Cirrhosis Postnecrotic

Non-cholestatic cirrhosis (e.g., alcoholic cirrhosis, postnecrotic cirrhosis, and drug-induced cirrhosis)... 

Jaundice and pruritus were observed at age 6 weeks and resolved spontaneously after approximately 2 months. He was hospitalized for pneumonia at age 20 months, and an enlarged liver was noted. A percutaneous needle biopsy specimen from the liver was interpreted to show postnecrotic cirrhosis, although reevaluation of the biopsy specimen showed the presence of globules that were periodic acid-Schiff (PAS) positive, diastase resistant (Fig. 4-1). He was then referred to our institution at age 2.5 years for liver transplantation. 

Fig. 7.15 Active, micronodular, in part moderately nodular (alcohol-related) cirrhosis with pronounced pathways of postnecrotic connective tissue...

Postdystrophic (monophasic) cirrhosis (= incomplete postnecrotic cirrhosis)... 

In the course of massive subacute liver necrosis (or hepatic dystrophy), large parts of the hepatic parenchyma can be destroyed within a few months. Extensive regenerative nodes form from the remaining epithelium. Within these regenerations, the lobular architecture is either still maintained or has been partially restored. Areas of parenchymal loss are converted into fibre-dense scar tissue with embedded pseudoductuli and duct proliferations as well as irregularly located residual hepatocytes. This course is extremely rare. In the literature, it is also called incomplete postnecrotic cirrhosis. 

The early hepatic s3unptoms and signs are those of acute or chronic hepatitis, which then develops into a postnecrotic type of cirrhosis. There is nothing to distinguish the symptoms referable to involvement of the hver in the course of Wilson s disease from those of postnecrotic cirrhosis... 

Primary peritonitis in adults occurs most commonly in association with alcoholic cirrhosis, especially in its end stage, or with ascites caused by postnecrotic cirrhosis, chronic active hepatitis, acute viral hepatitis, congestive heart failure, malignancy, systemic lupus erythematosus, or nephritic syndrome. It also may result from the use of a peritoneal catheter for dialysis or central nervous system ventriculoperitoneal shunting for hydrocephalus. Rarely, primary peritonitis occurs without apparent underlying disease. 

This is the group of patients in which dye metabolism has been most studied. There is variable impairment of dye handling in patients classified as postnecrotic cirrhosis (KIO), chronic active hepatitis (M4), or simply as cirrhosis (D7, Z5). Increased BSP retention commonly also occurs in bilharzial hepatic fibrosis (Bl). 

The conditions for which hepatic transplantation has been applied differ in pediatric and adult cases and are shown in Tables 1 and 2. 50% of the pediatric cases have been transplanted for biliary atresia.The majority of the other pediatric recipients have been transplanted for alpha 1 antitrypsin deficiency or chronic liver disease of unknown ethiology. In contrast, the leading conditions for which hepatic transplantation has been applied in adult recipients are postnecrotic cirrhosis, primary biliary cirrhosis and primary hepatic malignancy. 

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