Stages
Laennec's cirrhosis has three stages. The pathologic features of this form of cirrhosis change with time. Therefore, it is helpful to break the disease down into three stages: 1) the fatty liver stage, 2) the fibrotic liver stage and 3) the nodular liver stage.
In early stages the liver is large and fatty. In this early stage, fat accumulates in the liver cells around the central vein (fatty change). The liver becomes large, even huge (hepatomegaly). The normal liver weighs about 1,200 grams. By comparison, fatty livers can weigh in at over 6,000 grams and may, in the living patient, fill the abdominal cavity (remember that the normal liver extends 2-3 finger breadths below the right costal margin). At autopsy, the fatty liver is greasy and a cut surface is yellow. As dramatic as these changes are, the fatty change is reversible.
In later stages, the liver becomes scarred (fibrotic). In this stage, the liver returns to a more normal size; however, it does not return to normal in any other way. In fact, the changes that develop during this stage are irreversible. The fatty change subsides and is replaced by fibrosis (scarring) and some chronic inflammation. No doubt the retreat of fatty change and the shrinking effect of scar tissue is responsible for the over-all decrease in liver size.
In the final stage, the liver becomes lumpy (nodular). In this stage, the liver shrinks even further. It may not extend below the costal margin at all. Liver cells attempt to regenerate in an increasingly fibrotic setting. They find it difficult to do so and form "regenerative nodules" that only partially carry out normal liver function. This shrunken, nodular texture has been dubbed the "hob-nail" or "cobble stone" effect.
Read more about this topic: Laennec's Cirrhosis
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