Obstructive Biliary Cirrhosis and Alcoholic Cirrhosis: Comparison of Clinical and Pathologic Features

Abstract

Cases (27) advanced alcoholic cirrhosis, advanced cirrhosis caused by biliary obstruction, and early cirrhosis caused by biliary obstruction were compared with regard to clinical and pathologic observations. Biliary cirrhosis was seen most frequently in patients with a long history of intermittent jaundice due to benign obstruction. Of the patients with alcoholic cirrhosis 89% died from hepatic insufficiency or bleeding esophageal varices, while most patients with biliary cirrhosis died of complications of surgical treatment for relief of their obstruction. Histologic features predominant in biliary cirrhosis in general were: atrophy of liver cells, evidence of bile stasis including bile lakes, less evidence of cellular regeneration, loose irregular bands of internodular fibrous connective tissue, and small irregular regenerative nodules which only partially replaced the parenchyma and infrequently compressed adjacent venules. Histologic features predominant in alcoholic cirrhosis were: fatty metamorphosis, acidophilic cytoplasmic bodies (Mallory''s alcoholichyalin), much evidence of cellular regeneration, dense and regular bands of internodular connective tissue, and clearly demarcated round or elliptical regenerative nodules which frequently distorted adjacent venules and almost entirely replaced normal parenchyma. Splenomegaly was most marked in advanced biliary cirrhosis, but it was not much greater than in alcoholic cirrhosis. Esophageal varices, abdominal collateral circulation, and ascites were all more frequent and more marked in alcoholic cirrhosis than in biliary cirrhosis. It may be significant that the regenerative nodules were more numerous and larger, and seemed to compress surrounding structures more in alcoholic than in biliary cirrhosis. Data suggest that regenerative nodules play an important role in development of portal hypertension by distorting normal circulatory relationships and also by compressing hepatic venous and portal radicles within the liver.