Cirrhosis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Charmaine Patel, M.D. [2]

Overview

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

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]

Classification Based on Etiology

Cirrhosis can be classified by etiology. This is a more 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. 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.

References

  1. 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.
  2. Nayak NC, Ramalingaswami V (1975). "Indian childhood cirrhosis". Clin Gastroenterol. 4 (2): 333–49. PMID 47794.