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!macronodular 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


Toxins and drugs


Methotrexate, methyldopa, and isoniazid


Hepatitis (non-A, non-B virus)

Hepatitis (delta virus) Schistosomiasis japoni-cum

Disturbed immunity

Chronic active hepatitis

Primary biliary cirrhosis

Chronic cholestasis Gallstone, biliary tumor, stricture, biliary atresia Mucoviscidosis

Metabolic disorders Primary hemochromatosis Wilson's disease

Alpha-l-antitrypsin deficiency

Vascular diseases Veno-occlusive disease Budd-Chiari syndrome Chronic right heart failure


Indian childhood cirrhosis Intestinal bypass

Cryptogenic causes


5—15% of chronic alcoholics

1—2% of acute infection 5-15% of chronic disease

20—60% of chronic disease

30-50% of chronic type B

viral hepatitis 6-15 per 1 million population (incidence) 4-14 per 100,000 (prevalence)

1 per 8,000-15,000 live births

2-20% of patients (1 per 2,000 live births)

2-3 per 1,000 (prevalence) 30 per 1 million population

(prevalence) 1 per 15,000 Scandinavian adults lar 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.

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