Colour : green bile stained Size : enlarged Consistency : firm due to fibrosis Surface & cut section : micronodular cirrhosis Colour : green bile stained
Serum Elevated cholebilirubin (obstructive jaundice ) Elevated cholebilirubin & autoantibodies