Structural Alterations in the Clinical Evaluation of Cirrhosis

Abstract

Summary Based on examination of 229 liver biopsy specimens from 185 patients with cirrhosis, and on correlation of the results with clinical and laboratory findings, a functional-therapeutic classification of cirrhosis is proposed. This is based on the morphologic criteria of the extent and rate of progression of the characteristic features of the disease, the regenerative nodule and portohepatic vascular anastomoses, and on the degree of concomitant liver-cell damage. Liver-cell degeneration is related to the incidence of jaundice and gastrointestinal bleeding. As expected, all the hepatic tests show a higher percentage of abnormal results when marked liver-cell degeneration is present. The only clinical feature related to the extent of the disease was the presence of splenomegaly in far-advanced cases. None of the laboratory tests clearly indicated the extent. In progressing cirrhosis, jaundice, ascites, splenomegaly, and spider nevi or palmar erythema are more common than in arrested cirrhosis. This is most clearly reflected by increase of the serum gamma globulin level and the thymol turbidity test. Appreciation of the rate of progression appears to be important from the standpoint of prognosis and therapy. In the management of cirrhosis liver biopsy is recommended for evaluation of the disease process.