Classification
Cirrhosis is classified on the basis of morphology and etiology. The morphological classification recognizes three types based on the size of the nodules:
1. Macronodular cirrhosis.
The liver is firm, large or small in size, with bulging irregular nodules greater than 3 millimeters in diameter.2. Micronodular cirrhosis. The liver is usually enlarged, and very firm or hard in consistency. The nodules on cut sections appear small and uniform, less than 3 millimeters wide.
3. Mixed micro!Tnacronodular cirrhosis. The liver shows groups of small nodules interspersed with fields of large nodules.
The terms “micronodular” and “macronodular” cirrhosis replace the older terminology, Laennec’s and postnecrotic cirrhosis.
Neither the gross nor the microscopic appearance of the liver can alone differentiate among the many causes (see Table VIII.28.1). In individual cases, the etiology is often unknown. Alcohol injury is most frequently associated with the pattern of micronodu-
Table VIII.28.1. Etiology and incidence of cirrhosis
| Etiology | Incidence |
| Toxins and drugs Alcohol Methotrexate, methyldopa, and isoniazid | 5—15% of chronic alcoholics |
| Infections | 1—2% of acute infection |
| Hepatitis (non-A, non-B virus) | 5-15% of chronic disease |
| Hepatitis (delta virus) Schistosomiasis japoni- cum | 20—60% of chronic disease |
| Disturbed immunity | |
| Chronic active hepatitis | 30—50% of chronic type B viral hepatitis |
| Primary biliary cirrhosis | 6-15 per 1 million population (incidence) 4—14 per 100,000 (prevalence) |
| Chronic cholestasis | |
| Gallstone, biliary tumor, | 1 per 8,000-15,000 live |
| stricture, biliary atresia | births |
| Mucoviscidosis | 2-20% of patients (1 per 2,000 live births) |
| Metabolic disorders | |
| Primary hemochromatosis | 2—3 per 1,000 (prevalence) |
| Wilson’s disease | 30 per 1 million population (prevalence) |
| Alpha-l-antitrypsin defi- | 1 per 15,000 Scandinavian |
| ciency Vascular diseases Veno-occlusive disease Budd-Chiari syndrome Chronic right heart failure Others Indian childhood cirrhosis Intestinal bypass Cryptogenic causes | adults |
Iar cirrhosis, and other causes in this category include primary biliary cirrhosis, primary hemochromatosis, and chronic right heart failure. The macronodular deformation is seen in the cirrhosis due to viral, drug, and cryptogenic origins, and in the end-stage cirrhosis of any etiology.