Portal cirrhosis and post-necrotic liver scarring

Abstract

It is now time to consider what conclusions are possible from the foregoing discussion. My purpose in writing this paper has been to draw attention to the distinction between portal cirrhosis and post-necrotic scarring, because I believe that these conditions are distinct and that it is of value to separate them where possible. The view has been adopted that the majority of cases of true portal cirrhosis, or diffuse hepatic fibrosis, result either from long continued fatty infiltration or, less frequently, from repeated attacks of zonal necrosis. For the latter little can be done at present, but for the former much may be possible in the way of prevention. Fatty infiltration is nutritional in origin. It is frequently associated with alcoholism, but may result from a wide range of nutritional deficiencies, or oxygen lack, from vascular or haematological conditions which indirectly result in deficient nutrition of the liver cells. If the cause of fatty infiltration is one which can be removed, such as a dietary deficiency or a haematological or cardiac condition amenable to treatment, it may be possible by judicious therapy to do much to prevent the onset of cirrhosis or to slow its progress when developed. If this paper should stimulate the wider use of punch biopsy as a means of detecting the presence of fatty infiltration with a view to treatment it will have served its purpose.