Cirrhosis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Charmaine Patel, M.D. [2]
Overview
Cirrhosis of the liver can be classified using two methods; classification based on etiology, and classification based on morphology. Currently, classifying cirrhosis based on morphology is not used, as it requires an invasive procedure to examine the gross appearance of the liver, and it provides little diagnostic value. Classifying cirrhosis according to etiology is a more accepted form of classification, as it can be attained through non-invasive laboratory testing, and has a higher diagnostic value.
Classification Based on Etiology
Cirrhosis can be classified by its etiology. This is the most widely accepted method of classification.
Alcoholic Cirrhosis
This is the most common cause of cirrhosis, and is caused by continuous and prolonged alcohol abuse. The American Academy of Family Physicians estimate that 60-70 percent of all cases of cirrhosis are a result of alcohol abuse.
Post-Necrotic Cirrhosis
This type of cirrhosis occurs after a massive event causes liver cell death. Viral hepatitis is the most common cause for this type of cirrhosis. Agents that are toxic to the liver can also cause this type of cirrhosis, as well as certain types of carcinomas.
Biliary Cirrhosis
This type of cirrhosis results from any diseases that cause biliary obstruction. There is usually a blockage in the bile duct and there may also be inflammation. The excess bile in the liver causes tissue destruction. It commonly results in jaundice.
Cardiac Cirrhosis
This type of cirrhosis is caused by congestive heart failure causing poor circulation of oxygenated blood to the liver. This results in liver cell death, and the subsequent replacement of dead cells by fibrous tissue.
Genetic Disorder
This is when the cirrhosis is caused by a genetic disorder such as hemochromatosis, Wilson's disease, or alpha-1 antitrypsin deficiency.
Malnutrition
This category contains cirrhosis caused by various forms of malnutrition, such as Indian childhood cirrhosis.
Classification Based on Morphology
Cirrhosis has historically been classified upon the nodular morphology that is seen on upon the gross appearance of the liver. Accurate assessment of the liver morphology can only be obtained through surgery, biopsy, or autopsy, therefore more recently, more non-invasive means of classifying and determining the causes of cirrhosis are used.
Micronodular
Micronodular cirrhosis is characterized by nodules that are less than 3mm in diameter, and is caused by:
- Alcohol
- Hemochromatosis
- Cholestatic causes of cirrhosis
- Hepatic venous outflow obstruction
- Nutritional causes of cirrhosis
Macronodular
Macronodular cirrhosis is characterized by nodules that are more than 3mm in diameter, and can be caused by
- Chronic viral hepatitis
- Hemochromatosis
- Wilson's disease
- Post-necrotic cirrhosis
Mixed
It has been shown that micronodular cirrhosis can often progress into macronodular cirrhosis. During this transformation, a mixed form of cirrhosis may be seen. [1] Mixed nodular cirrhosis is also seen in Indian childhood cirrhosis. [2]
References
- ↑ Fauerholdt L, Schlichting P, Christensen E, Poulsen H, Tygstrup N, Juhl E (1983). "Conversion of micronodular cirrhosis into macronodular cirrhosis". Hepatology. 3 (6): 928–31. PMID 6629323.
- ↑ Nayak NC, Ramalingaswami V (1975). "Indian childhood cirrhosis". Clin Gastroenterol. 4 (2): 333–49. PMID 47794.