Pathologic anatomy

Cirrhosis of the liver. There are three main morphological types of cirrhosis: postnecrotic, portal (septal) and biliary.
Postnecrotic cirrhosis. The most striking characteristics of this type of cirrhosis are of different size, often large, regeneration sites, separated by wide connective cords. The appearance of the liver resembles a bunch of grapes. The size, uzlovatom and colour vary depending on the stage of development of cirrhosis, the volume of damaged parenchyma, the degree of cholestasis.
Postnecrotic cirrhosis inherent unevenness of severity cirrhotic changes. Microscopically found wide connective tissue bands, bearing characteristic signs of collapse-close-portal of the field and the Central zone, three or more of the portal triads in the same field. The latest sign Steiner (1960) regards as morphologically pathognomonic for postnecrotic cirrhosis. Such wide belt collaborating reikalingas stroma liver, along with a thin connective tissue partitions divide the liver parenchyma on plots of various sizes - pseudodevice (Fig. 61). Sometimes consist only of the newly formed liver tissue. Sometimes contain one or more almost unchanged liver segments with normally located in Central and CNC channels. Fat in the liver cells usually absent, although some of them can meet; predominant protein degeneration of hepatocytes. Characterized by the presence of active messy regeneration, often with the formation of multi-core liver cells.

Fig. 61. Postnecrotic cirrhosis. Explanation in the text.

In periods of activation of the cirrhotic process detected necrosis of liver cells in the centers of segments and units. Possible proliferation cholangio connective partitions or hepatic nodules. Sometimes celebrated painting cholestasis: gall clots in the ducts and bone or pigment accumulation in liver and coppersky cells.
The inflammatory response is always expressed, but is changeable according to the degree, type, and location. In partitions visible to all small cells or eosinophils, histiocytes, plasma cells, sometimes neutrophils. Fibroblasts are few. The content of collagen in all stages disproportionate to the number of fibroblasts.
Clinical and morphological comparisons allow to distinguish three stages of development of postnecrotic cirrhosis: primary, stage formed cirrhosis and end-dystrophic stage.
Morphologically for the initial stage of postnecrotic cirrhosis is characterized by the absence of deformation, some increase and compaction of the liver, individual speakers units between which there are areas of saved liver tissue.
Stage formed cirrhosis morphologically characterized by the restructuring of the architectonics of the liver in all volume of the body. The liver may be enlarged in volume, but there is often a reduction in the left lobe of her. The surface of the liver grubbegata, mainly in the form in which it is stored. Histologically detected expressed rebuild liver tissue.
For the final stage of postnecrotic cirrhosis typically a significant reduction in the hepatic parenchyma with the expressed prevalence of fibrosis. Liver deformed, bumpy, always reduced. Microscopically different size units as would be disseminated in a wide field vascularized connective tissue.
In the final stage of postnecrotic cirrhosis loses its morphological features and is virtually indistinguishable from a similar stage of liver cirrhosis of different morphological type.