[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Liver and gallbladder](https://durgical.com/en/general-pathology/areas/liver/) › Cirrhosis: morphology

# Cirrhosis: morphology

- Lesion

Cirrhosis is the whole liver turned into islands of regenerating cells wrapped in scar; it is the end stage of many diseases.

Updated Nov 12, 2026

## Key points

- Three features define it: diffuse involvement, bridging fibrous septa and parenchymal nodules.
- Micronodular (nodules under about three millimetres, e.g. early alcohol) versus macronodular (larger, e.g. after viral hepatitis); mixed is common.
- Leading causes worldwide: hepatitis B and C, alcohol, MASLD; in Colombia alcohol and MASLD are rising causes.
- Cirrhosis is the main precursor setting of hepatocellular carcinoma.
- Cryptogenic cirrhosis: no cause found; many are burnt-out MASLD.

## What it is

Cirrhosis is a diffuse process in which fibrous septa divide the whole liver into regenerative nodules, with loss of the normal lobular architecture and vascular shunts. It is the common end of chronic viral hepatitis, alcohol, metabolic steatotic disease, biliary and metabolic disorders. Its consequences are liver failure, portal hypertension and a high risk of hepatocellular carcinoma.

## Structure

- Gross: small or normal-sized firm liver with a bumpy surface; cut surface shows nodules surrounded by grey-white scar; colour may be yellow (fat), green (bile) or rust (iron).
- Micro: nodules of hepatocytes without normal central veins, surrounded by septa containing ductular reaction and lymphocytes.
- Clues to cause: fat and Mallory-Denk bodies (alcohol, MASLD), ground-glass cells (HBV), lymphoid aggregates (HCV), iron (hemochromatosis), PAS-D globules (A1AT), bile duct loss (PBC, PSC).

## Main causes of cirrhosis and the clue the biopsy may give

| Cause | Biopsy clue | Other clue |
| --- | --- | --- |
| [Alcohol-associated liver disease](https://durgical.com/en/conditions/alcoholic-liver-disease/) | Steatosis, ballooning, Mallory-Denk bodies, perivenular fibrosis | AST higher than ALT; history of drinking |
| [MASLD](https://durgical.com/en/conditions/metabolic-dysfunction-associated-steatotic-liver-disease/) | Steatohepatitis pattern similar to alcohol | Obesity, diabetes, dyslipidemia |
| [Chronic viral hepatitis](https://durgical.com/en/conditions/viral-hepatitis/) | Portal lymphoid aggregates (C), ground-glass hepatocytes (B) | HBsAg or HCV RNA in serum |
| [Hereditary hemochromatosis](https://durgical.com/en/conditions/hereditary-hemochromatosis/) | Heavy hemosiderin in hepatocytes (Prussian blue) | High transferrin saturation and ferritin |
| [Wilson disease](https://durgical.com/en/conditions/wilson-disease/) | Steatosis, hepatitis, copper stains | Low ceruloplasmin, Kayser-Fleischer rings |
| [Alpha-1 antitrypsin deficiency](https://durgical.com/en/conditions/1-antitrypsin-deficiency/) | PAS-positive, diastase-resistant periportal globules | Low serum A1AT; emphysema |
| [Primary biliary cholangitis](https://durgical.com/en/conditions/primary-biliary-cholangitis/) | Loss of small bile ducts, granulomas, cholestasis | Antimitochondrial antibodies |
| [Autoimmune hepatitis](https://durgical.com/en/conditions/autoimmune-hepatitis/) | Plasma-cell-rich interface hepatitis | ANA, anti-smooth muscle, high IgG |
| [Chronic heart failure](https://durgical.com/en/conditions/heart-failure/) | Zone 3 fibrosis linking central veins (cardiac sclerosis) | Raised venous pressure |

## Markers

- Trichrome
- Reticulin
- Prussian blue
- PAS-D
- Rhodanine (copper)
- Keratin 7 (ductular reaction)

## Clinical notes

- Compensated cirrhosis may be silent; decompensation shows as ascites, variceal bleeding, encephalopathy or jaundice.
- Regular imaging surveillance for hepatocellular carcinoma is standard in cirrhosis.

## Memory aid

Cirrhosis is a city rebuilt without a plan: islands of new houses, walls of scar, and roads (vessels) that no longer lead where they should.

## Test yourself

Think of the answer, then tap the question to see it.

## Which three features define cirrhosis?

Diffuse involvement of the whole liver, bridging fibrous septa, and parenchymal nodules that replace the lobular architecture.

## What does PAS-positive, diastase-resistant periportal globules on a cirrhotic liver suggest?

Alpha-1 antitrypsin deficiency (accumulated misfolded PiZ protein).

## What is cardiac sclerosis of the liver?

Fibrosis linking central veins after long-standing right heart failure, the result of chronic congestion and zone 3 necrosis.

## What is the most feared neoplasm that arises in cirrhosis?

Hepatocellular carcinoma.

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## Elsewhere in DurgiPedia

- [Liver: lobule, acinus, hepatocytes, sinusoids, Kupffer cells](https://durgical.com/en/histology/liver-lobule-acinus-hepatocytes-sinusoids-kupffer-cells/)
- [Functions of the liver](https://durgical.com/en/physiology/functions-of-the-liver/)

## Connections

## Related 6

- [Liver fibrosis and its regression](https://durgical.com/en/general-pathology/liver-fibrosis-and-its-regression/)
- [Liver failure: acute, chronic and acute-on-chronic](https://durgical.com/en/general-pathology/liver-failure-acute-chronic-and-acute-on-chronic/)
- [Portal hypertension](https://durgical.com/en/general-pathology/portal-hypertension/)
- [Hepatocellular carcinoma](https://durgical.com/en/general-pathology/hepatocellular-carcinoma/)
- [Fibrosis in organs: TGF-β and the myofibroblast](https://durgical.com/en/general-pathology/fibrosis-in-organs-tgf-and-the-myofibroblast/)
- [Special stains in diagnosis: Congo red, Prussian blue, PAS, Ziehl–Neelsen, Gram](https://durgical.com/en/general-pathology/special-stains-in-diagnosis-congo-red-prussian-blue-pas-ziehl-neelsen-gram/)

## Related conditions 10

- [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/)
- [Alcoholic liver disease (biochemistry)](https://durgical.com/en/conditions/alcoholic-liver-disease/)
- [Metabolic dysfunction-associated steatotic liver disease (MASLD/NAFLD)](https://durgical.com/en/conditions/metabolic-dysfunction-associated-steatotic-liver-disease/)
- [Viral hepatitis](https://durgical.com/en/conditions/viral-hepatitis/)
- [Hepatocellular carcinoma](https://durgical.com/en/conditions/hepatocellular-carcinoma/)
- [Hereditary hemochromatosis](https://durgical.com/en/conditions/hereditary-hemochromatosis/)
- [Wilson disease](https://durgical.com/en/conditions/wilson-disease/)
- [α1-antitrypsin deficiency](https://durgical.com/en/conditions/1-antitrypsin-deficiency/)
- [Primary biliary cholangitis](https://durgical.com/en/conditions/primary-biliary-cholangitis/)
- [Autoimmune hepatitis](https://durgical.com/en/conditions/autoimmune-hepatitis/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Hepatic Cirrhosis](https://www.ncbi.nlm.nih.gov/books/NBK482419/) (StatPearls (NCBI Bookshelf), 2022); [Liver disease: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000205.htm) (MedlinePlus, US National Library of Medicine, 2026).

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Source: https://durgical.com/en/general-pathology/cirrhosis-morphology/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/cirrhosis-morphology/