Review Question - QID 214619

This patient is presenting with alcoholic cirrhosis (fatigue, chronic alcohol use, scleral icterus, telangiectasias, hepatomegaly, and elevated GGT, bilirubin and AST/ALT ratio). The hallmark biopsy finding of cirrhosis is fibrosis, which is mediated by stellate cells.

Cirrhosis is caused by chronic damage to the liver, most commonly due to hepatitis C infection or chronic excessive alcohol consumption. Chronic hepatic inflammation leads to cytokine-mediated activation of stellate cells (pericytes found in the perisinusoidal space), which mediate the subsequent repair mechanism resulting in fibrosis. Excess fibrotic tissue impairs hepatic blood flow and function, which leads to various signs and symptoms such as jaundice, hepatosplenomegaly, ascites, telangiectasias (spider angiomata), palmar erythema, and gynecomastia. Laboratory tests reveal hepatocellular damage (elevated AST, ALT, GGT, and bilirubin). Liver biopsy can confirm the diagnosis. Management includes treatment of the underlying cause (e.g., decreased alcohol consumption or antiviral drugs) and medications for treating complications.

Figure/Illustration A is a liver biopsy with trichrome stain demonstrating cirrhosis. Fibrotic bands (stained blue, black arrow) surround regenerative nodules (stained red, yellow circle) of liver parenchyma.

Incorrect Answers:
Answer 1: Hepatocytes make up the main parenchymal tissue of the liver. Their functions include protein synthesis, protein storage, synthesis of cholesterol, and detoxification of exogenous and endogenous substances.

Answer 2: Langerhans cells are macrophages of the skin that are found in the stratum spinosum. They are antigen-presenting cells that contain Birbeck granules. Langerhans cell histiocytosis is a rare cancer that causes lytic bone lesions most commonly in the skull and is associated with rash.

Answer 3: Paneth cells are a principle cell type of the small intestine epithelium found in the crypts of Lieberkuhn. Paneth cells contain acidophilic granules and secrete lysozymes and defensins that aid in innate immunity.

Answer 5: Sinusoidal endothelial cells (SEC) form the lining of the hepatic sinusoids (smallest blood vessels of the liver). SECs play a central role in the clearance of blood borne waste (e.g., alcohol); however, they do not mediate fibrosis in response to the inflammation induced by excessive blood borne waste.

Bullet Summary:
Cirrhosis is a condition caused by chronic damage to the liver resulting in fibrosis, which is mediated by stellate cells.